Written Statement: Independent Maternity Services Oversight Panel – Cwm Taf Morgannwg University Health Board – Summer Progress Update

I am making this statement to provide an update on the work of the Independent Maternity Services Oversight Panel and improvement activity at Cwm Taf Morgannwg UHB in respect of maternity services.

On 30 April 2019 I published the Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives joint report, following their review of maternity services at the former Cwm Taf University Health Board.

One of my immediate actions was the establishment of an Independent Maternity Services Oversight Panel. I issued statements on 23 May 2019 confirming the full Panel membership, and on 25 June 2019 confirming its full Terms of Reference.

I have now received an update on progress from the Panel Chair and would like to share the key developments.

The Panel has adopted an evidence based approach to its work. It has looked to learn lessons from the evaluation of intervention approaches adopted elsewhere to address systemic failure. It is vital that we learn from when things have gone wrong and use this as a basis for future improvements.

The Panel is developing three key strategies to underpin its work:

• An improvement monitoring and assessment process;
• Engagement and communication strategy;
• Clinical review strategy.

Operating arrangements have now been agreed by the Panel, including a structured meeting schedule.

Improvement monitoring and assessment process           

Within Cwm Taf Morgannwg UHB, the Director of Nursing, Midwifery and Patient Care is responsible for maternity services improvement. This includes responsibility for the development of a comprehensive maternity services improvement programme that responds to the recommendations of the joint Royal Colleges’ report and other internal and external reviews. The actions identified build on the previous improvement plan and changes that have already been made.

Detailed milestones are being agreed by the Panel in order to track progress and improvement. The Panel and my officials believe that there has been a tangible improvement in the pace of progress and the level of cohesion at Board and operational delivery level. 

The Oversight Panel is due to meet later this month to scrutinise progress against the health board’s emerging maternity services improvement programme.

In addition to the detailed work around the maternity services improvement programme, Mick Giannasi has been working with the Chair, the newly appointed interim Chief Executive of the health board and the Nurse Director, to design a high-level strategic framework. This focuses on:

• the delivery of safe and quality care,
• restoring trust and confidence amongst patients, staff, partners and the wider public; and
• the adoption of a whole systems holistic approach.

The framework, aligned with the wider quality governance concerns, should allow the Board to embark upon a broad strategic transformation programme. The aim remains the creation of a modern, high-performing organisation which is fit for purpose and sustainable in the longer term. The Public and staff deserve nothing less.

Engagement and communication strategy

The engagement and communication strategy is being developed by the health board with support from Cath Broderick, the Lay Panel member. I understand this work is advancing well and driven by a number of principles:

• Women and families, in particular those directly affected by events leading to the RCOG review, will be at the heart of:
  1. the work undertaken by the Panel; and
  2. central to development and delivery of the health board’s engagement and communication activity;
• The delivery of maternity services, the practice of individuals and the strategy for engagement and communication should be viewed through the eyes of the people who use services in Cwm Taf Morgannwg;
• It must be as easy as possible for people to be involved and they should be actively involved in ways that are meaningful and provide real opportunities to influence change and improvement;
• People must be informed about how their involvement has influenced decisions and practice.

The suggestions from women and their families are central to the development of this strategy. Building trust and confidence in maternity services in Cwm Taf Morgannwg UHB is important for those women and families currently using services as well as those who may require them in the future.

The Panel has met several times with a number of women and families directly affected and will continue to meet with them as work progresses. Cath Broderick has started the extensive process of working with key people in the health board and partner organisations to better understand how current approaches to patient engagement and feedback can be developed and improved.

The Maternity Services Improvement Board comprising representatives from Cwm Taf Morgannwg Community Health Council, midwives, engagement and communication leads will oversee a new women and families work stream to take this forward.

Clinical review strategy

The Panel is developing a clinical review strategy which will set out how the three key areas for review will be taken forward. These include:

1. 2016-18 cases identified in advance of the RCOG review and those subsequently identified;
2. 2016 to 2010 look-back;
3. Women and families who have self-referred.

The Panel’s Obstetric and Midwifery Leads, Alan Cameron and Christine Bell have undertaken an initial assessment of the cases referred to in the RCOG report. Work is now underway to expand their team with additional, relevant experts to ensure that steady progress can be made. The Panel has confirmed the 2016-18 cases will be considered first.  I anticipate being in a position to provide a more detailed update on this aspect of the work in my next update.

I am grateful to the Panel for the work they have undertaken thus far and will provide a further update when I publish their first Quarterly Report in the autumn term.