‘Maternity service has long way to go’
Independent panel to review 100 more cases:
AN independent panel set up to improve maternity services at two Welsh hospitals is set to review more than 100 extra cases, it has been revealed.
Cwm Taf Morgannwg University Health Board (UHB) came under fire in April after a report by the Royal College of Obstetricians and Gynaecology (RCOG) and the Royal College of Midwives unearthed “systematic failings” at maternity units at Prince Charles Hospital, in Merthyr Tydfil, and the Royal Glamorgan Hospital, Llantrisant.
It was prompted by a consultant midwife who was concerned by an apparent under-reporting of serious incidents, including deaths of babies.
It found maternity services in both hospitals to be “dysfunctional”, with inadequate support for junior doctors, unacceptable midwife staffing levels and a “punitive culture of blame”.
A total of 43 pregnancies between January 1, 2016, and September 2018 were investigated by the two colleges to see if there was any “avoidable harm” – 21 of them were stillbirths, five were neonatal deaths and 17 were complications in labour.
But now, following the appointment of an “independent oversight panel” by Health Minister Vaughan Gething to monitor improvements in the service, a total of 150 cases will now be looked at.
Former police chief Mick Gianassi, chairman of the independent panel, said he has seen “green shoots” of progress but admits there is an awfully long way to go before Cwm Taf’s maternity services are taken out of special measures – the highest level of government control.
Commenting on the panel’s first quarterly report, covering June to September 2019, he said: “It’s very early stages, but the health board has responded positively and is putting the right foundations in place for delivering improvement.
“We have focused on those areas which would impact on safety and we are reasonably reassured that those things have been addressed or are currently being addressed.
“The right leadership is also now coming into place, but there is a long way to go and it will take some time to address the challenges on the scale the RCOG identified [in its report].”
Alan Cameron, obstetrics lead on the panel, said while there will be a thorough investigation into the additional cases, is does not necessarily indicate more failings in care.
“We have estimated that looking at data from the health board that there will be about 150 cases that need further independent review by a multi-disciplinary team of obstetricians, midwives, neonatologists and lay people,” he said.
“They need to look at these cases and examine whether any lessons need to be learnt.
“The reason the number has tripled is not because there is more potential malpractice, it’s because we have extended the entry criteria for cases we want investigated.
“The initial 43 cases were more or less picked at random, so we have now looked at national criteria that should be met.”
The first quarterly report by the panel stated that eight of the 11 recommendations suggested by the RCOG have now been implemented by the health board.
However, two main areas – midwifery staffing levels and a punitive culture of blame – will still need further work.
A Birth Rate Plus report, which looks at midwifery staffing levels in more details, is set to be published later this month by the health board.
And the report added that while there are “early
signs” that behaviours among senior staff may be improving, feedback the panel has received suggests there remains a need to change the underlying culture and values.
“It’s humbling, difficult and challenging to hear some of the things people have experienced,” Mr Gianassi added, who admitted changing cultural attitudes among Cwm Taf staff could take many years.
“It’s heartbreaking to hear some of their stories. What’s emerged over the past few months is how, when people have raised their concerns, they have not had a positive response and have not been treated seriously.
“That’s one of the things we will be really challenging the health board about, is to improve the way they deal with things when they go wrong.”
Cwm Taf Morgannwg UHB, which now also has responsibility for Bridgend, has appointed 13 new midwives over the past few months.
Former chief executive of Cwm Taf Morgannwg UHB, Allison Williams, stepped down from her post in August.
Commenting on the report, Mr Gething said: “There is clearly still a considerable way to go to address the fundamental issues and concerns which have come of light within the health board. I appreciate this has been a very difficult time for all staff concerned.
“However I am encouraged by the way in which they have accepted the need to make sustainable, organisational wide change which puts quality, safety and patient experience at the heart of all that they do.”
Greg Dix, director of nursing, midwifery and patient care at Cwm Taf Morgannwg UHB, said: “We are committed to addressing the concerns raised by the Royal Colleges’ review and making the changes required to deliver the highest quality services to women and families.
“In recent months we have been working hard to make a number of improvements, including developing our engagement with women and families alongside a new quality governance framework and putting in place regular review meetings to learn from things when they have gone wrong.
“However, we recognise there is still much work to do. We know how important it is to learn from the past and the clinical review process, which has been outlined today, will identify any further action to ensure the right systems and continual improvements are in place for the future.
“We are grateful for the advice and support we are receiving from the independent panel and will continue to work closely with them to provide assurance to our communities and partners that the report’s recommendations are being fully implemented.”
Rhondda Cynon Taf council leader Andrew Morgan said: “The report identifies a level of progress which is encouraging, but clearly there is a lot more to do to consistently achieve the standard of care and service which we all want to see.
“I welcome the transparency and honesty in the reports, with the recommendations and findings amplifying the real-life experiences patients and the public have experienced and which they continue to voice to myself and other elected representatives.”
Leader of the Welsh Conservatives, Paul Davies AM, said he does not want Cwm Taf to follow in the footsteps of the Betsi Cadwaladr University Health Board by “languishing” in special measures for years on end.
At First Minister’s Questions, he said: “I hope Cwm Taf isn’t another Betsi Cadwaladr in the making where Welsh Labour allows another health board to languish for years, failing the people it is meant to serve.”
Plaid Cymru AM Helen Mary Jones said Mr Gething should be “getting stuck in” to help out Cwm Taf.
She said: “That the panel has seen fit to report that maternity services at Cwm Taf are a long way from being declared safe should be a source of shame to the health minister.
“It’s been five months since we in Plaid Cymru were left with no choice but to table a motion of no confidence in the health minister. In the intervening months, one might have thought that he would have rolled his sleeves up to ensure swift action at Cwm Taf.
“And yet the health minister is content to be ‘encouraged’ that the need for change has been accepted. I have to say to him – the time for accepting the need for change has long gone.
“Now is the time for action. It’s what the families expect, and it’s what they deserve.
“As this report outlines, this particular health board has an enormous job of work to do. With Cwm Taf in special measures, it is quite literally the health minister’s job to get stuck in and help make the improvements that people expect.
“If he’s unable to do that, someone else should be given the opportunity to.”
Following publication of the report, the health board has opened a helpline to ensure queries are dealt with openly and efficiently.
It will initially be active until Friday between 9am and 5pm.
You can contact the helpline on 08000 328 999.
You can aso email any queries to: CTM_MaternityImprovementProgramme@nhs.wales.uk.
This email address will remain open for the foreseeable future.