Cwm Taf maternity services – update
I wanted to update constituents about my work around the review of maternity services in the former Cwm Taf university health board. In a short report like this I cannot hope to cover the full range of issues I am considering, but I hope it gives you an insight to my input around this important issue as your local AM.
I remain very mindful of the women and families who have spoken out about the failings. As always please do get in touch if you wish to meet with me about these issues. I have included the details of available support if you are affected by any of the matters discussed in this report.
Most importantly at this point we know that the Health Minister has put the maternity services in to special measures. This means that a range of external people have recently been appointed to oversee changes and improvements in the maternity services. I see this as a key step in providing some independent reassurance about the situation going forwards.
The consultant-led service in Cwm Taf Morgannwg has been centred on Prince Charles hospital since March 2019, with the Royal Glamorgan being a midwifery-led unit. This means any consultant-led expertise that is required is now centred in one unit – PCH – and not spread across two sites. The performance in the new unit is being closely monitored as we know maternity services face staffing pressures in many areas of the UK, so the local service can remain under pressure at times.
The work of the Independent review panel will include a further look back and review of past cases.
The Health Board are implementing a maternity services improvement plan and that work will, quite rightly, continue for some time to come.
Trust and Faith
I have told the leaders of the health board about the break in trust and confidence with them. I need to be assured that the information they share with me in future is information I can trust. I still wish to learn more from the new Independent Panel about what the review called “false assurance” about this service.
Accountability – establishing the facts
In the face of these distressing issues I am determined that we ask the right questions, to help gather the right evidence, in order to get the answers we need about these failures. This is how we will all help to move the service forwards. The women and families who were previous users, and those who continue to use these services, deserve no less.
I have heard, very clearly, a message that other women and families using these services should not have to suffer the experience previous women have now told us about.
I have had meetings with both the Chair and Chief Executive to question them on the service. I have compared what has been reported, with what they have told me previously, and I am trying in great detail to understand the reasons behind the findings of the Independent Review.
The experience of women and families
I was able to sit in a recent meeting between the Health Minister and many of the people who spoke out during the review. The conversations will remain private but I thank those people concerned for speaking so openly about their experiences. It was very difficult to hear those personal stories, but they have reinforced my determination to help see that things are put right.
Scrutiny in the Assembly
As a member of the Assembly’s Health, Social Services and Sport Committee I also had a formal opportunity on 23rd May to scrutinise members of the health board in the Assembly. You can follow that session by clicking this link
In the time available my themes/questions focused on:
– Governance, and lines of accountability.
– the issue of what the report calls “False assurance”.
– the “culture” of the organisation,
– How did the failings continue unchecked?.
In broad terms what have I learnt up to this point?
Any thoughts that I share at this point are only emerging ideas, but it helps me to reflect, and to learn about the situation.
The first two of the themes/questions listed above are linked. A weakness in governance structures clearly relates to information not being adequately shared. As best possible we need to more clearly understand who reported what, to who and when? Then we need to know what action was taken, by who and when?
The Chair, along with the help of Independent advisers, is now changing the reporting system so the Board better understand the many aspects of the services they deliver. There is a big focus on building an improved understanding of the patient experience into these changes.
However my initial view is that there was more knowledge about these ‘problems’ than senior executive leaders within the health board have previously admitted. But there is still far more I need to learn about the giving of “false assurance” around these maternity service. This, in turn, will tell us more about the implications for the women using this service, and to those organisations and elected representatives in the Cwm Taf area.
I want to understand why insufficient action was taken after reported meetings between users and health board executives, and/or between staff and those same leaders. The emerging response appears to be that problems were known about, some action taken to correct problems, but the problems would return after a period of time. I want to learn more about those previous actions.
In her evidence to the Assembly Committee last Thursday I noted that the Chief Executive specifically identified issues at Prince Charles hospital, and I certainly need to understand that evidence in more detail as your local AM. When was that fact known, and why were interventions to improve the service not completed? Why was I as a local AM not told about the concerns when visiting and discussing these very services with the Chief Executive?.
From my own experience I know that many staff do their work diligently and show incredible commitment to our NHS.
I will be happy to listen to staff, and have spoken to some of their trade unions. I would be pleased to hear their views on these matters. I am sure it is a distressing time for them, and many of them perhaps weren’t even in the service when these things happened.
But I have noted there is also talk in the evidence about “the culture” between some professional groups, and a reported failure to follow procedures and professional practice. This needs to be better understood.
I need to know whether the problems remain, as we cannot have the good efforts of many staff being lost if some are letting their colleagues, and the public down.
We have also asked for information and reassurance about performance in other areas of service, and that the replies we receive about them are validated in some form, as we cannot yet trust what the Board tell us.
I have also met with representatives of the patients watch dog, Cwm Taf Community Health Council. They have shared with me their reports and associated concerns. We have considered together what action is best taken to better hear the voice of patients and the types of changes that may be required to improve the ways we can all hear about patient experiences going forwards.
The leader of the independent oversight panel has made clear that his responsibilities include an assessment of accountability for the reported failures. I believe It is right and proper that such accountability is based on clear facts, and people are held accountable for explaining these failures. This process should be led by evidence so we all learn the right lessons.
It is one understandable, but sometimes, frustrating feature of the recent Review that it does not, in itself, explicitly clarify accountability for problems. For example it talks about “false assurance” but does not explain by whom and how?. We need to get beyond some of the statements in the report and consider the more detailed evidence on these matters.
We have been told that any staff named by patients, or those whose actions are a cause of concern, have all been cross referenced to check where they are working, whether are they still practicing in Cwm Taf or elsewhere, and whether there are any issues for their professional bodies to consider. That can include fitness to practice or the need for training and support. It is reported that some people have retired.
I am told that a number of key new staff appointments, including consultants, have been made in recent months and that the recruitment of maternity staff continues. We know that with the service now centred on PCH some maternity staff have naturally chosen to work in Cardiff and Bridgend, so the impact of that is being monitored.
Updates to follow
Our work in understanding the circumstances that required this type of review to be needed, and the subsequent report to be published, will receive my continued attention.
There is an overriding priority to focus energy on improving the service and making the experience right going forwards. But that should not, in any way, take away the need to more fully understand the issues of the past. Further updates will follow.
Do you need support?
There are a number of support and information services available for anyone who is concerned or may have been affected:
- Sands bereavement support volunteers are providing emotional support to parents and partners attending the meeting with the Cwm Taf Health Board today, and anyone affected by the issues raised by the review can contact their helpline on 0808 164 3332.
Full details of Sands’ bereavement support services.
- The Health Board’s Patient Advice & Liaison Service (PALS) can be contacted for further information or personal advice. The team is available from 8.30am to 4.30pm Monday to Friday and can be contacted via telephone on 01685 724468 for Prince Charles Hospital or 01443 443039 for Royal Glamorgan Hospital. Their email address is: [email protected].
- The Community Health Council (CHC) is able to provide you with independent advice. Their advocacy service is free and client-led, covering all aspects of NHS treatment and care. The local CHC office in Cwm Taf is contactable via email: [email protected] or via telephone: 01443 405 830 (during office hours). If you require further information please visit their website http://www.wales.nhs.uk/sitesplus/899/home
- Putting things Right is a service for anyone not happy with care or treatment provided by or for the NHS in Wales http://www.wales.nhs.uk/ourservices/publicaccountability/puttingthingsright