The next item is a statement by the Minister for Health and Social Services on maternity services and governance improvements at Cwm Taf Morgannwg University Health Board. I call on the health Minister to make his statement—Vaughan Gething.

Thank you, Llywydd. I wanted to take the opportunity today to update Members on the progress in improving maternity services and wider quality governance arrangements at Cwm Taf Morgannwg University Health Board. I thought it particularly important that I assure everyone that, while we necessarily have to pay so much attention to managing the unfinished COVID pandemic, we have also retained a focus in important areas such as this one. I especially wanted to reassure women and families affected that this is the case, and that the actions that I put in train last year to secure the required and sustained improvements in maternity services have continued over this difficult period.

On 28 September, I published the fourth update report from the independent maternity services oversight panel. The panel has continued to play an essential role in providing the necessary external assurance that sustainable improvements are being made in a timely and transparent manner. I was therefore very encouraged to see the panel confirm that further progress has been achieved over the past six months, and in particular their assessment that the health board has done remarkably well to sustain momentum against the background of COVID-19. I do not underestimate what an achievement this has been, and I want to thank all the staff involved in doing so.

I accept and recognise that the panel’s assurance process has had some constraints, as they themselves have pointed out, whilst the COVID restrictions remain in place—notably their being being unable to have face-to-face contact with women and families as well as staff to hear first-hand from them about their experiences. The panel will be revisiting key areas once restrictions can be relaxed to ensure that the changes are embedded and sustainable. 

Clearly, some other aspects of improvement have also had to be put on hold during this time, such as leadership and cultural development programmes. These will need to be resumed at the earliest possible opportunity, but clearly, given the current pressures, we have to be realistic about when that might be. It is also unfortunate that the Tirion birth centre at the Royal Glamorgan had to close temporarily due to staffing constraints during the initial COVID peak. Sadly, plans to reopen the centre last week have had to be further delayed given the current outbreak. However, the health board will be keeping this under regular review and are determined to reopen the centre as soon as it is safe to do so.

Today I also wanted to update Members on the progress with the clinical review programme. This currently involves the review of care provided to women and babies in three defined categories from January 2016 to September 2018. This includes the care of women, particularly those who needed an admission to intensive care, babies who were sadly stillborn or died in the neonatal period, as well as other aspects of neonatal care. There are now around 160 cases undergoing a review, with the number having increased largely due to self-referrals from women requesting a review of their care. My commitment to women to have their care reviewed if they have a concern remains, and there is a well-established process in place for considering such self-referral requests.

The clinical review programme is therefore extensive and the work has continued without any delay during the COVID outbreak. That in itself is a testament to the commitment of all involved. The panel is near to concluding the maternity category of reviews, and in the coming weeks will be writing to the women affected to share their findings with them. Following this, they will then produce a thematic analysis of their findings and recommendations, with the aim of doing so by the end of this calendar year. Once I receive it, I will of course publish it, as with all panel reports.

The panel has emphasised the need for the health board to ensure that the necessary mechanisms are in place to support women, families and staff as the findings from the clinical reviews begin to emerge. I also want to thank those women and families involved for their patience and understanding as the work continues to progress. I can appreciate that it must be difficult waiting for the outcome of the review and the anxiety this may generate. It is important that this process is expert, thorough and centred on the experiences of those people using the services. Unfortunately, this does mean that it will take some time for all women and families to receive their individual feedback.

The health board has continued to make progress with its wider quality and governance arrangements as part of the targeted intervention requirements. They have implemented a new clinically led, locality-based operating model. I am pleased to see that later this week they will be launching their new values and behaviours framework. That follows extensive engagement with staff, patients and stakeholders.

These are important steps in demonstrating that they are a truly quality driven, open and learning organisation. The open and transparent way in which they have responded to the current and serious COVID outbreak at the Royal Glamorgan Hospital is a further example of this. I do not think any of us will underestimate the impact that this has had on our staff, or their commitment to doing their very best for the communities they serve.

I also understand that Healthcare Inspectorate Wales and Audit Wales will be undertaking follow-up work in the coming months to assess progress against the recommendations that they made in the quality governance review last year. This will be an important piece of work to provide us with external assurance about the extent of the progress that is being made.

There is clearly still significant work to be done. I am, though, optimistic that progress will continue to be made, particularly given the commitment that the health board and its staff have demonstrated, against the background of the exceptionally challenging times that we are all living through. Thank you, Llywydd. 

