Investigation into Cwm Taf maternity services extended to 160 cases

An investigation into maternity services at a Welsh health board has been extended to 160 cases.

An independent panel overseeing improvements at maternity units run by Cwm Taf University Health Board was appointed after 22 neonatal deaths and five stillbirths were uncovered at two of its hospitals in south Wales.

Cwm Taf was put into special measures by the Labour-run Welsh Government in April 2019, following investigations into standards of maternity care at Prince Charles and Royal Glamorgan hospitals between 2016 and 2018.

On Monday, the panel's fourth progress report said 10 new self-referrals since the last progress report six months ago have now increased the number of episodes of care under investigation to 160.

It will also begin releasing its findings in the autumn to mothers and families, and produce its first report to the public towards the end of the year.

The September 2020 progress report said the health board had done "remarkably well" and so far delivered 53 of the 79 recommendations within its maternity improvement plan.

But the panel admitted it would have to revisit some of the "signed-off" improvements at a later date, due to the pressures of coronavirus, meaning its validation process had not been as "robust" as it would have otherwise been.

10 new self-referrals have increased the number of episodes of care under investigation to 160 Credit: PA

Investigators have had no opportunities to visit the hospitals, it said, and have had to rely on paper evidence and conversations with senior managers and clinicians using remote technology.

The number of recommendations which remain to be delivered relate to culture change and leadership capacity, managing concerns and complaints.

Wales' health minister Vaughan Gething said both the panel and the health board had remained committed to delivering improvements within maternity and neonatal services, despite the "difficult and challenging" circumstances of the Covid-19 pandemic.

He said: "The panel has confirmed there is evidence of incremental progress, with a further 12 of the Royal Colleges' recommendations having been signed off during this period.

"This is commendable progress given the pressures resulting from Covid-19 and stands as testament to the hard work and determination of the staff delivering maternity and neonatal services.

On review findings being shared with families, he said: "This is an important step towards providing answers for women and families who may have had a negative experience of maternity services and I welcome this continued progress.

"Moreover, it will provide valuable learning for the health board and ensure that the experiences of women and families remain the driving force of the organisation's improvement journey."

Andrew RT Davies, the Welsh Conservatives' shadow health minister, said it will be an "extremely distressing time" when bereaved parents are told of the findings of the investigation, and called for them to be supported.

He said: "I cannot even imagine what the parents, whose lives have been so cruelly affected, have been going through for the past few years, and while I hope that the findings may begin to bring a sense of closure, it is going to be an extremely distressing time for them."

He added: "It's all well and good hearing the usual lines of 'this has been an experience of learning from past mistakes', but that is likely to be little comfort for the grieving parents.

"They need the support now as much as before, because revisiting the circumstances of their child's death will only serve to reopen old wounds."

  • Analysis by Health Correspondent James Crichton-Smith

The latest update from the Cwm Taf Morgannwg Maternity Services oversight panel is a broadly positive one, but we shouldn't forget why it was set up in the first place.

The oversight panel was put together in response to one of the most damning assessments ever into NHS services in Wales. The focus was on maternity services and how - over a number of years - standards of care, systems and management had deteriorated to such a level that the deaths and serious injuries of babies were not being reported properly.

The maternity scandal that was uncovered in 2018 may feel like a distant memory but for the families affected it continues to define their lives. We have reported previously, and it is worth reiterating again, that there are families in south Wales that, because of failures by the then Cwm Taf health board, do not have future generations. 

There is, though, movement in the right direction. That the chair of the panel, Mick Giannasi, can now say that services are 'safe' is a good development, but there is still work to be done.

In Mr Giannasi's words, there is 'turbulence' ahead as mothers are informed on what the panel has found. This will be a very difficult time and will be a real test for the health board to see how well it copes, and how much it has changed.