Significant improvement made to maternity services at Prince Charles Hospital in Merthyr Tydfil

It was positive to see that many improvements have been made since our previous inspection in September 2022, with many areas of good practice noted. However, an area of ongoing challenge remains around efforts to improve the culture and morale amongst staff. Significant improvement has been made, but due to immediate patient safety risks identified during the inspection an immediate assurance notice was issued to address the low staffing levels on night shifts, and to ensure that cupboards containing hazardous substances are securely locked. 

Inspectors completed the unannounced inspection of the hospital’s maternity services across three consecutive days in January 2024, focusing on Ward 21, which provides antenatal and postnatal care, as well as induction of labour. Also included in the inspection were the Labour Ward, Day Assessment Unit and the Triage Assessment Area.

It was noted that staff at all levels were working hard to provide a positive experience for women and birthing people. The interactions observed during the inspection were respectful, and professional towards patients and their families. There were adequate facilities and amenities within the unit, and when asked, the majority of the patients told us they were treated with dignity, compassion, and kindness. 

Inspectors saw evidence of patient choices being listened to and actioned, including if these fell outside of national guidance and pathways. These choices were then risk assessed and planned, which inspectors noted as good practice.

There were specialist midwives available at the unit to support patients and their families who needed additional support. Inspectors saw individualised care throughout, including advocacy arrangements in place. When asked, patients told us that although the unit was very busy, staff still tended to their needs in a timely manner. However, when inspectors reviewed patient records, they found pain relief administration was sometimes delayed, which was attributed to the unit’s low staffing levels. 

There were sufficient security measures in place to ensure babies were safe and secure in the unit, alongside effective infection and prevention control measures throughout the wards. Governance of the department was robust, and there were many examples of effective and efficient multidisciplinary team working. The rate of mandatory training compliance for staff was excellent, including bereavement and equality, diversity, and inclusion training. 

Senior managers described a wide range of initiatives that have and continue to take place to support well-being and engagement with staff. However, when asked, staff told us there was a perceived lack of engagement and visibility amongst management within the unit. It was disappointing to find that the comments from staff were similar to the ones made during our previous inspection, including concerns around low staffing levels leading to a negative impact on their personal well-being. 

Chief Executive of Healthcare Inspectorate Wales, Alun Jones said:

‘It was positive to see significant improvement has been made since our previous inspection, with many instances of good practice. However, the health board must ensure there is adequate resourcing on the wards, which could in turn have a positive impact on staff moral and well-being. We will continue to engage with Cwm Taf Morgannwg University Health Board to ensure there is sustained progress against our findings.’

• January 2024 - Hospital Inspection - Maternity Services, Prince Charles Hospital, Merthyr Tydfil