Cwm Taf maternity services review results in special measures

The Cwm Taf Health Board, which is responsible for the two struggling maternity services, has been placed into special measures – the highest level of government intervention – by the Welsh Health Minister Vaughan Gething.

The review, which was triggered by reports of concerning infant mortality levels between January 2016 and September 2018, examined allegations that patients’ concerns and complaints were not taken seriously, and that serious incidents – including stillbirths – were not being properly reported in national statistics.

Several areas of immediate concern were identified in the review, which was led by the Royal College of Obstetricians and Gynaecology and the Royal College of Midwives including:

• Insufficient staffing putting teams under “extreme pressure”
• “Fragmented” consultant cover with poor availability out of hours
• High reliance on temporary/locum staff at all levels
• A “punitive culture” within maternity services including a failing by senior management to listen to concerns.

The authors of the review reported evidence of a lack of clinical leadership, concluding that “patient care has fallen far short of what we would expect”.

They have now recommended a case review stretching back to 2010 to “determine the extent of the under-reporting”, after identifying at least 67 stillbirths not included in statistics for a national database.

While the chief executive of Cwm Taf Health Board has issued a public apology and committed “to making things right as the organisation’s utmost priority”, the review findings have confirmed the worst fears and been met with significant distress by families from across South Wales.

“This will confirm every bereaved parents’ worst fears and raise uncomfortable questions amongst those with children who have struggled since birth. Management was clearly lacking here and women and their children will have suffered.” said Cathryn Davies, senior medical negligence solicitor at Thompsons Solicitors in Cardiff.

“We are already acting on behalf of one woman who was sure there was fault by the hospital for her child’s injuries and sadly we fear she won’t be alone.

“Our breadth and depth of experience in this specialist field means we are well placed to help guide anyone with concerns about treatment received at the Royal Glamorgan Hospital or Prince Charles Hospital.”