Item 4, therefore, is a statement by the Cabinet Secretary for Health and Social Services on Cwm Taf maternity services. I call on the Cabinet Secretary to make the statement. Vaughan Gething.

Thank you, Llywydd. Further to my written statement on Friday, I thought it important to update Members on actions that are being taken to support maternity services at Cwm Taf university health board. Reports over the past week are clearly very concerning, and Members will want to understand how the situation occurred. As a parent, I do appreciate how distressing this is for all those affected. I expect the health board to provide support to families and to be both open and transparent about individual review findings and any improvement actions that are needed. Whilst an adverse outcome cannot always be prevented, it is important that care is reviewed to identify any potential learning. Families, understandably, may also have questions that need answers. 

When women go into hospital, we rightly expect them to have good quality, safe care. Childbirth can be stressful, but also an experience that brings joy, so the welfare of women and babies must be our immediate concern. I've made it clear, through my conversation with the health board chair, that I expect every possible action to be taken to provide assurance that services are providing safe and compassionate care. My officials are also monitoring the situation closely and seeking such assurance. 

I also appreciate that this is a very difficult time for our staff, and they must be appropriately supported too. A key focus must be on ensuring safe staffing levels and strong clinical leadership. At a leadership level, we're ensuring that additional senior midwifery and medical management support is in place to provide both oversight and advice. The health board has successfully appointed a consultant midwife and recruited 15 additional midwives, of which 4.8 whole-time equivalent newly qualified staff take up post this week. Experienced midwifery support is also being provided by neighbouring health boards, including a clinical supervisor of midwives, and actions are in hand to increase medical staffing, including the appointment of an additional middle-grade doctor. 

I know that concerns have been expressed that Parentcraft antenatal classes have been cancelled, but I am advised that they will be reinstated within weeks—early next month—as staffing levels improve.

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.

A number of Members were late for the start of this statement, and if there is time, you will be called, but I'll call those Members who were here to hear the whole statement first. Someone who was here, Angela Burns. 

Thank you, Presiding Officer. First of all, I would like to put on record how incredibly sorry I am for the affected families. A moment of maximum joy is what they should have been feeling, but it turned to events of terrible despair, and we are appalled by what's happened. 

In July of this year, a young couple came to see me. It's an appalling situation. They are part and parcel of what's happened here: a consultant who didn't visit the mother's bedside because of his rage at being put on a rota he wasn't expecting; warning signs that were ignored; a baby, barely alive, who was moved to another hospital and put on a cold cot, but to no avail. Having read their horror story, what really struck me, Cabinet Secretary, was the health board's reaction. They wrote to the chief executive officer saying what had happened and asking for help to understand it and for more information. They were essentially palmed off to a junior staffer who was reluctant to engage. There seemed to be a total lack of compassion for people at their lowest ebb, a dismissive attitude, a dragging of heels, no apology of any meaning—and I'm not talking about financial, I'm talking about the sincerity level. There was no timely response to letters.

So, how will you, Cabinet Secretary, ensure that the health board provides proper support to these families who've been affected? In your statement, you say that you expect them to provide support for the families, but I can tell you that, from the evidence that I saw, the reports that were written and the letters that were sent to this young couple, that did not happen. So, I'd really like to understand in what meaningful way you can ensure that this health board do what they should do, and actually come alongside these families. 

Of course, at the time, I didn't realise that this seemed to be part of some kind of systemic failure. So, Cabinet Secretary, the independent review that you are going to put in—will they be going through each case themselves, because in your written statement you say that some have now been reported and are being fully investigated? Again, from the paperwork that I was given by this young couple, within Cwm Taf health board, an independent paediatrician actually wrote a report that was pretty scathing about what happened to them, and it was ignored by the health board. So, will you be able to get your independent review, or ask the independent review, in their remit, to really dig down into the individual cases to ensure that there is no possible forgetfulness of the events or an abrogation of transparency, because I think it is the least that these families deserve? And do you have a timetable for when you would hope to have this review report back? 

