Independent review into Maternity and Neonatal services in Swansea Bay announced

Swansea Bay University Health Board (UHB) has today (Tuesday 12 December) announced that it has commissioned an independent review of its maternity and neonatal services in order to maintain public confidence in the care being delivered.

Like many Maternity and Neonatal Services across Wales and the UK, Swansea Bay UHB Maternity Services have been subject to sustained service pressures for which maintaining acceptable midwifery staffing levels have been a significant contributory factor.

In the last five years there have been a number of internal and external reviews of the Health Board’s Maternity Services. 

Despite this, there has been sustained scrutiny of and comment on the services in the public domain and this has caused concern amongst the public and affected the morale of staff.

The Health Board believes an independent review will help address these concerns and maintain confidence in the service, with good practice highlighted and any lessons to be learned clearly identified and actioned.  For that reason, over the last two months, it has been developing a Terms of Reference and has appointed an expert and experienced team of maternity and neonatal clinicians from outside Wales that will deliver the review. 

At the heart of the review will be an in-depth analysis of mortality figures published as part of the MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) report for 2021 as well as their 2022 report that is expected to be published later this month.  Preliminary internal data for 2023 will also be reviewed.

The independent review will be overseen by an Oversight Panel, chaired by an individual who is independent of, and unconnected to, the Health Board. 

The independent Chair will oversee the progress of the review and ensure that appropriate plans are put in place to address its findings, reporting back directly to the main Board of the Health Board. 

Recent users of Swansea Bay’s maternity and neonatal services will be invited to share their experiences as part of the review as will staff within the service.

This announcement comes on the back of significant successful recruitment into the maternity services, with 23 new midwives and 14 new midwifery care assistants (with further cohorts to follow) recruited since October 2023 and now working in the services. 

In 2021 the Health Board alerted the Welsh Government to sustained staffing pressures due to a national shortage of midwives, staff sickness and maternity leave.  These pressures continued throughout 2023 but the recent recruitment drive, backed by an additional £750k investment by the Health Board, has helped relieve that pressure, ensuring that the service has recently reverted to Birthrate Plus compliant staffing levels – an important quality measure. 

As a result, the Health Board last week took the significant and welcomed step of lowering the risk rating for its staffing pressures on its overarching risk register.

The Health Board also announced in October 2023 plans to reinstate its Birthing Centre at Neath Port Talbot Hospital and the community based Home Birth service (both had been suspended in 2021 due to pressures), allowing the Health Board to focus on providing a safe service at Singleton.  The exact timing of the resumption of both services will be subject to due diligence around quality and safety, but, when implemented, the resumption will provide a more appropriate birthing option for low risk mothers, enhance choice and will further relieve pressure on Maternity services at Singleton Hospital.

Commenting on the independent review, Emma Woollett, the Health Board’s Chair said:

“Our maternity and neonatal services have been subject to a number of reviews over the last couple of years, all of which have been positive along with identifying some areas for improvement, especially relating to the consequences of not having enough staff. 

“Our teams of dedicated doctors, midwives, nurses and support staff are all passionate about providing the best possible care for our women and babies but over the last couple of years, there is no doubt that their work has been made more challenging as a result of a UK-wide shortage of midwives and other registered staff. 

“That’s why we believe the time is right for a definitive independent review, overseen by an oversight panel that will be chaired by an individual unconnected to the Health Board.  This will ensure that our services are reviewed thoroughly, in conjunction with service users and our staff, with no stone left unturned, as we seek to cement public confidence in the service and ensure continuous improvement.”

Commenting further, Dr Richard Evans, Interim Chief Executive of the Health Board said:

“While there’s no doubt that our maternity services have experienced significant pressures in recent times due to staffing shortages, we’re confident that our recent large-scale and successful recruitment activity has made a big difference to service users and our hard-working staff.

“That said, there’s no doubt that recent scrutiny of and comment on the services in the public domain has affected confidence levels and that’s a big concern for us and is something that has added to the pressures our teams have faced.  That’s why we’ve invited this experienced, independent review team to access all areas and without fear nor favour, establish the facts.

