NHS maternity service put in special measures after eight stillbirths and five deaths

Maternity services provided by an NHS board have been put into special measures after a report found patients were at risk.

An investigation into maternity units at Cwm Taf University Health Board, which has two hospitals in South Wales, raised “significant concerns” around staffing, processes and culture which it says have compromised care.

On Tuesday, Welsh Health Minister Vaughan Gething apologised to families affected by failures at the Royal Glamorgan Hospital in Llantrisant and Prince Charles Hospital in Merthyr Tydfil, after 43 potentially serious incidents were identified.

These included eight stillbirths and five deaths shortly after birth between January 2016 and September 2018.

The review, conducted by the Royal College of Obstetricians and Gynaecologists and Royal College of Midwives, found staff were under “extreme pressure” and worked under “sub-optimal” clinical and managerial leadership.

Low staffing levels, lack of support for junior doctors and lack of awareness of guidelines were also criticised.

A separate report said some women’s suspicions and concerns about their pregnancies were ignored by staff, which then led to tragic outcomes including stillbirth and neonatal death of their babies.

One woman told the report: “I’m broken from the whole experience, the lack of care and compassion.

“That terrible experience I was put through because of the staff that treated me. That experience will stay with me forever.

“I felt worthless, like I did not matter – that’s how I felt.”

The report also said many women and families received no bereavement counselling or support after the loss of a baby, and continue to experience emotional distress.

Mr Gething, who commissioned the report in October last year, said it made “very difficult reading” and its findings were “serious and concerning”.

He said: “I have been deeply saddened by this report. I cannot begin to appreciate quite how distressing it will be for families who have been directly affected by these failures.

“I am also conscious of the concern that will be felt by families currently receiving care in these hospitals and at a time when such a significant life event should be a moment of joy.

“There is no doubt that this report confirms the service has fallen well short of the expectation that I have for care provision anywhere in Wales.”

An independent review of 43 pregnancies between January 2016 and September 2018 will also now be undertaken, while an independent panel will oversee maternity services to drive improvements.

Following the report’s publication, Plaid Cymru called on Mr Gething to resign, saying the failings followed a series of others at other health boards in Wales in recent years.

Shadow health minister Helen Mary Jones AM said: “What’s happening at Cwm Taf is part of a consistent pattern of failure. From these appalling failings in maternity services, to years of under-performance at Betsi Cadwaladr in the North, the mistreatment of patients at the Tawel Fan ward at Ysbyty Glan Clwyd, and the poor patient care identified in Bridgend in the Andrews report.

“This pattern of poor performance has now reached a point where the Health Minister must resign. Time after time, he has failed to get to grips with the significant challenges facing the Welsh NHS, such that his position is now untenable.”

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