Review of Cwm Taf maternity services

For the record here is my question to the Health Minister and his response. I also provide a link to the first quarter review by the Independent Panel.

08/10/2019 15:25:49 / Dawn Bowden AM
Can I thank you, Minister, for your statement? And, at this point, can I once again put on record my condolences and thoughts with the families who were affected by the failings in this health board and have had to live with those tragedies since then? Can I also repeat the thanks to the members of the independent maternity oversight panel for their work, and, in particular, Mick Giannasi, who gave me several hours of his time at Prince Charles Hospital when I had the opportunity to talk to him directly about the work of the oversight panel and see at first hand some of the things that were being put into place, including talking to some of the staff and some of the new managers who were there? So, I was very grateful to him for having the opportunity to do that.

I was also pleased to attend the briefing this morning that you facilitated with the oversight panel, together with my colleague Vikki Howells, and we had the opportunity to directly ask the oversight panel questions at that briefing. What I would say is, unlike some of the comments that I’ve heard this afternoon, I see this slightly differently in terms of what I’ve seen, what I’ve heard and what I’ve experienced in talking to some of the staff and patients. And I do take some reassurance from the thorough work that the panel has now put in progress and as a result of your intervention, although no-one, as you’ve said, and as others have indicated, should underestimate the challenges that still lie ahead. Indeed, one of the things we heard from the briefing this morning was that, following the inquiry into the Morecambe Bay maternity services, it took some six years from the point at which Morecambe Bay went into special measures to the time that they were considered to be a good unit. And that unit now is actually seen as an exemplar of maternity provision. So, I think the point I’m making here is that anybody who thinks that there is a quick fix to this is clearly not on top of the brief in terms of what needs to be done. There are no quick and easy solutions, it seems to me.

However, I’m sure that you would agree that the experience of women and families must remain at the heart of this improvement journey. So, to that extent, the response to the 11 ‘make safe’ recommendations so far is encouraging, though, as you’ve already indicated, there clearly is much more to do. Now, I note that the number of cases in the clinical review has been extended as the criteria of the panel has been broadened, to ensure that all appropriate lessons can be drawn from the process. While that is something that I welcome, I will await the expert evidence from those reviews before making any detailed comment on them. But I am encouraged to hear about signs of improved performance as a result of the changes already in place.

Now, Minister, you’ve talked a lot about resourcing, but, as the work has to be centred on improving the experience of women using this service, can you assure us that you will continue to provide the resources that are required to support the work with those women and families who wish to continue to be involved with this review?
And, finally, do you agree with me that, if we are to achieve some of the cultural changes that clearly are needed, we must create an environment in which people, staff, feel confident about speaking up and speaking out without fear or favour about poor practice and poor behaviour? Because, for too long, doing that has been a career-ending decision for too many staff. And, if we are to see that cultural change, people have to feel secure in the knowledge that they can make those concerns known to the highest levels of the authority without fearing for their own careers in the process.

08/10/2019 15:30:03 / Vaughan Gething AM

Thank you for the comments and the questions that you’ve asked. In terms of your first point about there being no quick fix, that is absolutely right, and I just need to be honest with people about that at the outset, as I have been in the first statement today as well, rather than suggesting that there will be a point of political convenience that will drive what happens, rather than doing the right thing by the service and honestly reporting the level of progress that has been made, as well as that that is still required. Again, I’m happy to reiterate that women and families will be at the centre of the work that is being done in the engagement work that is being led initially by Cath Broderick, and now the health board are taking a greater lead on, as they should do. In taking that forward, there are going to be three public-facing events—one in Merthyr, one in Llantrisant within the next six weeks or so, and then one in the new year in Bridgend, so that the health board will try to co-produce their future strategy with women and families to try to make sure that there isn’t a disengagement between the service and the people using it.

The improvements are real that the panel set out, but they’re not even, and we’re not in a state of perfection. In any human service, there is always room for error, even in a good service. But I wouldn’t try to pretend that people won’t have things come to their postbag that are more recent, where there are reasons to go back to the health board. I wouldn’t try to say that to anybody. But it is, nevertheless, true that it is in a better place now than it was before the intervention had started. My ambition is to see that improvement carry on and on and on, because I don’t want to hear continued, justified complaints being made about the quality of care and the experience of women and their families in any of these services.

That’s why I can confirm that there will be future resources to support women and families who are engaged in this. There are the resources in the support services that are often provided by the third sector. So, for example, the Snowdrop support group and the Sands service, again, are available to families to make use of, and what I think is a very helpful ‘frequently answered questions’ sheet that the panel have produced for the public that sets out how to get in touch with them. But, in addition, if women and families need to be supported in engaging with the panel on some of the review work, then we’ll look to see how we actually properly facilitate that to make sure they’re supported. And, obviously, the community health council are engaged in doing that work as well.
On your final point on supporting people to speak up, that’s part of the culture change we need to see happen, to move away from a punitive culture, where people feel that if they step outside, either with their managers, or in a prevailing group of opinion with their peers in work—that people feel punished in their day to day work—and that, actually, we do move to being a learning organisation, where people recognise where things go wrong, as well as recognising excellence, to be able to point that out and to talk about it in a learning environment. And that’s part of the reason why I’m really clear the panel can’t have a role in saying ‘It’s your job to go and find people who are responsible’, because, actually, that will turn it into a blame culture. It will reinforce a punitive culture, rather than moving on to being a genuine learning environment, where people are supported to point out when things go wrong, to hold their hands up for themselves when things go wrong, to make the improvements that all of us want to us to see in a real and sustained way.


Information on the work of the Indepedent Panel can be found here


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