There are a number of fundamental weaknesses in governance around patient safety and the quality of care at Cwm Taf Morgannwg University Health Board, a joint review by Healthcare Inspectorate Wales (HIW) and the Wales Audit Office has found.

It expresses concern that the weaknesses are compromising the Health Board’s ability to identify and respond to quality of care and patient safety problems.

Following well-publicised concerns about maternity services at the Health Board, the joint review examined the organisation’s overall approach to quality governance. It found that whilst there has been a strong focus on financial balance and meeting key targets, less attention has been paid to the overall quality and safety of its services.

The report highlights the need for stronger and broader leadership in respect of quality and patient safety and worryingly, points to a culture of fear and blame in some parts of the organisation that has prevented staff from speaking out and raising concerns.

Directorate-level arrangements for oversight of quality and safety of services need to be strengthened and made more consistent with more clearly defined roles and responsibilities and better business processes. Crucially there needs to be a shift in organisational approach to enable directorates to take better ownership of responses to concerns and complaints

More broadly, reviewers found gaps in key governance arrangements associated with the management and identification of risk, and the provision of information to support effective scrutiny by the board and its committees. The need for improvements in the way incidents are classified and reported was also highlighted.

Whilst the review has highlighted a significant number of concerns, it does note that the Health Board has started to take actions to address them. It also highlights the impact that new leadership is starting to have in tackling what is a considerable set of challenges. 

The report makes 14 specific recommendations to the Health Board, including:

• Identifying clear organisational priorities for quality of services, and reflecting these in an updated Quality Strategy;
• Strengthening identification and management of risk across the breadth of its services;
• Clarifying roles and strengthening leadership in respect of quality and safety, especially in relation to the roles of the Medical Director and Clinical Directors;
• A number of actions to help strengthen scrutiny and oversight of quality and safety within the organisation; and
• Engagement with staff to help embed a new Values and Behaviours framework, and broader actions to demonstrate a stronger approach to organisation learning.

Dr Kate Chamberlain, the Chief Executive of Healthcare Inspectorate Wales, said:

“Our joint review findings make worrying reading. Whilst maintaining a necessary focus on its finances and other performance targets, the Health Board has not given due attention to the quality of the services it provides. Urgent action is needed to correct this and to support staff on the ground to deliver care that is safe and of high quality”.  

Adrian Crompton, the Auditor General for Wales, said:

“The scale of the challenge for the Health Board is significant. Fundamental aspects of quality governance have been allowed to lapse and work is now urgently needed to rebuild both those internal systems and the external confidence in the Health Board. New leadership, who have a clear idea of what needs to change, gives cause for optimism but they will need to act with both resilience and pace to effect the many changes that are necessary”.

Healthcare Inspectorate Wales and the Wales Audit Office acknowledge the open and transparent way in which the Health Board has supported the joint review and urge other NHS bodies to pay close attention to its findings in reviewing their own quality governance systems.

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Notes for Editors

• Concerns highlighted in a succession of previous reports prompted Healthcare Inspectorate Wales and the Wales Audit Office to undertake this review, which was not commissioned by the Welsh Government.
• The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £15 billion of funds that are voted on annually by the National Assembly. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £7 billion) and to local government (over £4 billion).
• The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the National Assembly or government.
• The Wales Audit Office (WAO) is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.
• Healthcare Inspectorate Wales is the independent inspectorate and regulator of healthcare in Wales. We regulate and inspect NHS services and independent healthcare providers against a range of standards, policies, guidance and regulations to highlight areas requiring improvement.