Thank you, Minister, for your statement, and how appropriate it is that this statement's being taken this week, given that it is national Baby Loss Awareness Week, as was described and touched on in the business statement and, I believe, some questions that the First Minister took as well. I'm also pleased to see the progress that is being made by the review panel and I'm grateful for the briefing that Members were able to receive some two weeks ago now with that panel. 

If I could ask a series of questions of the Minister in relation to his statement: he touched on, obviously, the current outbreak at the Royal Glamorgan Hospital of COVID-19, but also the other two hospitals that are in the Cwm Taf health board area are affected by outbreaks. I'd be grateful to understand whether maternity services have been affected at all, and are expectant mothers and families receiving a different level of service because of these outbreaks, because special restrictions have been put in place for other services at the hospitals? So, if you could clarify that. I'd also like to understand, when he touched on the staffing constraints at the birthing centre because of the earlier actions that were taken because of the COVID outbreak—can he give an assurance that those staffing constraints are now no longer in place and, once normal circumstances resume, there's no reason why the birthing centre couldn't fulfil its full role in supporting expectant mothers?

I'd also like to understand as well, if possible, please, what level of support he understands the health board are putting in place for families that have been affected by this terrible episode in maternity care in the Cwm Taf area, along with the support for staff, in particular when it comes around to, obviously, the maternal category reviews, which he highlighted would be made available before Christmas. It is vital that, obviously, the families, as well as the staff, are supported when those reviews come out and some of their conclusions become public.

Likewise, when he talks of the clinical review starting to emerge—and I fully understand, obviously, the current situation and that there will be delays in some of this information coming forward, but could he elaborate more on how long he thinks the feedback process might take? He did say it will take a little longer than desirable in his statement, but I think if he could clarify the length of time that we're working to, certainly from a Member of the Senedd's perspective who represents this area, it would be helpful when engaging with constituents if we could understand the length of time that he envisages or the review panel envisage.

And, finally, when it comes to maternity services more generally across Wales, can he give an assurance that the issues were in the Cwm Taf area—and I know that he's given this assurance previously, but obviously some time has now elapsed—can he give us the assurance that maternity services in other parts of Wales are not suffering the same dilemma that Cwm Taf found itself in, which was a lack of governance, a lack of oversight that led to such tragic consequences for many expectant families on what should have been one of the most joyful occasions that anyone should experience in their lives? Thank you, Presiding Officer. 

Thank you for the questions. In terms of the broad picture of maternity services across Wales, the regular assurance that the chief nurse's department undertakes in terms of midwifery services demonstrates that concerns are being dealt with across the service appropriately, and that maternity services are safe. And I hope that's helpful in terms of providing that assurance from the regular engagement that we receive through the chief nursing officer with midwifery services. 

In terms of the time for clinical audit reviews, I can't and I won't give a definitive time period, because part of the challenge, as I said in my statement, is that we've seen an increase and expected about 140 reviews up to 160 to be reviewed, and it is possible that more women and their families will come forward. And I think it would be unhelpful for me to set what would inevitably be seen as a target for those reviews to end, when actually the most important thing is for the reviews to be concluded. We'll learn more as we go through this first stage of the three categories and, as I say, I was able to say today that that first category should report by the end of this calendar year. But my experience is that, once you start to set time frames for work that should be led by the evidence, and should be led by taking proper account and a person-centred way, then the time pressure itself leads to a very unhelpful impact for families and for staff. 

That goes back to the point about support for families, which I'm glad you've raised, because we do have a dedicated helpline. We have also been able to have some support from Sands who, as you know, are a charity dealing with baby loss, and that support is for families who will need to be supported. For many families, unfortunately, whilst they are on the one hand looking forward to receiving an independent review of the care that they and their families have received—and it's important to recognise that not every family in the 160 reviews had lost a child—in understanding that, for many of them, they will be reliving difficult experiences. So, it is important for them to be supported, and that's why we do have that specific support in place. 

We'll also need to support staff who, again, will find this a potentially difficult period of time. And as you'll recall from previous reports, there has been intervention by the health board in looking again at the workplace cultures, and an understanding of how some of the behaviours that were set out in very difficult detail in the first report of the panel, and how those have been addressed and moved on in a positive manner.

You asked a question about the impacts on maternity services with COVID and, in particular, in this health board with activity, bearing in mind that there are a number of hospital-acquired infections and also COVID that's come in from the community. In the Royal Glamorgan Hospital, the Tirion centre is still closed, as I said in my statement, so I don't expect that midwifery-led unit to be opening until it is safe to do so. It was due to open in early October and, as I say, it will be open when it's safe to do so. Maternity services on the other two sites are continuing and, of course, the community midwifery team continues to provide care within communities for women and their families.

