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Maternity services at Singleton Hospital in Swansea require immediate improvement

Healthcare Inspectorate Wales (HIW) has issued a report, 15 December, following an inspection of the maternity unit at Singleton Hospital in Swansea.

Singleton Hospital - Maternity Services

Inspector's completed an unannounced inspection of the hospital's maternity services, run by Swansea Bay University Health Board, across three consecutive days in September 2023. During the inspection of the antenatal, labour, and postnatal care, inspectors identified significant patient safety concerns, and an immediate assurance letter was issued to the health board.

We identified issues regarding many aspects of the delivery of safe and effective care within the unit. Inspectors were not assured that the processes and systems in place were sufficient to ensure that patients were consistently receiving an acceptable standard of care. This includes arrangements for maintaining cleanliness, routine checking of essential lifesaving equipment, safe storage of medicines and safety issues relating to the hospital environment. We found that there were issues with safe staffing levels not always being met, low levels of mandatory training compliance and inadequate security measures to ensure babies were kept safe and secure. 

Inspectors found staff were working hard to provide women and birthing people, and their families, with a positive experience despite the sustained pressures on the department. Staff were observed providing kind and respectful care, and those we spoke to were generally positive of the care they received from staff. Inspectors observed good multidisciplinary team working across services such as neonatal, pharmacy, theatres and anaesthetics with women and their partners being supported and communicated with effectively. Concerns were raised with us about staff availability to support those using the service. Some of the women we spoke to on the postnatal ward indicated that when they required pain relief, it was not always administered in a timely manner, which they believed was due to staffing shortages and high workloads.

Staff feedback reflected the impact of sustained periods of pressure, with less than half agreeing that they would be happy with the standard of care provided by the hospital for themselves or their loved ones. Midwifery staff also told us they were struggling to cope with their workloads and were concerned about their own health and wellbeing. Inspectors noted that teams were working hard to support each other during these difficult circumstances. 

Most leadership roles within the department were temporary and there have been some challenges maintaining a stable leadership team over the last two years. We were advised that additional measures were in place to support the interim leadership team, including peer mentoring and coaching. 

Some key clinical staff told us that they were not aware of the formal process for raising concerns about staffing levels or other issues. The health board must ensure that comprehensive and effective staffing escalation procedures are followed and communicated to all clinical staff. This must include clear guidance of the process to follow when unsafe staffing levels are identified. 

Due to our concerns, we issued an Immediate Assurance letter, in which we wrote to the health board immediately after our inspection requiring urgent remedial action.

HIW has continued to work closely with the health board since the inspection and has accepted a comprehensive improvement plan which aims to address all of the issues identified.

Chief Executive of Healthcare Inspectorate Wales, Alun Jones said: 

Our inspection identified areas for improvement that posed a risk to patients and staff within the maternity unit at Singleton Hospital. We are aware of the sustained pressure on NHS services, and it is positive to hear the commitment of staff to ensure they provide women and birthing people with a positive experience in spite of those pressures. Immediate improvements were identified during our inspection, and I hope this report will accelerate Swansea Bay University Health Board to take action, not only for expectant and new mothers but also staff within the maternity unit.