Revamp of maternity and neonatal services at Welsh hospital backed by health chiefs

Twm Owen, Local democracy reporter

A revamp of maternity and neonatal services, which are below national standards, at Gwent’s biggest hospital has been backed by health chiefs.

They heard at present a lack of beds for new mums is contributing to delays at the Grange Hospital, in Cwmbran, and could also be contributing to a spike in caesarean births as pressures on staff means expectant mums can’t always be induced.

The revamp will see a Transitional Care Unit created at the Grange as its neonatal unit is currently the only “level three” unit in Wales without one and beds will reallocated to provide postnatal and post-operative care for maternity patients.

The Aneurin Bevan University Health Board also backed putting in place dedicated neonatal therapies staff at the unit as despite being one of the largest in Wales it currently doesn’t have the specialist workforce.

At present transitional neonatal care that provides extra support beyond normal newborn care so babies can stay with their mums on the postnatal ward, rather than be admitted to the neonatal unit, is described as “ad-hoc” without dedicated funding or a formal structure to support the service.

The Chief Midwifery Officer for Wales highlighted the need for improvement following a visit in November 2023 and an audit, by the board, found four transitional care cots are required to adequately support mothers and newborns who need additional assistance during transition from intensive hospital care to home or lower-dependency settings.

A report for the board’s January meeting stated the changes are intended to bring the unit closer towards national standards. It stated the overhaul is intended to ensure “services are more closely aligned with national standards”.

It will see eight beds on Ward A3 at the Grange currently designated for gynaecology patients repurposed to provide postnatal and post-operative care, expanding maternity services by creating the dedicated area for transitional care and postnatal recovery.

Maternity beds will increase from 40 to 48 and gynaecology beds on the ward reduced from 14 to six while eight beds will remain assigned to general surgery. The loss of gynaecology beds will be offset by other steps that have reduce delays within the hospital.

The creation of the dedicated neonatal therapies staff is intended to fill what the report described as a “notable gap in the support available” at the neonatal unit highlighted as “a significant concern in external reviews.”

Specialists such as dieticians, physiotherapists, occupational therapists, speech and language therapists, and paediatric psychologists will be embedded in the unit as current capacity is described as “insufficient” which is an added risk to neonatal babies and their long term health.

Chief operating officer Leanne Watkins said she recognised she was asking the board to support an investment of just over £1 million at a time its finances are stretched. The board is having to redraw its financial plan after the Welsh Government withdrew approval due to an expected £18m deficit by the end of the financial year.

She said chief executive Nicola Prygodzicz wouldn’t have allowed her to bring it forward the “if it wasn’t absolutely necessary”.

Caesarean section births, within the board’s hospitals, have increased from 27 per cent before the 2020 Covid pandemic to 40 per cent currently, said Ms Watkins and is also contributing to a “significant pressure” in demand for beds and delays at the Grange.

She also stressed the risk of potential failures in maternity services, which are currently subject of a Wales wide review, and reminded members of critical reports into maternity serivice failures in England.

She said: “There is a very high risk of legal claims in maternity cases with an average pay out of £5-10m per case.”

She said the £1.7 billion Welsh risk pool, to cover payments for clinical negligence liabilities in 2024/25, has maternity cases as the majority of its claims, with the figure standing at 165.

Director of nursing, and deputy chief executive, Jennifer Winslade said she had “just agreed” a £23m claim for an “adverse experience” at birth.

She said: “This is one of the highest, if not most high risk, areas and if you do not get it right at birth you damage a baby’s life chances. I have just agreed a case for a £23m claim for an adverse experience at birth.”

She also said potentially some of the increase in caesarean births is due to delays for induced births: “It’s a risk our teams are dealing with every day.”

The board agreed the revamp is a priority for investment though implementation is linked to “affordability” which will be considered as part of the board’s integrated medium term plan for 2026/27 and discussions with the Joint Commissioning Council.

Several board members questioned what services would have to be deprioritised or the board wouldn’t be able to provide if the changes to maternity and neonatal services are backed.

But Professor Helen Sweetland warned if a case was to go to court the board would be challenged on transitional care and said without it: “We would not have a leg to stand on.”

Phil Robson said the board has to make “difficult decisions and prioritise” but said it needed to support the proposal.

He said: “We need to get all our services as right as they can be but I think this one needs to be super right as it’s bringing new life into the world.

“It needs to go forward to the next (decision) round with huge amount of support from the board. If we don’t get this right I don’t know where we’re going?”