And, of course, you'll know that throughout Wales, at the moment, we're going through quite a significant transformation agenda; there's a lot of centralisation going forward in other health boards at present. So, how will you ensure that lessons learnt from the Cwm Taf experience are actually translated really well into all those other health boards, because I think that we need to put these health boards on notice that if we're going to do this stuff, we have to do it safely and we have to remember that the patient is what it's all about, and that these mothers and babies—wherever they are in Wales—deserve the chance to have a successful outcome?  

Cabinet Secretary, I was also really concerned that this trend didn't seem to be spotted earlier. So, will your independent review be looking at that? Will they be looking to see whether or not the agencies that are responsible for monitoring performance and outcomes within health boards—where were they? Why didn't they spot it earlier? Did anybody step in to say, 'Hang on, something here doesn't look right,' because we've got access to mortality figures? We should know what should be the right trend and what shouldn't be the right trend.

I will say that my young couple are now in the safe hands of an Assembly Member on another bench to mine, because that individual is actually their constituency Assembly Member, but I just want to say that, of all of these families who have been affected by this, if their stories are anything like the young couple who came to see me with their sheaf of paperwork, and told me of the fear that they have of trying to have another baby, having lost their little girl at six days through a catalogue of errors that was nothing to do with them, then we should be absolutely determined to make sure that Cwm Taf are held to account, the right people are held to account, whoever they may be, and that we learn these lessons in a meaningful way. There's a very big health board in England that's going through a not dissimilar process at the moment. We should be learning from each other. This shouldn't happen. It is a real tragedy.

I thank the Member for her comments and questions, and, of course, I'm sorry for any family who suffers the loss of a baby or a young child. I would not want any family to feel the way that you described. Now, I can't, obviously, comment on the individual circumstances, but I do want to be clear that part of the point of this review is to try to learn what has happened. We're now looking at 44 cases in that cluster of cases to be reviewed. It's not clear at this point that care has gone wrong in any or all of those cases, but the cluster of cases of concern is why there is an imperative to investigate, and hence the now independent review with the two royal colleges, with oversight from the chief nurse and the chief medical officer.

The health board do, of course, now have that additional scrutiny that I've outlined in my statement—additional scrutiny and support to look at both clinical practice, clinical culture, but also one of the points you made—clinical leadership. In fact, we're having the review now because a new head of midwifery services saw some of the data and flagged it up as a concern, and that's led to the issue being escalated. But part of our challenge is to make sure that it doesn't need to have an additional fresh set of eyes at that level.

So, there are good reasons to have the review and to want to learn from it, but I'd be cautious about saying that in every single instance there has been a failure of care. That's why we have the review—to look at those individual circumstances, to understand what is individual, what is cultural, what does it tell us about practice, and to help us to make recommendations for the future as well.

Now, I've been clear in my statement on publication so the recommendations and any response to those recommendations from the review will be published. What I can't tell you is that there is a timetable. It's regularly the case that, for politicians, you would want to set a timetable that is prompt or long, depending on your perspective. I think it's important the colleges have the terms of reference to allow them to do what they need to do in a properly independent and robust manner, and I don't set an artificial timetable, but, obviously, I'd want the review to be as prompt as possible. The sooner we have something that is robust and understood, then the sooner we're able to understand what measures do or do not need to take place, and also what is individual about the health board and what is system-wide learning, and what is a system-wide challenge across Wales.

On your point about centralisation, these services have not yet been centralised, and so the model itself, a new model, isn't a contributory factor. We're looking at practice, but there are arguments that I'm sure the colleges will want to look at in terms of the optimal organisation of the service, and we know that in the past, though, our royal colleges said that the move that we're making is towards a better model to provide better care. Well, they're matters that I'm sure will be commented on in the review, and, as I say, that will be published together with any response to it.

