New health board boss working to restore confidence in hospitals
The new Cwm Taf health board chief executive talks about the maternity scandal, Covid-19 and A&E being saved. Mark Smith reports
CWM Taf Morgannwg University Health Board finally has a new permanent chief executive.
Paul Mears, who has 17 years of experience in the NHS in England, officially joined earlier this month, more than 12 months after his predecessor Allison Williams stepped down.
Ms Williams, who had been in charge of the health board since 2011, faced mounting calls to resign after “systematic failures” were uncovered in maternity units at the Royal Glamorgan Hospital, Llantrsiant, and Prince Charles Hospital, Merthyr Tydfil.
She went on sickness absence and was replaced in the interim by the deputy chief executive of Cardiff and Vale University Health Board, Dr Sharon Hopkins.
Mr Mears, who was previously chief executive of the Yeovil District Hospital NHS Foundation Trust in Somerset for six years, was appointed as the country braces itself for a second wave of coronavirus cases.
We spoke to him about the pandemic, the maternity scandal and the plan for his first 100 days in charge.
Local authorities in Cwm Taf in lockdown
The local authorities of Bridgend, Merthyr Tydfil and Rhondda Cynon Taf (RCT), which make up Cwm Taf Morgannwg UHB, all currently find themselves under individual local lockdowns.
Latest figures show that Merthyr Tydfil and RCT in particular have among the highest number of Covid19 cases per 100,000 population of anywhere in the UK, at 147.5 and 135.5 respectively.
“We are making sure we can do everything as a health board to make our response to coronavirus as effective as possible. One of our priorities is how we can work with the local council, particularly, on that front,” he said.
“Secondly, we need to have a very clear understanding of how we can support our own staff. We recognise that they have been through months of really challenging times, and we’re just about to start heading into the winter which is sure to be a really pressurised time as well for the NHS.”
Wards closed at Royal Glamorgan Hospital
On Wednesday, September 23 it was announced that the Royal Glamorgan Hospital had closed two of its wards following an outbreak of coronavirus cases.
Public Health Wales (PHW) figures showed that Cwm Taf Morgannwg UHB accounted for 25 of 31 Covid-19 infections “probably” or “definitely” caught while in hospital.
Mr Mears said: “The number of cases at the Royal Glamorgan Hospital has been contained. It has not grown. So we are cautiously optimistic that we have been able to get on top of that outbreak through the various infection control measures we’ve put in place.
“I think it’s a good indication of how careful we need to be, and that’s why we have chosen to restrict visiting both at the Royal Glamorgan and our two acute hospital sites to try and reduce the number of people coming in.”
He added: “I know it’s really difficult but the reality is this virus is circulating now widely in our communities and we need to try and contain the amount of people coming into our hospitals so we reduce the risk of these sorts of outbreaks occurring.
“When [coronavirus] first started, we were dealing with something that had never been managed before, so some of the processes for tracking the origin of where the virus had come from weren’t as developed as they are now. We are better placed now to track and see where transmission occurs and whether that’s inside or outside the hospital.”
Patient confidence in using Cwm Taf hospitals Mr Mears reiterated that the health board was continuing to contain the spread of the virus and urged people to attend their appointments when necessary.
He said: “Services at the Royal Glamorgan, and indeed our other sites, are continuing with a limited amount of them being face to face.
“We are doing as much as we can remotely, particularly around outpatient activity where we are providing a number of clinics which avoid people having to come in.
“But clearly where people do have to come in for something, whether that’s a procedure, a scan or an operation, we’ll be making sure that we are riskassessing every patient on a case-by-case basis.
“I would encourage all patients who are due to come in to try and attend if they can. If they are concerned or worried they should check and we will give advice to them about any potential risk.”
The Cwm Taf maternity scandal
Following an independent investigation by the Royal College of Midwives (RCM) and Royal College of Obstetricians and Gynaecologists, a catalogue of failings at maternity units in the Royal Glamorgan and Prince Charles hospitals were uncovered.
Their report found that dozens of serious incidents – including stillbirths and neonatal deaths – went unreported.
