National review of maternity services in Wales finds services are delivered in a safe and effective way, but some aspects need improvement

The review’s aim is to provide a picture of the quality and safety of maternity services across Wales, and to identify wider learning to improve services for women and their families.

It is important to highlight that this review and its inspection programme was undertaken prior to the COVID-19 pandemic, and publication of this report delayed due to measures we took to reduce the burden of our work on services during the height of the pandemic. As such, the review has not examined in any way how maternity services across Wales have been delivered during the pandemic.

Our review found that the quality of care being provided across Wales is generally good, and the majority of women and families who use maternity services report positive experiences, delivered by a hugely committed and dedicated group of professionals. We believe that maternity services are, in general, delivered in a safe and effective way, and this is supported by almost 3,500 responses to our public survey. The overwhelming majority of respondents were satisfied and positive with the standard of care and support they received along each stage of the maternity pathway, however, we identified some areas requiring improvement.

We found that the level of support, advice and guidance for women and families was positive, and that women receive enough information to make informed decisions about their care. However, some women did not feel they were able to express opinions and concerns about their birth choices, felt ignored, or they did not receive consistent care due to the number of professionals they saw on their pregnancy journey.

The 25 maternity unit inspections (with each report published on our website), were generally satisfactory. However, we consistently found improvements were required around the checking of neonatal resuscitaire and emergency equipment, medical emergency arrangements, security of new-born babies and management of medicines. These issues were addressed immediately following each inspection through our Immediate Assurance process, with the relevant health board providing us with assurance regarding actions taken to address these concerns. 

We found staff to be committed and dedicated, doing their utmost to provide high quality care. However, it was clear from our inspections and survey results that staff were working under pressure, and they felt that there are not enough staff to enable them to do their job properly. 

We did not find any significant concerns regarding the oversight of services within each health board, and found clear organisational structures in place throughout Wales, with clear lines of reporting and accountability. Overall, across our inspections, we saw clear and robust processes for reporting and investigating clinical incidents and concerns. In general, risk assessments and risk registers were completed and maintained, and were updated regularly. However, we did find room for improvement in ensuring that trends, themes and learning arising from incidents are effectively shared with staff. Health boards need to ensure that a positive, clear and transparent reporting culture is present within their maternity services, so that quality of care can be maintained and improved.

Alun Jones, the Interim Chief Executive of Healthcare Inspectorate Wales, said:

Our review has found that the quality of care being provided across Wales is generally good, and the majority of women and families who use maternity services have positive experiences, with care delivered by committed and dedicated staff. Whilst there is room to learn and improve to ensure that that the people’s experience of the maternity pathway is as positive as possible, we believe that maternity services in general are delivered in a safe and effective way in Wales.

I’d like to thank all who have participated in our review so far, including maternity services and health board staff, our stakeholder and advisory panels and the women and their families who shared their invaluable experiences through our national survey.  Those experiences have been central in helping us to complete this review. This emphasises the important contribution that the public can make to our work.