“And the oversight panel, which will be independently chaired by somebody with no links to the Health Board, will ensure that the review team has all the resources and access it needs to do its job properly.

“We’ll also be working very closely with the Welsh Government in the months ahead, ensuring that they have the assurance they need and making sure that they are able to support us wherever necessary.

Notes to editors:

1. The review team consists of a Consultant Obstetrician, Midwifery Lead, Neonatal Nursing Lead, Neonatologist Lead and an engagement lead
2. The oversight panel will be independently chaired by an individual with no links to the Health Board.  The identity of the Chair will be announced in the New Year. 
3. The review is expected to take 10 months to complete
4. A full copy of the Terms of Reference for the Review will be published on our website.
5. On Friday 15 December, HIW will be publishing their report into an unannounced visit on 5-7 September 2023.  As well as presenting its findings, the report will include the Improvement Plan submitted by the Health Board and accepted by HIW.

Frequently Asked Questions

Q         Why has the Health Board commissioned an external review of its maternity and neonatal services?

A         This review has been commissioned as a result of sustained public scrutiny of and comment on our maternity and neonatal services, much of which has had a detrimental impact on service users and staff

Q         Is this an admission that it is a failing service and that previous external reviews have been wrong?

A         No.  The Health Board has found all of the reviews already completed – both internal and external – to be consistent and helpful and it has diligently applied the learnings.  This review has been commissioned at a time when the service has changed significantly on the back of large scale and successful recruitment activity boosting staffing levels and ensuring compliance with Birthrate Plus staffing standards.  It will, therefore, provide the most up-to-date assessment of the service.

Q         Is the service currently safe?

A         Yes, our assessment is that the service is currently safe.  This is based on the outcomes of the internal and external reviews undertaken to date, none of which pointed to any serious failings that resulted in harm to women or babies.

Q         What is your message to women who might be currently using the services or about to use them?

A         I’m sure that those currently using the service will have already seen for themselves the passion of our staff and will have experienced the outstanding care they provide.  For those who haven’t yet come into our care, I can assure them that they will receive a high standard of care from a service that has overcome many of the staffing challenges it has faced over the last couple of years.

Q         How can you assure the public that the review is truly independent?

A         The review team is an experienced and established independent team that has completed a number of significant reviews of maternity and neonatal services across the UK.  The review team has no links to the Health Board and its work will be overseen by an independently chaired Oversight Panel, providing an added layer of independence to the process. 

Q         Who will chair the Oversight Panel?

A         We will announce who the Chair is in the New Year.  

Q         How long will the review take to complete?

A         Around ten months.

Q         What will happen to the findings – what happens next?

A         The findings of the review will be considered by the Oversight Panel who will then develop an action plan that it will present to the Health Board for implementation. 

Q         Will individual cases be looked at as part of the review?

A         Individual cases will be looked at as part of the review insofar as they either relate to the 2021 and 2022 MBRRACE data, the internal Health Board mortality data for 2023 or they relate to patient experience.

Q         Will the review team be talking to families who have used the service recently?

A         Yes.  A public call out for contributions from recent service users will be made at the outset with individuals given the option of writing to the reviewers or, in some cases, meeting the review team on a one to one basis.

Q        Why has it taken so long to commission this review given that the issues it’s covering date back to 2021?

A        This review follows a number of other reviews, both internal and external, that have been completed since 2021.  However, the publication of the 2021 MBRRACE data in May 2023 and the upcoming publication of the 2022 MBRRACE data later this month, together with our own internal data covering mortality rates in 2023, means that there is a new body of evidence available to be scrutinised and tested.  

Q         Through announcing this review now, are you just pre-empting what could be a very negative HIW inspection report at the end of the week?

A         Not at all.  We are unable to comment on the HIW Inspection Report until we formally receive it and it is published on 15 December.  The report relates to an unannounced visit they undertook between 5-7 September.  The report will include the Improvement Plan we have submitted – an Improvement Plan HIW has evaluated and accepted as providing sufficient assurance.  In addition, a number of immediate improvement actions have already been completed and accepted by HIW.