So, that's the current position, but if any of that picture changes, then either myself or the health board will make that clear to the public and, indeed, all Senedd Members who represent this part of Wales. 

Leanne Wood. Leanne Wood seems to have lost the connection. Can you confirm that you're there, Leanne Wood? I know you've had problems. 

I'm here. 

Okay. Carry on. 

Okay. Diolch, Llywydd. Minister, this update will be welcomed by the women who raised concerns all those years ago, and who were patronised at that time and ignored. Now, I'm pleased that the review panel has concluded that improvements have been made to maternity services, but there will be understandable concern in the community about whether lessons have been learned. There will, of course, be questions about whether the current COVID outbreak that has claimed the lives of many people in the Royal Glamorgan Hospital could have been prevented, and whether infection control procedures have been as good as they should have been. I know that the Minister in his statement said that the board has been honest about this and that this is a sign of progress, and I wonder if that implies that the previous board may not have been honest. But can the Minister today give us an assurance that there will, in the future, be an investigation into this outbreak and give us assurances that the board and the Welsh Government will be fully open and transparent here, because, of course, that will be vital in ensuring that the community has confidence in local services?

The Minister's statement also praises the board for making improvements against the backdrop of COVID. It is, of course, the case that the staff in our NHS need to be thanked every day for the unprecedented work that has gone on this past year. But I do fear that the Minister has omitted another significant pressure that staff in the Royal Glamorgan Hospital have had to deal with, and that has been the uncertainty over its future role and question marks over the services there. It has been an entirely unnecessary distraction. So, can the Minister confirm today that staff will not have this distraction placed over their heads again in the future, and that accident and emergency services will be part of the Royal Glamorgan in the future post pandemic?

Moving on to other staffing issues, we know that the birthing unit has had staffing problems and is now under temporary closure. So, can the Minister commit to increasing staff so that the unit has more resilience through the winter?

Finally, I wanted to ask a more general question about maternity services that will be of wider interest, and that is relating to the general rules about access to maternity, birthing and neonatal services during this pandemic. We know that the ban on visitors to accompany women to appointments and scans or when in hospital, sometimes necessarily, has harmed those women. So, will you commit to a review of the rules and consider measures that can enable both parents to participate in all aspects of the pregnancy and birth, and the conditions that need to be put in place in order that everyone can do that safely?

Thank you for the variety of questions. I hope that this update is welcomed by women who were previously ignored and did not have their concerns taken seriously. I ordered the independent review by the joint royal colleges on the basis that there was plainly a problem that had not been resolved and could not be satisfactorily resolved if the health board themselves were commissioning a review, because I do not think that would have commanded the confidence of the public, which is essential.

In terms of the concern about if lessons are really being learned, that's exactly why we have an independent panel and an independent assurance process. So, it is not simply the health board marking their own homework. That self-assessment is the sign of a mature and confident organisation that is doing the right thing. But we still need to build confidence and need to have independent oversight, so the work of the independent panel is certainly not completed, and I recognise that in both my written statement and in my statement to the Senedd Chamber today.

Now, in terms of the issues around the Tirion Birth Centre, and the ability to recruit staff to it—it will be re-established on the basis of Birthrate Plus, which is a recognised workforce tool, to make sure it does have adequate staff and it does have sustainability built in to be able to operate safely and to the standard that I would want for any woman going to give birth in any part of Wales. And in committing to establish to Birthrate Plus, that's a national commitment that we have been proud to make in the past, and we have actually done relatively well in terms of recruiting people into the Cwm Taf Morgannwg health board. There was some concern that we would struggle to recruit because of the challenge given the problems in maternity services that led to this report and to the need to have an independent improvement process. And, again, I think it's one of the positive aspects of the panel's oversight. They recognise that progress is being made and it's actually helped them to change the culture positively within units where the recruitment is taking place.

Now, on your point about the learning from the outbreak, I don't think that there is any link to draw between practices identified in this report and the outbreak itself. There will undoubtedly be learning, and, in fact, the chief medical officer has already asked for a lessons learned report to be shared here about the outbreak in the Royal Glamorgan, about the two smaller outbreaks at present in the Prince Charles and Princess of Wales hospitals, and to look back about learning from Wrexham Maelor earlier in the year. But, given the risks that exist with a rising tide of COVID that we will see community transmission coming into a range of our hospitals, I'm afraid that, given the increasing levels of COVID in the community, it is inevitable that we'll see more people testing positive in our hospitals as opposed to those people who are being admitted with confirmed or suspected COVID as well.