Can I say that I also, not least as a parent, feel for everybody affected and those concerned? Perhaps I could start, actually, by asking, Cabinet Secretary, if you could tell us what services are going to be put in place locally to provide support for those affected or who may be anxious about giving birth in the Cwm Taf area.

We need to be sure about what happened. That's the purpose of reviews. We also need to be sure about the scale of what happened, and, certainly, I welcome the Government action in taking over the process of commissioning the review. It's vital, of course, to restore confidence that the investigation into what has happened is genuinely independent, and an internal review, I don't think, would have achieved that. Can you confirm that this will, indeed, be an independent review that will have scope to expand the investigation if necessary, as has been the case in Shropshire? And I think this is also important, because, on Good Evening Wales on BBC Radio Wales last Thursday, the interim director of nursing seemed to imply that this was somehow an exercise that every health board was undertaking and that the challenges themselves were faced by every maternity service in the UK. But I think that the number of serious incidents that we're talking about here quite clearly suggests that there may be a more severe problem. And I wonder whether you regret that already it seems the board seems to have gone into some crisis-management, public-relations mode in seeking, somehow, to downplay the seriousness of the situation, which, to be fair, the Welsh Government isn't doing.

Moving on to staff, it's been heavily implied that staff shortages are a factor here. Your statement says that one doctor and 15 midwives have been recruited, with 4.8 whole-time equivalent midwives starting this week. I'm just not sure about why you go from roles to full-time equivalent numbers side by side. Can you give the actual numbers starting this week, so we know where we're at?

We'll have time to explore many issues, but a couple here: the statement also announces a number of new systems to improve safety, including a 24/7 on-call rota for senior midwife advice and safety briefings at each handover. Why weren't these things already in place, because they seem to me to be pretty basic? And your statement also tells us that antenatal classes will restart within weeks as staffing levels improve. Now, the fact that these were cancelled in the first place is painting a picture of some quite serious cuts that had happened recently in services. So, can I ask what the alarm systems are that Welsh Government has to identify when these kinds of negative effects are coming towards us, if you like, and are any of these early alarm systems that you have presumably in place alerting you to problems elsewhere, currently?

Thank you for the series of questions. In terms of the support being provided to the health board, I outlined that in my statement. My officials and the delivery unit are providing support and challenge in addition to the co-opting of senior leadership support from experienced midwives in neighbouring health boards, and in addition, of course, to the steps that the health board themselves have taken.

And I note the point you make about the numbers of staff. The point I was simply making was that a number of staff of the 15 that have been recruited are due to start this week, as opposed to recruiting 15 and they won't necessarily come on stream to work in the service for a period of months. So, that's why we can be confident that antenatal classes will start in the near future, because they will have additional staff there within the week. 

On the point you ended on—the point about the surveillance—again, in the statement I made reference to a number of different points that do help us to have an overview and a look: the Birthrate Plus tool that we look at for staff numbers and the fact that they'd withdrawn from antenatal classes because they had a short-term challenge on staff numbers. Those are things we definitely look at, in addition to the broader performance boards going through the range of issues that I outlined in my statement. All of those things will matter, and the chief nurse and her officials will review those together with the health board. 

Now, I'm not aware, and my officials are not aware, that there is a similar issue of concern in any other health board in Wales. However, we have not waited until an issue has been reported. My officials have been in direct contact with health boards, and the chief nurse has written to all health boards seeking formal assurance about the quality of care being provided, including issues around staffing and for that assurance to be provide within the next two weeks. So, we are not waiting for there to be a challenge uncovered. We are seeking that assurance, as I'm sure you would expect us to do. 

I don't think the health board are downplaying the seriousness of the challenge. They understand very well that this is a serious matter that needs to be properly reviewed, as any other health board would do. And what should happen in every health board is that, of course, a serious incident is reviewed and learning taken from it. That is, I think, the normal process that was being referred to, but, of course, this additional measure and the measures that the health boards themselves are proposing to undertake are not usual, everyday occurrences. You don't ask two royal colleges to come and review your practice as an everyday, standard course of action.

