Foreword from the Chair of the panel

Pregnancy, birth and early care are foundational for each person’s life course. Care provided during that crucial period is not only vital for a healthy physical and psychological start for babies and their mothers, but also for the whole family’s relationships and wellbeing.

It is with that long view in mind that my expert panel and I began our work in September 2025 to complete an assurance assessment over a 4-month period of the quality and safety of maternity and neonatal services in Wales.

We set about this task with the commitment that when newly pregnant or considering having a baby, women and their partners need to be reassured about some fundamentals. They need to be confident that will they be treated with care, dignity and respect and that they will receive the individualised care they need and want. They should expect be listened to and meaningfully involved in decisions about their care. They should also feel trust and confidence that they and their baby will receive high-quality, safe care to prevent problems and to maximise their opportunities for a healthy pregnancy, birth and start as a new family.

Many newly pregnant women will face complex physical and mental health needs, social challenges and racism and statistics show that those facing these barriers will need additional support. The best health care systems will not just treat everyone equally but take action to reduce those inequalities.

To achieve these goals, healthcare systems must also ensure that staff at all levels are enabled to do the job they are committed to and have been educated and trained to do. They need time, support, equipment and a safe environment to do this.

This assurance assessment was requested by the Cabinet Secretary for Health and Social Care to take account of the findings of the recent reviews of maternity and neonatal services across the UK, including in Swansea Bay. He stated that he wished a ‘real time’ assessment of safety, but also that the assessment had been tasked with identifying examples of good practice as well as risks and concerns.

Our task has therefore been different from a retrospective review or inquiry into failings of a particular service. We have shaped our approach to enable us to identify both strengths within the current system as well as concerns. To do this, we have adopted a whole system, multi-method approach. We have carefully listened to hundreds of women, parents, families, community advocates and staff from all over Wales. We have visited nearly all maternity and neonatal units in Wales and observed practice as it happens. I am proud of what we have achieved to gain a rounded picture in a very short period. What we have found The view of the expert and independent panel of which I am Chair, is that there are many strengths in Welsh maternity and neonatal services, but there are some important vulnerabilities in some of the key conditions required for safe and reliable care.

Strengths from the report include:

These include much positive feedback from expectant women and their partners, and new mothers and fathers about many aspects of the quality of their care in maternity and neonatal services. Where they have not received the care they need, many are keen to help services improve.

Staff who engaged with our assessment demonstrated a strong commitment to providing high quality and safe care throughout the maternity and neonatal pathway and we observed much positive practice during our site visits. This commitment was evident despite many challenges in the current system.

Freestanding midwife-led units enable many women to receive antenatal and postnatal care and give birth in high-quality environments, particularly supporting those in rural areas to avoid long journeys to hospital.

At a national and local level, there has been a renewed focus and commitment to maternity and neonatal services in the last few years, and this has led to positive changes in some measurable outcomes. 

Despite these clear strengths, we are concerned about some key vulnerabilities and weaknesses:

Many families report poor experiences, with concerns about postnatal support, the involvement of fathers and unmet mental health needs. 

Our assessment is that national organisations tasked with delivering, commissioning, monitoring, holding to account and driving improvements in maternity and neonatal services are too often working in parallel, rather than maximising the potential of their collective knowledge and remits. The potential for real-time monitoring of data and spotting unsafe trends, understanding inconsistencies and inequalities and setting national and local priorities is not yet realised.

Current staffing levels and configurations do not meet the requirements of current population needs, nor the rapid increase in caesarean births and induction of labour. This means that safety and well-being is compromised throughout the maternity journey. Staff morale has been hit hard by these issues, and by what is experienced as a relentless negativity about maternity services in the public domain.

There are inconsistencies in the organisation and staffing of triage and induction of labour processes and shortages of obstetric theatre provision. Postnatal care, especially, is inadequately staffed and supported.

Analysis and necessary reconfiguration of neonatal provision in south Wales has been unduly delayed.

Wales lags behind Scotland and England in its provision of mental health care in maternity and neonatal units.

The process of responding to incidents, including death and serious injury, is inconsistent, overly procedural and does not reliably involve families. It often serves to further traumatise families who have experienced harm and limits the capacity to learn and improve.

And finally, but importantly, Wales along with the rest of the United Kingdom has seen an unprecedented rise in medical interventions, particularly caesarean rates, without evaluating the consequences for women, babies, families, and for health service resources. Our recommendations address these vulnerabilities.

Our recommendations address these vulnerabilities.

My panel members, who have extensive experience of maternity and neonatal services in all four nations of the United Kingdom have confirmed that the challenges facing Wales are replicated across the United Kingdom. While keeping a close eye on Wales’s population profile, culture and geography, we have indicated in our recommendations where Wales may wish to either draw on work already underway in other UK nations or where it may be prudent for cross-national collaboration to find the most effective solutions to shared challenges. 

Members of the excellent Stakeholder panel and Consultative groups have made passionate pleas that this report must create change. They noted that there have been many reports, with good recommendations, but women, families and staff haven’t experienced those changes in practice. 

Our recommendations will require action, funding and accountability. I expect Welsh Government to lay out clear mechanisms to address the issues highlighted in this report, including transparency on how this process will be measured, monitored and reported. The challenges are large, but they are solvable, if they include those who rely on or work in Wales’s maternity and neonatal services every step of the way.

Professor Sally Holland
Independent Chair
25 February 2025