It also discovered fragmented consultant cover at the two units, inadequate support for trainees, a lack of a functioning governance system and a culture of blame among senior staff.
Mums shared their harrowing and distressing accounts of childbirth at the two hospitals as part of the scathing review.
However, quarterly reviews of the maternity units, carried out by an independent panel of experts, have noted significant improvements over
the past 12 months.
“Coming into the organisation I was made very much aware by the chairman, and other colleagues in the executive team, about the review and subsequent independent panel that has been set up to oversee the improvement work,” said Mr Mears.
“I had a conversation last week with the independent panel. I have been out this week and met staff at the maternity units in both Prince Charles Hospital in Merthyr Tydfil and Princess of Wales in Bridgend and heard directly from staff about how they have seen improvements.
“That’s not to say we’ve got there completely yet, there’s still further work to do, but I think early indications tell me that significant improvements have been made in the past year or so. But I still believe very strongly that there’s more we need to do.
“We need to carry on building our relationships up with the families who have been affected by this, because I’m very conscious that this is a really difficult time for them.
“The thing that really encouraged me this week, after talking to staff, is that the feedback we are now getting from families and women who have given birth is really, really positive.”
Mr Mears confirmed that the midwife-led unit at the Royal Glamorgan Hospital, which has been shut during the coronavirus pandemic, is due to reopen on Monday, October 5.
Saving the Royal Glamorgan’s A&E department
Despite the pandemic, in June a decision was made to retain a 24-7, consultant-led emergency department at the Royal Glamorgan Hospital.
Cwm Taf Morgannwg UHB warned it could not continue to operate the emergency unit safely on a full-time basis due to a severe shortage of doctors.
The unit was heavily reliant on locum doctors and had been forced to close twice over the Christmas period in 2019 due to a lack of cover.
Proposals included reducing the number of hours the department operates, for example from 8am to 8pm, or turning it into a permanent minor injuries unit.
But there was fierce public opposition to the plans, with many claiming that any form of downgrade would have a hugely detrimental impact on surrounding communities.
A demonstration involving hundreds of people, which received cross-party support, took place on the steps of the Senedd on Wednesday, February 12 this year.
Two new consultants were recruited to work at the under-threat A&E department which strengthened the argument for it to be retained.
The coronavirus outbreak also inadvertently showed the health board that the region needed the emergency unit.
“One of the things that struck me coming into this patch is the strength of the local communities across Cwm Taf Morgannwg,” Mr Mears said.
“And I think that process showed how passionately people care about their local health services.
“What we need to do is make sure we collaborate with the local community, so if we want to modify or adjust the way services are delivered that we do it in partnership with them and make sure we draw on their knowledge of their local area.”
His first 100 days in charge
Mr Mears said he has put in place a 100-day plan for his initial months in post in order to meet as many staff, patients, partners and stakeholders as possible.
“I was just very conscious that the staff might feel quite distanced from what the chief executive is doing, so I wanted to make sure that they understood what I was going to be doing in the first 100 days of taking up the post,” he explained.
“But also, as part of that plan, I wanted to get out and about. As a health board we cover a large geography and we’re responsible for about 40odd sites. I wanted to make sure I was talking to staff, getting to know them and for them to get to know me.
“I also wanted to talk through any challenges and opportunities they could see to improve services.
“So the 100-day plan includes what I’m doing internally in the organisation, but it also highlights some of the external relationships I’m looking to build with colleagues in other local authorities, other NHS organisations and voluntary organisations.
“Clearly this is all a challenge at the moment [due to Covid-19] but we are also looking at various ways of doing things virtually. We’re also looking at how to engage with staff via social media.”
Public health issues and the Welsh NHS
Mr Mears added that one of the things that enticed him into the job was the chance to improve public health outcomes in an area of the country with among the highest levels of obesity and chronic conditions.
“We have some significant public health challenges in our patch and one of the things that attracted me to the job is the opportunity to work with the councils, with the voluntary sectors and communities to really see what we can do to improve those outcomes,” he said.
He added: “One of the things that’s struck me already in Wales has been the health board structure which means that all the health services for a particular geography are run by the one organisation.”