I'm happy to finally deal with your point about staff shortages potentially being a factor, and also the royal colleges will. It's part of the concern and it will be part of the terms of the colleges to look at whether those staff shortages play a part or not. It'll also be part of them looking at whether it's clinical practice or clinical leadership—the whole range of factors that we'd want to properly understand to make recommendations for the future. In that sense, if the royal colleges wish to go further, then their terms of reference will not restrict them to an artificial review. They will have the scope to look where they need to, provide the sort of review that they themselves, professionally, would want to sign up to, and to give us and the wider public the sort of confidence that we'd all want to have.

Can I thank you, Cabinet Secretary, for your statement, and can I also place on record my deepest sympathy and concern to anyone who's been affected by the situation in Cwm Taf health board? As you would expect, I've had long and detailed conversations with Cwm Taf health board about the situation there and how this came about. I was given no indication or impression that they were in any way downplaying the seriousness of what has happened there, but it does seem to me that, when a vital service has not performed as expected, as with the review of these adverse outcomes, we then need to do two key things to reassure the women using this service as well as the wider public. Firstly, we do, as you've already outlined, need to provide an independent means to examine the circumstances and to report any action points for further learning and improvements to ensure that there is confidence in the system. I would hope that your actions, in addition to those actions already taken by the health board in relation to the peer review that they're introducing, will deliver the necessary improvements that my constituents would expect in the service in the future. They would not be expecting anything less. 

Secondly, do you agree with me that we must make sure that we continue to encourage a culture where the health and care systems, especially in our health boards, are not in any way discouraged from identifying problems or issues themselves, as was the case in Cwm Taf when the health board itself identified the failures of its own process? We should always be signalling to the health boards and to staff that reporting their concerns, like with these adverse outcomes, is helpful to allow for a response by the wider health system where that is necessary. And just as importantly, while our response must be handled in a sensitive and robust manner, they should not be sensationalised or politicised, given the importance of the services that we're discussing and the need to provide reassurance. 

Yes. I particularly welcome your point about not trying to overly sensationalise what has happened, and, equally, that's at the same time as not trying to downplay the seriousness of the concern that exists as well. It is entirely possible to recognise the serious situation, with 44 cases being reviewed—it was 43, but we've identified literally very recently a further case that should be reviewed as part of this. It's very easy to launch into an attack upon the service when you do have significant concerns to review, but I think it's important that we do resist leaping to judgment in this case, but that must go alongside having the proper, independent reassurance that you refer to.

I'm also pleased that you have had direct conversations with the health board, because I think it is important that they are open with all stakeholders, and that of course includes Assembly Members, as well as the public, as well as the families who are directly affected.

The point about the independent review is that the health board were doing the right thing in asking the royal colleges to come in and review what had happened, but there is always a challenge in the impression of independence and it's really important if the public are to have confidence in it. That's why I took the decision to make sure that the Welsh Government commissioned that, so that there's no impression the health board are being allowed to mark their own work. I think that would have been the wrong thing to have done. I do not think that would have helped either the health board, the staff or the women who rely upon the service.

I think your second point is really important too, about making sure there's a proper, open culture to identify and address challenges at an early point, so that people aren't fearful of talking about challenges or concerns they have with the service, and to make sure that you don't somehow have an expectation of suppressing or covering over potential bad news, because that ultimately makes the situation worse, because people lose faith and confidence in a process that the public really should trust, but also because those opportunities to learn are then lost. That will be important to understand within the review, and whether, from a cultural and practical point of view of the way that the service is delivered, we have the right culture and practice in place, and, if not, then to openly want to address that. As I said in my statement, maternity services and midwifery services in Wales are recognised across the United Kingdom as having made significant improvements. So, I want to see that improvement continue, but this review is equally important in that sense to make sure that we maintain public confidence in our system and in our ability to properly and critically look at where something might have gone wrong.   

