My officials will be receiving regular updates on the staffing situation. They will be visiting this week, and have a regular presence, going forward. My officials have also kept Healthcare Inspectorate Wales fully briefed, so that that they can determine what action they may wish to take.

A number of systems have been set up to support patient safety. This includes a 24/7 on-call rota for senior midwife advice, and safety briefings at each shift handover, to ensure any potential concerns are triggered without delay. Revisions have been made to the incident-reporting system, including a daily review of data, to ensure there is no opportunity for incomplete reporting. The NHS delivery unit will be working with the health board to urgently review its arrangements for incident reporting and investigation, in addition to providing oversight of the maternity incidents under review.

All organisations must have robust incident-reporting arrangements in place, with the necessary escalation arrangements. I have asked my officials to seek assurance from all health boards in this regard. It is important that we learn from this, and understand what happened to lead to this situation. Members will be aware that, in the light of the seriousness of the situation, I announced on Friday that an external review should be independently commissioned by the Welsh Government. I felt it was important to take this action to ensure public confidence in the process. The chief nursing officer and the chief medical officer are in contact with the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives. I hope the review will be up and running within weeks. This will take the place of the external report the health board planned to commission, but will very much build on the review they have undertaken to date. The terms of reference for the review, and, ultimately, its findings will, of course, be published.

We must remember that, across Wales, the great majority of women receive excellent maternity care. Since the introduction of 'A Strategic Vision for Maternity Services in Wales', in 2011, there have been significant improvements across the whole NHS Wales system. To ensure a consistent drive for improvement, national performance indicators were set that cover areas such as smoking cessation, weight management, support for women with serious mental ill-health, caesarean section rates, breast feeding, and staffing levels. Annual maternity performance boards are held, where performance is measured against these indicators, as well as sharing new or innovative practice. In terms of workforce, all health boards are asked whether they are Birthrate Plus compliant for midwifery staffing, and compliant with the Royal College of Obstetricians and Gynaecologists standards on consultant obstetrician presence on labour wards.

Every woman has a choice about where she will deliver her baby, depending on her personal circumstances and risk factors, whether that is at home, by midwife-led care, in either an alongside or free-standing unit, or obstetric-led care. There has been a growth in midwife-led care, and every health board now has a consultant midwife to provide leadership and to support midwives. Every midwife in Wales has a designated clinical supervisor who is an experienced midwife, to support them in their practice. And we have seen a fall in the number of caesarean sections performed in Wales as a result of providing women with more information and support.

A national maternity network provides clinical expert advice. Part of their work has been to address the stillbirth rate in Wales. Over recent years, this multifaceted programme has seen: the introduction of national growth assessment protocols—GAP and gestation-related optimal weight—GROW foetal growth charts; new national standards for managing gestational diabetes; the introduction of practical obstetric multiprofessional training—PROMPT multidisciplinary training to improve communication and decision making within teams; a new perinatal mortality review tool and guidance to staff on seeking a post mortem; as well as improved cardiotocograph—CTG foetal monitoring training; and standards for intelligent intermittent auscultation. The network ran a successful safer pregnancy campaign, which promoted important messages to women about what they can do to look after themselves during their pregnancy. Evaluation showed a high level of knowledge and awareness among expectant mothers about what they need to do, with the support of their midwife.

There have also been developments and significant investments in neonatal care. The neonatal network issued revised neonatal standards in September 2017. That's based on the most up-to-date evidence and best practice guidance, to make them clinically and operationally relevant. And they are influenced by neonatal developments across the United Kingdom, and take into account the recommendations of the British Association of Perinatal Medicine, the national neonatal audit programme, the Royal College of Paediatric and Child Health, Bliss, and other standards published in both England and Scotland. 

Building on the success of the 2011 plan, a new vision for prudent maternity services is being drawn up in collaboration with professionals and informed by a survey of nearly 4,000 women who gave birth in Wales. It will also be important to ensure that any learning from the Cwm Taf review informs the plan to ensure Wales-wide learning and improvement. I will, of course, keep Members updated on progress.