Statement on Cwm Taf maternity services

Please see here copy of the Health Minister’s statement on Cwm Taf maternity services.

TITLE Update on Maternity Services and Targeted Intervention – Cwm Taf Morgannwg University Health Board
DATE 21 January 2020
BY Vaughan Gething AM, Minister for Health and Social Services

 

Llywydd, further to my Written Statement yesterday, I wanted to take the opportunity to update Members on the range of actions underway to secure improvements both in maternity services and the wider quality and governance arrangements across Cwm Taf Morgannwg University Health Board.

Yesterday I also published the second update report from the Independent Maternity Services Oversight PaneI. I’m sure we will all be encouraged by the overall assessment provided by the Independent Panel, that there has been good progress in implementing the recommendations made by the Royal Colleges’ following their review of maternity services last year.

Importantly, and in the words of the Panel members, they are now ‘cautiously optimistic’ that longer-term sustainable improvements will be achieved.

The Panel has assessed evidence which has provided them with reasonable assurance that a further 25 recommendations have been delivered since they last reported. This includes:

  • improvements in both the quality and uptake of training for both medical and midwifery staff, underpinned by robust plans for continued delivery;
  • having a comprehensive clinical governance framework in place which is resulting in improvements in clinical practice;
  • improvements in the reporting, investigation and learning from serious incidents; and
  • very importantly, confirmation that the midwifery staffing levels which the health board has been working to over the past nine months are now in line with Birthrate Plus recommended levels.

The Panel will revisit these and other areas periodically over the next 6-12 months to ensure they are embedded in practice and improvements are therefore sustained, whilst also assessing progress against the outstanding recommendations.

Whilst I am encouraged to see these improvements in the safety and quality of clinical care, I am particularly pleased by the positive feedback about the experience of care being reported by women and families using services currently. In addition to the health boards’ processes for capturing real time experience, this feedback is also corroborated by findings from Community Health Council visits over recent months. Furthermore the recent inspection report from Healthcare Inspectorate Wales found that care was being provided in a safe and effective manner at the Tirion Birth Centre, the midwifery led unit at the Royal Glamorgan Hospital.

However, as the Panel has made clear there remains much more to do to build on this progress. As I confirmed in my Written Statement yesterday an important component of the Panel’s role is to undertake a programme of clinical reviews looking back at the quality of care previously provided. This is important to ensure that all possible learning is identified and acted upon, but equally to try to answer any outstanding questions women and families may have about their care.

I’m grateful to the Panel for the extensive work that has been undertaken to develop a robust and thorough process, supported by a large team of independent experienced clinical reviewers who have now been recruited. They, and I, are determined that women and families will be at the centre of this work and all will be supported to be involved if that is their wish. Additional advocacy support is being provided by the CHC to assist with this.

I am pleased to have had the opportunity to meet with women and families last week, alongside the Panel.  Listening first-hand from their experiences is always difficult, but essential to understand how we ensure sustainable improvements in the provision of high quality, women and family centred services.

Before Christmas I also met with staff at both Prince Charles and Royal Glamorgan Hospitals. They told me that they now felt there was more coherence and credibility to the leadership and delivery of their service. I got a real sense of commitment, ownership and pride in the improvements that they were seeking to sustain and build upon. This, without doubt, has been a very difficult time for staff and I want to thank them for what that they have achieved in a short period of time and which has clearly been recognised by the Panel.

Much of the learning from maternity services is now helping to shape wider organisational improvements. Since my last statement in October, Members will be aware that Healthcare Inspectorate Wales and the Wales Audit Office have published their joint review of quality governance arrangements. This highlighted a number of fundamental weaknesses in those arrangements and the report makes wide ranging recommendations to address those. However, I was encouraged that they confirmed that the organisation’s new leadership had fully recognised the challenges, the need for change and that much of that work is already well underway.  This includes making changes to ensure their governance processes are robust, open and transparent, with clear lines of accountability and escalation when concerns arise.

There are a number of work streams underway to engage staff to address the concerns that have been raised around the culture within the organisation, together with those actions needed to rebuild patient, public, and stakeholder confidence and trust.  I particularly expect rapid and sustainable improvements to be made in how the organisation responds to patient concerns and complaints. This is essential to drive learning and improvement as well as being recognised as an organisation that is open and honest in all that it does.

The various reviews that have now taken place and reported over the past months have provided a comprehensive picture and diagnostic of changes needed. That includes ways of working and the underpinning values and behaviours that are expected to ensure the quality and standards of care that everyone has a right to expect. I am confident that the Board fully recognises the seriousness of the issues and the scale of the challenge that they face in achieving sustainable change and improvement remain considerable.

As I set out in my Written Statement last week on NHS escalation and intervention, the current levels of escalation remain in place. Maternity services remain in special measures and the organisation in targeted intervention.

There are now clear improvement plans developing to respond to the range of changes needed. My officials will continue to work closely with the health board to ensure they are both supported and challenged to deliver these improvements. Many can and must achieved at pace, while others will take longer to achieve and embed to ensure sustainable improvement.

I will of course keep members updated on progress.

 

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