In terms of the guidance that we've given to the health service on partners being able to accompany women at various stages in their pregnancy journey, then we've actually recently republicised guidance that's been endorsed by the chief nurse and also a number of the royal colleges. So, I'll make sure that is reprovided to Members so that we can be clear again about the guidance that is in place, because there is no blanket ban on partners accompanying women at various stages of pregnancy, or indeed in the after support, with home visits by midwives in the very, very early days post birth, and indeed health visitors thereafter. There are some challenges in the estate that we have, where there's a challenge about social distancing, and that needs to be worked through between the hospital providing care and, indeed, the woman and her family, but we do have, I think, a pretty clear position that I'll happily remake available to Members.

On your point about the future of emergency medicine, you started off by saying that you were concerned about women who had been previously ignored and had their needs rolled into other issues. I don't think it sits very well for a significant and important statement on maternity services and the improvements made and the improvements still required to try to link in a wholly unrelated area. The questions about emergency medicine have been resolved by the health board because of the successful recruitment that has been made, and I just don't think it's appropriate or does the women that we're supposed to be talking about today any favours to try to relive long-finished arguments.

Thank you for the update, Minister. Firstly, can I thank the oversight panel for their continuing work over recent months and note that the review says that the health board have kept to their commitment to review maternity services in Cwm Taf, and that is to be welcomed? Like you, I'd like to thank all of those involved in delivering those improvements. Secondly, to place on record again my sincere condolences to all those who suffered loss and to sympathise with those who had an experience during their pregnancy and birth that fell well below that which we would expect our NHS to deliver.

Minister, the women, families and others affected by the identified failings are shortly to enter a very difficult phase, when they receive the outcomes of their case reviews and of their experience, and that may well be the most difficult period that they have had to face to date. So, you will understand that my question at this stage is entirely focused on them. And you have talked about support for the families in your statement, but can you please assure me that, as far as possible, any support arrangements that are put in place will be in line with the wishes of the families, the women and the families, and that, given that all the experiences will have been different, the support available to them will be tailored to the needs of each individual involved in these reviews? 

Yes, thank you for the question, and I'm very happy to reiterate that we do need to provide support to women and their families. It will be, as I say, a very difficult experience, and it's not one that I can say that I understand, because I haven't lived through that experience, and it's important to understand that it will be different for different people. People who have suffered loss will experience that differently, people who have suffered poor care will experience that differently, and it's important to understand their individual circumstances in providing them with support. I can honestly say that in my direct interaction with families on previous occasions—I know you were able to attend some of the events that were held—there's been a real variety of experience, where some people attended but didn't want to talk to anybody, were visibly upset but couldn't speak to people; others who appreciated the fact that panel members were there, that I was there; and other people who were still incredibly angry and upset. And that variety of emotions is one that we can expect to see again when the reviews are published. But it is a necessary part of improvement to honestly provide the reports of the independent panel. And as I say, we've got support from a range of groups, including the local Snowdrop group, including Sands, and including the local committee health council as well, and all of the different things that they're able to do in terms of supporting people, and the direct advice line and the contact route that families have to the panel are there to make sure that we understand and we can actually respond to the individual needs of families. Because, as I say, I don't underestimate how difficult the experience will be, but, speaking honestly, it won't be an experience that I can understand or share with them, because I am fortunate not to have had the same experience as them with our maternity services here in Wales.

Minister, firstly, let me thank you for the statement and for the work that's going on, and I think we must all—and I think it's implicit in what everyone has had—recognise the important role that all our NHS staff in these hospitals in Cwm Taf are actually undertaking in the most difficult circumstances, month after month, and I think we still welcome very much what their contribution is to us all.

Many of the things I wanted to ask have been answered, but, with regard to the issue of family support, just the issue as to how that is going to be evaluated. The second thing I'd like to ask about is in respect of the community: as you know, there is a tremendous community spirit of support for the hospitals in the Rhondda Cynon Taf and in the Merthyr area, and that was witnessed recently. But how do we reassure and rebuild confidence? Because all the right building blocks are in place, all the right steps are being taken; pre-COVID, I was able to visit the hospital, and to see for myself the progress, the steps, the new initiatives, the new leadership that was under way, but there is still an area where we have to convince the community and to reassure them that that progress is genuine and that it's long lasting, et cetera.

And then, finally, can you just update us on the steps that have actually been taken now in terms of communicating the situation with the Tirion birth centre at the Royal Glamorgan Hospital, which is in my constituency, and how that is being communicated to those families that would need to traditionally access that service? Thank you, Minister.