I, too, join Members' sentiments about this terribly tragic sequence of events that have led to, obviously, the cases coming to public attention. It is worth noting that the Cwm Taf health board, from a senior management level, has been heavily engaged in a merger with the Princess of Wales Hospital, and I'd be grateful to understand from the Cabinet Secretary as to whether that merger has deflected from the day-to-day running of the health board. As I understand it, the two areas of concern are, one, on staffing, and, two, on reporting of incidents. Now, both of those things are down to the management and structure of the day-to-day delivery of the service. It's good to hear from the Cabinet Secretary that a significant number of midwives have been employed by the health board recently, but one can only wonder why such a huge staffing issue had been left to fill for so long. If they were 15 midwives short, why was that situation allowed to happen in the first place? 

And secondly, can he indicate at what level this reporting of incidents on the ward was not getting through the system so that events could be looked at and that each and every case could be looked at? Above all, I would hope—and I think I did hear the Cabinet Secretary correctly—that the review that he has commissioned will be looking at all areas of delivery and won't be stuck in very fixed terms of reference that the Minister might set out, but that the review board will have the ability to look at areas they deem necessary to complete their inquiry, so that we can have confidence that all areas of delivery have been looked into.  

Thank you for those, broadly, three questions. On the first point, I'm not aware that the proposed merger has had any impact on the delivery of services; it's not been a point that's been raised by anybody with concerns that, somehow, that's a factor in the quality of care and in this cluster of cases of concern. The serious incident reporting is what's led to us looking again at the cluster of cases, the number of them, the timeliness of reporting and the learning to be taken from those. There have been internal reviews of each of these, but, to look again to understand that, for this number clustered within the health board, we should take the opportunity to review matters now and not wait for a later point of reference. And that's why I've commissioned the independent review. That's why I've been clear in my statement and announcement today, and I think that the terms of reference will be broad enough for the two royal colleges, if they think it is necessary, to look further, because broadly this cluster of cases happened over a two-year period. If they wish to look back further, then they should have the ability to do so, and I'm certainly not looking to set either a timescale to prevent that or terms of reference to unnecessarily trammel what they would wish to review and look into, to provide us—as I said in answer to Angela Burns, Dawn Bowden and Rhun ap Iorwerth—with the sort of review and the sort of report that they're prepared to put the professional names of the two royal colleges to, to give the public the sort of confidence and reassurance that we would all want and, equally, to provide us with recommendations for further improvement and action, whether that is in this health board or, more broadly, across the whole healthcare system.   

Thank you for your statement, Cabinet Secretary. Are you concerned to know how a maternity service suddenly discovers that it's 15 midwives short? At what point did they find out they were 15 midwives short? A dedicated and hardworking staff, behind whom you will no doubt hide today, must have been sounding the alarm about staff shortages and their consequences for a long time; they mustn't have been listened to. The Cabinet Secretary has said that it's a very difficult time for staff; I'd suggest that's an understatement. There can be nothing more distressing for a healthcare professional to see patients, in particular babies, dying because of institutional failings they are powerless to do anything about. That things work well for the majority of families in Wales is no comfort to bereaved families, and my heart really, really does go out to those families who have been bereaved because of those failings.

However, it does display the typical complacency with which the Cabinet Secretary for health responds to failures in the health service for which he is responsible. Fifteen must be quite a large percentage of the midwifery staff. Can the Cabinet Secretary tell us why Cwm Taf health board thought they could get away with so few midwives before this situation came about? Is the Cabinet Secretary concerned that when he talks about a peer review that this board's peers are also failing to provide good care and outcomes for their patients? This Government has run the NHS into the ground and there is poor delivery in Labour's NHS everywhere you look. Where would the Cabinet Secretary suggest they turn for decent peer reviewing and should we not be concerned that an NHS board trusts its own judgment so little that they're going to ask other trusts for a second opinion? Shouldn't they know what makes a good and safe service and what doesn't?

