Improvements made at maternity unit following damning inspection

Richard Youle, local democracy reporter

Significant improvements have been made at the maternity unit at Swansea’s Singleton Hospital but more are needed to ensure mothers consistently receive acceptable care, health inspectors have said.

Healthcare Inspectorate Wales (HIW) had strongly criticised Swansea Bay University Health Board following a visit to the unit last September.

The regulator highlighted “significant patient safety concerns” and said the health board had failed to ensure safe staffing levels for four years. It added that fewer than half the staff surveyed said they would be happy if their own family members received the same care. In response the health board developed an improvement plan and invested hundreds of thousands of pounds in new midwives and maternity care assistants.

Challenges

In April 2024 HIW turned up again at the maternity unit for a follow-up inspection and assessed wards, units and theatres within it. Its new report said: “We found the health board has made significant improvements to the service since our last inspection, but challenges remain.

“Staffing has improved since our last inspection, however, many staff we spoke to confirmed there were still issues in having sufficient skill mix to match the acuity of patients.” Some of the required improvements, it said, still remained from the previous inspection.

The report said the experience of mothers-to-be and mothers was positive, although a high number of agency staff was noted by one parent.

Inspectors, however, sought immediate assurances about five matters including staffing levels and processes at the antenatal assessment unit (AAU). Staff at the AAU told the regulator that levels of qualified midwifery staff were low, that assessments of mums-to-be were delayed, and that they lacked confidence that improvements would happen.

Some midwifery staff said they didn’t always have access to essential medical equipment more generally at the maternity unit. A total of 62 staff responded to an HIW survey, with 41 saying they were satisfied with the quality of care and support they gave to patients but only 32 agreeing that they would be happy with the standard of care provided for themselves or for friends and family.

Missed breaks

Several staff said they often missed breaks because the unit was so busy, with one saying “we are regularly understaffed to a dangerous level”. Another employee largely agreed but said there was “incredible staff morale” and that coordinators always tried to ensure breaks where possible. Another staff member said: “Staffing is always at the top of supervision discussions and this needs to change.”

HIW noted improvements to the leadership structure but said some positions were still on an interim basis. The health board, it said, must monitor and improve levels and the skills mix of staff throughout the maternity unit. However, it also said that at the time of the inspection staffing levels for midwifery and medical staff were appropriate.

In response to the latest HIW report the health board said: “We are fully committed to continuously improving our maternity and neonatal services, and this latest HIW report recognises the ‘significant improvements’ already made, particularly around staffing and service leadership.

“However we acknowledge there is still more to be done, and are taking firm action to complete all the outstanding recommendations.” The health board also said that according to UK-wide mortality rate data its maternity and neonatal mortality rate was lower than similar units.

Staffing concerns

Staffing concerns at the maternity unit aren’t a new issue. When HIW inspected in 2019, staff said they felt levels had been reduced some time, that they often worked extra hours to cover shortages and found it difficult to take breaks. However, health bodies everywhere have faced challenges recruiting sufficient maternity staff. Despite this, Swansea Bay University Health Board has recruited 26 additional midwives since last September.

Meanwhile, health board members learned at a meeting last week that 140 recommendations from HIW’s September 2023 inspection had been acted on, leaving 19 to be completed. A report by the chief executive, Dr Richard Evans, also said that work on a long-awaited reopening of the Neath Port Talbot Hospital birth centre and home birth service continued, with a formal proposal to come before the board as soon as possible.

Separately, an independent panel is overseeing a review of Swansea Bay’s maternity and neonatal services. Last month its chairwoman, Margaret Bowron KC, stepped down reportedly following families’ calls for her resignation. She has been replaced on an interim basis by Dr Denise Chaffer, an experienced midwife and existing panel member.