There is "serious concern" that black, Asian, and ethnic minority women are being treated differently at Wales' largest hospital. A report released on Wednesday said the maternity department at the University Hospital of Wales in Cardiff needs "urgent improvement" after a number of issues relating to patient safety and staff morale were identified by inspectors.
One of the concerns identified by inspectors from Healthcare Inspectorate Wales was the feeling from some black, Asian, and ethnic minority women that they were being treated differently. Inspectors said this was of "serious concern" and the health board have since implemented a number of initiatives to improve their experience. The report said it is vital these improvements are sustained.
The report was released following an expectation which was carried out in March 2023,after an unannounced inspection in November 2022 identified a number of concerns around patient safety. The report said while some improvements had been made in the several months between the two visits there were still a number of issues that needed addressing. However the report commended how hard staff worked in the conditions that they were in, adding that staff members went "above and beyond" to ensure their patients were well cared for.
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During their inspection in November 2022 inspectors issued patient surveys to women on the ward. Inspectors spoke to one black woman on the ward who said she felt she was not listened to or provided with the same level of information or care as other patients. She told inspectors this had negatively affected their experience.
A patient survey issued by inspectors also received responses of a similar nature. One person's experience said: "It felt that some of the midwives were treating me in a different way because I’m an immigrant." Another said: "I have wondered since if my experience with the midwife….. was due to my race. I’m a Black British African.” Since the November 2022 inspection immediate improvements relating to this issue were needed. Staff have received equality and diversity training.
The issues raised with inspectors are particularly concerning due to the increased mortality rates black pregnant women face while compared with white pregnant women. According to the Royal College of Midwives black pregnant women are five times more likely, and Asian women twice as likely, to die during pregnancy and childbirth than white women.
A House of Commons committee report published in April 2023 found that "microaggressions" were a factor in the care that some black pregnant women received such as "black women having a lower pain threshold" and that some women were often viewed as "not like me".
Other issues identified in the inspections include:
- a period of low staff levels leading to low staff morale as they work extremely hard to meet patient needs in a challenging staffing environment;
- patients raised concerns about staff availability and sufficient support which was affecting the ability of staff to protect dignity and privacy of patients;
general infection prevention and control measures were not sufficiently robust in all areas;
medicine not being stored securely, a visibly dirty theatre and treatment areas, the availability of life-saving equipment, insufficient plans in place to protect the safety and dignity of patients, and insufficient management and security of confidential patient information, and;
lack of effective support for staff on the midwife unit.
Problems were also identified with the relationship between staff on the maternity unit and management and leaders. Midwifery staff gave positive feedback about their immediate line managers but inspectors found the wider leadership and governance arrangements were not having a sufficiently effective or supportive impact on the maternity unit. Some improvements were identified in the follow-up inspection in March.
Healthcare Inspectorate Wales chief executive Alun Jones said: "Our work has highlighted significant challenges within the maternity services at Cardiff and Vale University health board. 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 Children and Women Clinical Board, along with our Executive team, have implemented and embedded a number of initiatives and strategies to ensure the care we provide is as effective and compassionate as possible. As a learning organisation, we are fully receptive to any areas for improvement and will continue to build on the progress made so far.
“We would like to thank all patients and colleagues who engaged with HIW inspectors and reassure them that their voices have been heard. We are acutely aware that colleagues work tirelessly in often challenging environments and appreciate the valiant effort they make every day to ensure our patients are well cared for. The NHS faces a sustained shortage of nursing and midwifery staff nationally and we have on occasion made the difficult decision to temporarily suspend some services which has affected patient choice to ensure safe staffing levels are maintained on the main delivery unit.
“To mitigate these challenges, we have invested more than £2 million to improve recruitment and resources across maternity services within Cardiff and the Vale of Glamorgan. Our senior leadership team is also continuing to work with colleagues to find collaborative initiatives to enhance the way we work and ensure all colleagues feel supported, listened to and equipped to deliver the very best care to patients.
“It is reassuring that the report reflects colleagues’ dedication and passion, and we are pleased to hear that all patients who spoke with HIW at the follow up inspection had high praise for colleagues and felt cared for and listened to. We are also pleased the report highlighted a number of areas of good practice, including our ELAN team of midwives who look after women and birthing people with complex, social needs, our multidisciplinary approach to working, and the regular governance meetings introduced to foster a supportive culture and promote accountability and safe care.
“As a Health Board, we place the highest priority on cleanliness and hygiene and we are disappointed that on occasion, some areas have not met our high standards. Following the inspections, we took immediate action to resolve this and have developed a robust action plan to ensure these levels are maintained. Whilst we experience challenges with the aged infrastructure at the University Hospital of Wales, we would like to reassure our patients and the wider community that we are working hard to identify ways of mitigating these challenges and ensure we are equipped to deliver modern healthcare in a modern environment.”
If you would like to share your experience of maternity care at any of Wales' hospitals you can get in touch with our health editor at lydia.stephens@walesonline.co.uk.