The report makes mention of what they're going to do—hire a new doctor and a number of other staff—but it doesn't allude to what they think has actually gone wrong so far. So, what exactly led to 43 baby deaths in 2016? I think everybody deserves to know. Does the Cabinet Secretary think that the public forced to use these services should have a bit more of a handle on what has gone wrong so far? If the board believes that the employment of 15 more midwives and an additional mid-range doctor and certain other roles will help solve the problem, they must think they know something about how the problems have been created in the first place. If they can't or won't tell us how this awful situation has arisen, what comfort can we take from their current proposals to try and fix it? The hospital statement only says that they will share their findings of what went wrong with the families involved. Will the Cabinet Secretary now undertake, in the interest of future patient safety, to share all the findings with this place?

Many people say and believe that the NHS is above party politics and there is some merit to that, so I would hope that the Cabinet Secretary would not hide any of the findings to reduce his party's political embarrassment over this matter. Will the Cabinet Secretary give us that assurance? 

The Cabinet Secretary has ordered a review into the health board but we can't take any comfort from the Cabinet Secretary's promises and assurances, can we, because even when this Government takes direct control of a board, as you have with Betsi Cadwaladr, this Government sometimes manages to make things even worse? So, will the Cabinet Secretary tell this Assembly what he will do to ensure that, unlike the cases seen so far, the treatment of patients won't get even worse once his Government gets involved? We heard recently that Betsi Cadwaladr has not learnt lessons from the complaints and multiple reviews into failings there. So, what assurance can pregnant women and healthcare professionals in the service take from the statement made by the Cabinet Secretary today that there will be improvements? Not much, I'd suggest. I'll end my comments there. 

Well, the first part of your question I thought was entirely reasonable, to ask again about staff shortages, and that is part of the review that's been commissioned. The health board themselves have recognised that staff shortages may have had a part to play in the failure to report promptly some of these matters. The point about the independent review is to understand properly and in a robust manner whether there have been any failings in care, and to what extent any failings in care have contributed, whether there are any additional points of learning, whether there have been problems in care or not.

As I say, we use a Birthrate Plus tool and, more broadly, our system is Birthrate Plus compliant and we should be proud of that fact because of the additional investment we have made over a significant period of time in training more midwives. So, these are matters, of course, that are reviewed on a regular basis, as I said both in my statement and in particular in answer to a number of the questions asked by Rhun ap Iorwerth. 

I'm afraid to say that a large part of the comments were exactly what Dawn Bowden called for us not to do in using deliberately over-sensationalised and aggressive attacking language about either politicians or staff within the health board. I am certainly not seeking to hide behind our staff. In taking on the responsibility to commission an independent review, I'm in fact putting myself front and centre, because I will be responsible for making sure that the review is published, together with any recommendations and, of course, any response to that. It is actually an act of taking responsibility rather than hiding from it. 

The review: I appreciate you may not have heard or listened to all of the comments that were made, but the review itself is an independent review by royal colleges. That is the review that is taking place. Individual reports will be shared with individual families, and I would certainly not expect to publish any individual reports; those are matters for families themselves to receive. What we will be able to provide, as I have stated on several occasions before the Member got to her feet, is the report that we can provide and publish together, as I say, with recommendations and a response. But I do think that when you talk about the health board getting away with it, when you talk about babies dying because of institutional failings, you reveal yourself to be somebody who is much more interested in political capital than the real issues we face.

Presiding Officer, can I also record my sympathies to those who have been affected in any way by what will be seen as adverse outcomes that could have been, possibly, prevented? Obviously, the Cabinet Secretary's quite right: we must await further examination of the evidence. I do think that, when an event like this occurs and requires investigation—and this is really as a result of ongoing structural changes in the service that the statistical anomalies were revealed and the recording irregularities—. You know, those themselves are serious issues. I do think that this Chamber has the right to expect, on behalf of the people of Cwm Taf, a very clear assurance. I quote that you have said this afternoon that you have sought assurances from the health board that services are 'safe and compassionate' and that, quote:

'My officials are also monitoring the situation closely and seeking such assurance.'

