Part of the debate – in the Senedd at 3:46 pm on 30 April 2019.
Thank you, Deputy Presiding Officer. I have today published the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives report, following their review of maternity services at the former Cwm Taf university health board. This is accompanied by a further report, which provides accounts from the women and families who have used these services. Members will now have had an initial opportunity to consider the reports, and my written statement issued this morning.
I want to start by reiterating my apology to all the women and families affected by the failings and poor care described in the royal colleges' report. There is no doubt that the service provided to many women and their families fell well below the standard that I or anyone else would and should expect from our national health service. I do, though, want to thank the women and their families who shared their experiences to inform the review. I can't begin to fully understand the impact for those who have experienced unsafe or uncaring practice. Like most parents across Wales, our family's experience of maternity services was a positive one—one that every parent has a right to expect. The failings described in the report have no place within our NHS. I'm determined to ensure that this report is a catalyst for immediate and sustained improvement.
I commissioned the independent review of both royal colleges in October last year, after concerns relating to the under-reporting of serious incidents were brought to the attention of the Government. The reviewers have spoken with families and staff, and considered the information provided to them by the health board in forming their conclusions. My officials received the final reports on 16 April.
The report describes a number of serious concerns and there is a clear call for action. It highlights failings in governance, data accuracy, serious incident reporting, leadership and culture. The review makes clear that this has had an impact on pregnancy outcomes. The accounts from women and their families provide a deeply upsetting insight into how these failings have impacted on their experiences of pregnancy and childbirth. The report also acknowledges the extreme pressure that some of our staff have been working under. There are also significant concerns and questions about the effectiveness of the wider board leadership and governance.
In my statement this morning, I set out the steps that the Welsh Government is taking, and I'll now take this opportunity to confirm those measures for Assembly Members. As part of this response, I have placed maternity services at the former Cwm Taf university health board into special measures.
It was incredibly distressing for me to read that women and families did not feel that they were taken seriously when voicing their concerns and worries. Whilst within the report there was feedback that reflected individual good practice, overwhelmingly those who contributed spoke about distressing experiences and poor care. This morning, my officials have met with some of the women and their families affected to discuss the report, and to seek their continued engagement to improve the service. It is vital that their voices continue to be heard, and I again want to extend my thanks to them for the courage and resilience they have shown in telling their stories.