Changes to maternity and neonatal services in West Wales are safe, Royal College review finds

Changes to maternity and neonatal services in West Wales are safe, sustainable in the long-term and have led to improved outcomes for mothers and babies, a review by the Royal College of Paediatrics and Child Health has concluded.

In April 2013, Hywel Dda University Health Board’s proposals to reconfigure maternity and neonatal services in West Wales were referred to the Welsh Government by the local community health council for formal determination.

In January 2014, following advice from an independent expert panel, the Minister for Health and Social Services Mark Drakeford confirmed they would be concentrated at Glangwili Hospital, in Carmarthen, where a new local neonatal unit would be created; consultant-led maternity services were also concentrated at Glangwili Hospital and a new midwife-led unit was set up at Withybush Hospital, in Haverfordwest.

As part of the changes, which were introduced in August 2014, the Minister required that a set of robust safety net measures were put in place at Withybush Hospital while the midwife-led unit was being fully established. These included a dedicated ambulance vehicle and crew for emergency transfers to Glangwili Hospital for pregnant women and new-born babies and on-call consultant cover for obstetric and gynaecology emergencies out of hours.

Hywel Dda University Health Board made further changes to inpatient paediatric services at Withybush and Glangwili hospitals in October 2014.

The Royal College of Paediatrics and Child Health (RCPCH) was commissioned to evaluate the changes in June 2015. A review team, made up of representatives from the RCPCH, the Royal College of Obstetricians and Gynaecologists, the Royal College of Anaesthetists, the Royal College of Midwives and the Royal College of Nursing, reviewed the services, including extensive engagement with staff, the public and people who have used the services over the last 18 months.

The review concluded there is no evidence of any harm to patients as a result of the changes and that they are sustainable in the long term. It found the new services are safe; they are providing improved outcomes for mothers and babies; there is better compliance with professional standards and more women are being cared for in the Hywel Dda area than under the previous arrangements.

It concludes there would be no clinical sense in reversing the major decisions of reconfiguration made last year.

It also said women using the facilities are almost universally positive about their experiences.

The review found public fears about service safety were largely unfounded but anxiety generated by their experiences and those of others was real and damaged their confidence in services.

Professor Drakeford said:

“I welcome the review, which provides further reassurance to people in Pembrokeshire and Carmarthenshire that these services are safe and have led to improved outcomes for mothers and babies.

“Where the review team has made recommendations in relation to elements of the safety net, which I required to be put in place, I accept them all.”

The review has recommended the second phase of improvements to the estate at Glangwili Hospital, which will improve the environment of the maternity unit, is brought forward. Hywel Dda University Health Board will be submitting a business case early in the next financial year.

A more detailed report by the RCPCH will be discussed by the health board at its next meeting in November.