Investigation hears from almost 400 staff and patients about the alarming state of maternity care in Wales’ biggest hospital.
Also uncovered by inspectors was that some Black, Asian, and ethnic minority women felt they were given worse care because of their race.
By Ben Jones. Cover image: Midwives protest in Cardiff, Nov 2021, by Tom Davies
A new report has laid bare the shocking scale of issues at the maternity ward at the University Hospital of Wales in Cardiff, the largest and one of the most critical in the country.
The findings show the devastating effects of cuts to the NHS, through staffing shortages and a chronic lack of basic equipment in maternity services.
In November 2022, an unannounced visit to the hospital’s maternity ward from independent regulator Healthcare Inspectorate Wales revealed a ‘significant’ number of issues, prompting a second inspection in March.
According to the report ‘the volume and seriousness of significant issues’ led to the follow-up inspection due to concerns of low staff morale, patient complaints and staffing levels. The 97 page investigation involved an examination of the maternity department and saw a total of 380 questionnaires completed by patients or their carers, with 207 completed by NHS staff between the two visits in November 2022 and March 2023, respectively.
Despite some improvement noted between the two inspections, the report said that there remained a number of issues that needed addressing.
A common complaint from patients throughout the report were concerns of a lack of staffing, leading to insufficient support.
In October 2022, WalesOnline reported on the experience of a midwife at the University Hospital of Wales in Cardiff saying: “managers and coordinators are then having to beg for staff with most shifts needing covering for ‘any hours’ even just to cover staff breaks or just to ease a bit of pressure. It is soul-destroying if you’re rostered into that shift because you know how bad the situation is before you even start.”
Inspectors also spoke to one woman who felt she was being discriminated against because of her race: “It felt that some of the midwives were treating me in a different way because I’m an immigrant. I have wondered since if my experience with the midwife was due to my race. I’m a Black British African.”
This is especially relevant after recent studies showing that Black women are four times more likely to die during childbirth than white women and that South Asian NHS workers were overexposed to Covid.
Reacting to the report, The Birth Partner Project, a Welsh charity that supports asylum seekers and refugees who face birth alone, said it was “yet another report highlighting racial disparities in maternal and neonatal outcomes.”
“As an organisation that works with displaced women and birthing people from ethnic minorities, we are fully aware of the barriers and discrimination that families face accessing maternity care in Wales.”
During the follow-up inspection in March 2023, it was also reported that three of the four elevators to the ward were out of order. This posed a significant problem to patients who needed emergency transfer to the emergency room or theatre, risking delays.
A longer ‘emergency route’ was described, but would take expectant mothers through the most public areas of the hospital, exchanging speed for dignity. Most worryingly, if the last remaining elevator was to fail, the inspectors were told that there is currently no plan in place to protect the ‘safety and dignity’ of women and babies of the ward. However, the report does note that the hospital has taken enclosed measures in order to improve in this aspect.
In an updated staff questionnaire from March 2023 a staggering 89% of participants disagreed that there are enough staff at the organisation for them to do their jobs properly. Staff testimonials were included in the report, with one midwife saying: “I am genuinely worried about the risk of harm to women and babies with staffing levels as they have been over the last eighteen months.”
“Staff are exhausted and find it hard to work in the current conditions.”
This has been a consistent theme raised by midwives and their union, the Royal College of Midwives in their campaign for better pay in the sector.
As part of a series of spontaneous protests by midwives in November 2021, workers protesting in Cardiff told voice.wales, “I’ve always wanted to be a midwife and the reason I came into midwifery was so that I could care for women and give them the care that they deserved. But it’s difficult to do that when you just haven’t got the staffing or the facilities to do it.”
On an executive level, concerns were also raised in the report regarding a near-constant change in senior management, resulting in delayed salary payouts, broken communication between departments and a lack of internal support when concerns were raised.
Incidents that took place on the ward in this period of time were noted to not have been undertaken ‘in a timely manner’ and saw ‘extended timescales’ due to enormous backlogs.
A section of the report refers to a recent incident of ‘catastrophic harm’ which was not dealt with effectively at the time.
Alun Jones, Chief Executive at Healthcare Inspectorate Wales released the following statement along with the report: “Whilst there were some improvements identified during our return inspection in March, the scale of issues and pace of change was not sufficient and as a result further urgent action was required. I hope this report will accelerate the measures taken to drive forward timely improvements for not only expectant and new mothers but also staff within the maternity unit. We will be working with the health board to ensure robust improvements are made and evidenced.”
Abigail Holmes, Director of Midwifery, said: “The Health Board accepts the findings of the Healthcare Inspectorate Wales report in full and we have taken necessary action to address all immediate concerns outlined.”
“We would like to reassure the community that providing safe, effective and inclusive care to all women and birthing people is always our paramount priority. We remain fully committed to delivering the very best care possible and all findings will be used to make positive improvements.”
The full statement can be found here.