So, I just want to ask you simply: when will you be able to come back to this Chamber and give us the assurance that you've examined it and now believe the maternity services to be of a safe standard? Because you've not said that this afternoon, and we want to know when you'll be in a position to say it.

Thank you for the comments. Of course, these—. I politely disagree with him about the first point that the structural change is what's highlighted the anomalies. It was actually a new head of midwifery services coming in and doing what she should have done in reviewing the position and looking at the cluster of cases and recognising that those matters needed to be escalated. So, actually, it's a professional leader coming in to do her job and doing her job properly and escalating those concerns. And that has been properly escalated, and we now find ourselves here with a genuinely independent review taking place.

The assurance that I have sought is for every health board in Wales, and I want to be able to come back and to be able to provide a statement to Members about that assurance being provided. I've asked for that within two weeks, but I do think that women and expectant mothers in Cwm Taf should continue to have confidence in the compassion of the care that they receive and in the quality of it, with the additional staff who are arriving. Any woman who is concerned should discuss that with her midwife—any concerns at all, either about the more general points that are raised in the public eye or their individual care. 

And I do have to say that some of the most inspiring people I've met in the health service have been midwives, committed to learning and committed to improving the care that they provide. And we have seen a significant change in midwifery care in the last five to 10 years—a much greater move to having more midwife-led care and to re-normalise that and not have a significant medical intervention as being the norm, and that's actually been better for mothers and babies as a result. But it should of course be the case, as you say, that where we have significant issues of concern, we are prepared to review them, to look at that and to properly learn and apply that learning to further improve services in the future. But I will provide a written note to every Member, and I'll turn it into a written statement so that it's publicly available, about the assurance when we receive them from every single health board in the country.

I'd like to also place on record my sympathies to any families within the Cwm Taf health board area who've been affected by these adverse outcomes. I welcome the fact that, in your statement this afternoon, Cabinet Secretary, it seems that the terms of reference for this inquiry are flexible and can encompass many different strands. I've been involved in one case relating to maternity services in Prince Charles Hospital where I and my office have closely supported the affected family. There, we were told that just one senior midwife was covering both Prince Charles Hospital and the Royal Glamorgan at that time. So, I welcome your comments in response to the questions by Rhun ap Iorwerth that the review will be looking at whether staff shortages are a part of these issues. With patient flows from the bulk of Cynon Valley moving in the direction of Prince Charles Hospital, what reassurances can you give around the continued delivery of maternity services at the site? And that is specifically in relation to this crucial period in the meantime, before the findings of any review are published.

Yes. I'm happy to come in on the two points. The broader point about the quality of midwifery services and maternity services more generally: my understanding is, and the assurance that I've initially had from officials is, that women should continue to have confidence in the quality and compassion of midwifery-led care and broader maternity services within Cwm Taf. I've committed to making sure that—not just within Cwm Taf, but across the whole system—that I am to come back after the two weeks to provide that reassurance to Members more generally, and I'll make sure that that is specifically covered within Cwm Taf as well. What we've managed to do is we have managed to provide additional senior midwifery support. As I've outlined in my statement, that includes, actually, the head of midwifery services in ABMU moving across to help for a limited period of time to provide additional leadership support within Cwm Taf at this time, and that does show our system flexibly working to make sure that neighbouring health boards help each other to provide the right quality in the service. When I do provide the written note that I've indicated I will do for Members, I'll make sure that I'm able to address the broader points Members have raised today about immediate action, immediate impact on staffing numbers, what that's meant in terms of leadership, and the assurance that mothers across the country will want to hear, in addition, of course, to mothers and expected mothers within Cwm Taf. 

Thank you, Cabinet Secretary.