I'll deal with the last point first. So, every woman should have a community midwife who can give them direct access to support and guidance for their pregnancy, if they would otherwise have been giving birth in the Tirion birth centre, to explain to them the variety of alternatives that are available. And that's potentially not just within the health board, because I do know that Cwm Taf Morgannwg in particular have been working with Cardiff and Vale to make sure that they can support each other, given the outbreak in the Royal Glamorgan and given the impact that the inability to fully staff and safely staff the Tirion birth centre has actually put back the opening of that midwife-led unit.

In terms of your two other points, on support, every health board has a lead for both bereavement support, but more generally support in any event, and we are looking for every health board—including Cwm Taf—to have support in line with both the National Institute for Health and Care Excellence guidance, and the bereavement midwives in Cwm Taf will have had contact with a range of people around the family. Some of this is actually about going through historic issues, though, as opposed to the more usual experience of support nearer the time of bereavement, and that's why we've engaged with a range of external partners to offer that support. But any family who is concerned, upon receiving their report, or even in advance of receiving their report—all families have direct contact lines to go into the panel itself and to ask for that support, and they also have had the opportunity to have contact with the community health counsellor, who, to be fair, I think have done a good job in supporting women and their families to understand the options open to them and to support them, and again to understand what matters to them and to support them in finding that appropriate support and route forward.

On your point about community confidence that improvement is being made, that is a substantial part of the reason we're having this independent panel process: to openly and transparently set out what progress is being made, not by people who are employed by the health board, but people who have been engaged directly by the Welsh Government who don't provide a service in Wales. And part of that is the really important direct engaging of one of the panel members and a group of women in terms of re-understanding how maternity services should work and be improved within the area. So, there's a direct link, there's access and understanding, and it's about being very open and transparent. So, with all of the reports that we've had with the quarterly improvement reports, I've made sure that families receive that report first, before it goes into the public domain, so families do not read in the news what the reports say, and we've arranged previously direct access in terms of the opportunity to have a question and answer with panel members when the reports have been published. So, we're making sure that there are direct links and routes for those families, and indeed the wider communities they live in. And we need to continue that approach, as we hope that Cwm Taf will continue, in its new form as Cwm Taf Morgannwg, on this improvement journey to deliver the high-quality services that I want for my constituents, and I believe that every part of Wales should be able to enjoy as well.

There are many really positive findings in your panel's progress report that maternity services have weathered the worst of COVID-19 and a senior team at the university health board are maintaining their high level of commitment. And of course, I welcome those very much on behalf of my constituents. In terms of looking to the future and making sure that maternity services are of the highest possible standard for all of our families, the 'make safe' actions contained in the report are key. And I note that issues around the long-term cultural change are still outstanding, as is work around strengthening leadership. So, Minister, would you be able to say any more on these matters, as they constituted some of the most distressing parts of the original complaints?

I think that's very important, because I said in my statement that some elements of that had to be paused, but they're really important in terms of giving that reassurance that other Members have looked for as well. And part of this—if we're going to have an honest assessment of it, we can't simply say that, six months in, or 12 months in, we can tick it off the list. Because, actually, the long-term cultural change and the embedding of high-quality and compassionate leadership, both for staff and for the public that they serve, is not something that I think you can set that sort of timeframe on. It's one of the things where you know if it's there and you also know if it isn't there as well, and to know that the change is being sustained as well.

So, we will look to have a range of different methods. That's why it's important for the panel to be able to have conversations with women and families using the services now in a form—they'll be able to do so face to face when conditions allow, when it's safe to do so, but also have interaction with staff and their representatives. I think it's very important that trade union representatives representing staff are able to interact with the panel to set out honestly their view on the service as it is now and the progress that's being made. I do think it's fair to say that the executive director of nursing and midwifery, Greg Dix, has made a difference, and he is seen as someone who's come in after events, and so is seen in a role of being an honest leader without a tie to the past—that's been very helpful, I think. But it's important to make sure that, as we go through this improvement process, we don't try to rush and want to be able to tick off all of the issues that are a concern. We have a much more sustained answer for improvement. Because the idea is that we, at the end of this process, have a service that is high quality, self-sustaining and people have confidence in, rather than we've led to—we've worked to an artificial deadline that might suit a politician like myself, rather than, actually, the staff working in the service and the women and their families who rely upon it.

Thank you, Minister.

The next items are items 7 and 8, the regulations under those two items. And in accordance with Standing Order 12.24, unless a Member objects, the two motions under items 7 and 8, the health protection coronavirus Wales amendment regulations, will be grouped for debate, but with votes taken separately. If there is no objection to that grouping, we will move on.