Maternity services run by scandal-hit Cwm Taf Morgannwg University Health Board are making "encouraging signs of progress", it is claimed.
An independent panel set up by the Welsh Government to oversee progress at the health board's two maternity units has published the second of its quarterly reports into the units.
It found that in the last three months of 2019, maternity services at the Royal Glamorgan Hospital, Llantrisant, and Prince Charles Hospital, Merthyr Tydfil, made good progress, prompting "cautious optimism" that longer-term improvements will be delivered.
However, the panel said the pace of improvement has not been fast enough - partly due to unforeseen staff absences - and needs to be ramped up.
It added that more than two-thirds (68%) of the actions the health board needs to take remain "a work in progress" and will require widespread changes in culture and operational practice to fully deliver.
It was also revealed that since the initial report was published in April 2019 by the Royal College of Obstetricians and Gynaecology (RCOG) and the Royal College of Midwives - which unearthed "systematic failings" in maternity services and prompted the creation of the oversight panel - 20 serious incidents have taken place and been flagged up with Welsh Government.
However, the panel said this was "within normal bounds".
Mick Giannasi, the chairman of the independent panel, said: "In the first quarterly report we talked about solid foundations and improvement being created. We also talked about action to make the service safe.
"This time we have seen good progress in the recommendations made by the royal colleges, so in this quarter we've seen around a third of those being delivered and the rest a work in progress - and some of those are significant items."
The key areas of improvement highlighted by the panel include:
- improvement in the quality of training for both medical and midwifery staff;
- the creation of a comprehensive clinical governance framework which is tasked with evidencing that the maternity units are safe;
- confirmation that midwifery and nursing staffing levels are in line with recommended levels by 'Birthrate Plus';
- the development of a clinical auditing process and improvements in the processes for recording serious incidents.
Mr Giannasi, a former chief constable with Gwent Police, said twice-weekly surveys are now being carried out which document the experiences of women and the families on the maternity wards. He claims the feedback from the latest cohort has been "predominantly positive".
And he added that there is a "quiet evolution" going on when it comes to staffing levels and attitues.
"There's a new interim chief executive, a new director of midwifery has just started, along with new midwives, consultants and other staff coming in. There is a different kind of atmosphere and a renewed enthusiasm," he added.
"And what we have seen is a greater degree of openness and transparency, a willingness to learn and a recognition that things weren't right in the past and need to be put right."
Healthcare Inspectorate Wales (HIW) carried out an unannounced three-day inspection of the midwifery-led Tirion Birth Centre at the Royal Glamorgan Hospital in September 2019.
It concluded overall that "care was provided in a safe and effective manner", while staff "demonstrated a clear passion and drive to provide high standards of care to patients in a homely, relaxed environment".
The health board is currently awaiting the publication of an unannounced inspection of the consultant-led service provided at Prince Charles Hospital.
Commenting on the 20 serious incidents reported since October 2018, Mr Giannasi added: "We are satisfied that these are being investigated properly and are within normal bounds of what is expected [from a maternity unit].
"The previous problem was that serious incidents weren't being reported, so we are now confident they are being reported appropriately.
"And we have seen an improvement in the quality of investigations and the way they then reflect in a change in practice."
The report added the handling of complaints about the maternity units remained a matter of concern.
It stated: "Progress is being made, particularly in responding within more appropriate timescales to new referrals, but there are still significant challenges in terms of addressing the backlog of historical complaints
"The current arrangements are not as coordinated as they need to be and the culture is still sometimes defensive, with promises and deadlines sometimes not being kept."
The panel are also implementing the first phase of a "look back exercise" of 140 cases of potential poor quality care given to mothers and babies between January 2016 and October 2018.
A multidisciplinary team made up of midwives, obstetricians, anaesthetists and neonataologists will be conducing these reviews and have already been recruited.
"We have seen no evidence at all to suggest that the service is not safe," added Mr Giannasi, who admitted there was an initial "surge" in expectant parents requesting to use maternity units outside of Cwm Taf when the negative publicity first came to light.
"We have actually seen positive evidence to show there is a safety culture and that the organisation is progressively becoming better.
"The predominant experience of women using the service is now a positive one."
Cwm Taf Morgannwg University Health Board first came under fire in April 2019 following the publication of the royal colleges' report.
It was prompted by a consultant midwife who was concerned by an apparent under-reporting of serious incidents, including deaths of babies.
She found maternity services in both the Royal Glamorgan and Prince Charles to be "dysfunctional", with inadequate support for junior doctors, unacceptable midwife staffing levels and a "punitive culture of blame".
A total of 43 pregnancies between January 2016, and September 2018 were investigated to see if there was any "avoidable harm" – 21 of them were stillbirths, five were neonatal deaths and 17 were complications in labour.
Cwm Taf's maternity services are currently in special measures - the highest level of Welsh Government monitoring - as a result of the findings.
