Cwm Taf Maternity Services
The Cabinet Secretary for Health and Social Services today updated the Assembly on the independent review of maternity services at Cwm Taf University Health Board. You can find my question to him on my AM facebook page.
The statement was as follows:
“Further to my written statement on Friday I thought it important to update Members on actions being taken to support maternity services at Cwm Taf University Health Board.
Reports over the past week are clearly very concerning and members will want to understand how this situation occurred. As a parent, I fully appreciate how distressing this is for those affected. I expect the Health Board to provide support to families and to be open and transparent about individual review findings and any improvement actions needed. Whilst an adverse outcome cannot always be prevented, it is important that care is reviewed to identify any potential learning. Families understandably may also have questions that need answered.
When women go into hospital we rightly expect good quality, safe care. Childbirth can be stressful, but also an experience that brings great joy. So the welfare of women and babies must be our main and immediate concern. I have made it clear through my conversation with the Health Board Chair that I expect every possible action to be taken to provide assurance that services are providing safe and compassionate care. My officials are also monitoring the situation closely in seeking such assurance.
I also appreciate that this is a very difficult time for staff and they must be appropriately supported. A key focus must be on ensuring safe staffing levels and strong clinical leadership. At a leadership level we are ensuring that additional senior midwifery and medical management support is in place to provide oversight and advice. The Heath Board has successfully appointed a consultant midwife and recruited 15 additional midwives, of which 4.8 wte newly qualified staff take up post this week. Experienced midwifery support is also being provided by neighboring health boards, including a clinical supervisor of midwives. Actions are in hand to increase medical staffing, including the appointment of an additional middle grade doctor.
I know concerns have been expressed that parent craft anti-natal classes had been cancelled but I’m advised that these will be reinstated within weeks – early next month – as staffing levels improve.
My officials will be receiving regular updates on the staffing situation. They will be visiting this week and have a regular presence going forward. My officials have also kept Healthcare Inspectorate Wales fully briefed so that that they can determine what action they may wish to take.
A number of other systems have been set up to support patient safety: this includes a 24/7 on-call rota for senior midwife advice and safety briefings at each shift handover to ensure any potential concerns are triggered without delay. Revisions have been made to the incident reporting system, including a daily review of data to ensure there is no opportunity for incomplete reporting. The NHS Delivery Unit will be working with the Health Board to urgently review its arrangements for incident reporting and investigation in addition to providing oversight of the maternity incidents under review.
All organisations must have robust incident reporting arrangements in place with the necessary escalation arrangements. I have asked my officials to seek assurance from all health boards in this regard.
It is important that we learn from this and understand what happened to lead to this situation. Members will be aware that in light of the seriousness of the situation on Friday I announced that an external review should be independently commissioned by Welsh Government. I felt it was important to take this action to ensure public confidence in the process. The Chief Nursing Officer and Chief Medical Officer are in contact with the Royal Colleges of Obstetrics and Gynaecology and Midwifery. I hope the review will be up and running within weeks. This will take the place of the external report the health board planned to commission but will very much build on the review they have undertaken to date. The terms of reference for the review and ultimately its findings will of course be published.
We must remember that across Wales the great majority of women receive excellent maternity care. Since the introduction of the Vision for Maternity Services in Wales in 2011 there have been significant improvements across the whole NHS Wales system.
To ensure a consistent drive for improvement, national performance indicators were set that cover areas such as smoking cessation, weight management, support for women with serious mental ill-health, caesarean section rates, breast feeding and staffing levels. Annual maternity performance boards are held, where performance is measured against these indicators as well as sharing new or innovative practice. In terms of workforce all health boards are asked whether they are Birthrate plus compliant for midwifery staffing and compliant with the Royal College of Obstetricians and Gynaecologists standards on consultant obstetrician presence on labour wards.
Every woman has choice about where she will deliver her baby, depending on her personal circumstances and risk factors, whether this is at home, by midwife led care in either an alongside or free standing unit, or obstetric led care. There has been a growth in midwife led care and every health board now has a consultant midwife to provide leadership and support to midwives. Every midwife in Wales has a designated clinical supervisor who is an experienced midwife to support them in their practice.
We have seen a fall in the number of caesarean sections performed in Wales as a result of providing women with information and support.
A national Maternity Network provides clinical expert advice. Part of their work has been to address the stillbirth rate in Wales. Over recent years this multifaceted programme has seen: the introduction of national ‘Gap and Grow’ foetal growth charts; new national standards for managing gestational diabetes; introduction of PROMPT multidisciplinary training to improve communication and decision making within teams; a new perinatal mortality review tool and guidance to staff on seeking a post-mortem; as well as improved mandatory Cardiotocograph (CTG) foetal monitoring training and standards for intelligent intermittent auscultation. The Network ran a successful Safer Pregnancy campaign that promoted important messages to women about what they can do to look after themselves during their pregnancy. Evaluation showed a high level of knowledge and awareness in expectant mothers about what they need to do, with the support of their midwife.
There have also been developments and significant investments in neonatal care. The Neonatal Network issued revised Neonatal standards in September 2017 based on the most up to date evidence and best practice guidelines to make them clinically and operationally relevant. They are influenced by neonatal developments across the United Kingdom and take into account recommendations by the British Association of Perinatal Medicine (BAPM), the National Neonatal Audit Programme (NNAP), the Royal College of Paediatric and Child Health (RCPCH), Bliss and other standards published in England and Scotland.
Building on the success of the 2011 plan a new Vision for Prudent Maternity Services is being drawn up in collaboration with professionals and informed by a survey of nearly 4000 women who gave birth in Wales. It will also be important to ensure any learning from the Cwm Taf review informs the plan to ensure Wales- wide learning.
I will keep Members updated on progress”.