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I last updated Members on progress within maternity and neonatal services at Cwm Taf Morgannwg University Health Board on 02 February. This followed the publication of the first thematic report from the Independent Maternity Services Oversight Panel (IMSOP) describing the themes and learning emerging from the maternal category of the Clinical Review Programme. I also confirmed that I had accepted a recommendation from Mick Giannasi, IMSOP Chair to enhance the Panel membership to include neonatal expertise. I am now in a position to confirm that Dr Alan Fenton and Ms Kelly Harvey will join the Panel with immediate effect.


Dr Fenton has been a Consultant Neonatologist in Newcastle since 1995\. He has had a major role in developing perinatal services at the national level and was President of the British Association of Perinatal Medicine 2014\-17\. He was the neonatologist in the core team of the 2016 National Maternity Review (Better Births) and is a member of the Maternity Transformation Programme Stakeholder Council. He has been part of the MBRRACE\-UK collaborative since 2018\.


Ms Harvey has over 18 years’ experience as a neonatal nurse and Advanced Neonatal Nurse Practitioner and is currently lead nurse for the North West Neonatal Network supporting quality improvement and governance across a regional footprint. She has recently become a member of the Neonatal Nurses Association Executive Committee.


Both have also been involved with the IMSOP Clinical Review Programme for some time, as members of the Quality Assurance Panel, so are fully versed in the work and are able to transition to full Panel members immediately. This is timely given that the neonatal reviews are underway and it will be important to ensure that as the learning emerges it can be fed into the wider improvement programme.


Alongside this, they will begin by undertaking a deep dive into the neonatal service to take stock of the current neonatal service and its improvement plan to provide assurance that services are safe, effective, well led and importantly, integrated with the maternity service to provide a seamless service for women and babies. The health board has welcomed this development and the opportunity to draw on Dr Fenton and Ms Harvey’s experience and expertise to inform the improvements they are making on their journey to provide exemplar maternity and neonatal services.


I also wanted to advise Members that I have accepted a recommendation from the IMSOP Chair to defer the production of their next full progress report. Mr Giannasi has recently written to me to set out the rationale for this. When the Panel last reported in September 2020, it concluded that the health board had done remarkably well to maintain the focus and momentum of its Maternity and Neonatal Improvement Programme (MNIP) during the first wave of the COVID\-19 pandemic.


The Panel has continued to maintain oversight of the improvement programme throughout this last period. However, all their work is still being undertaken virtually and they advise it has become increasingly difficult to assess evidence of improvement in a robust and thorough way because of not being able to meet with staff face to face and visit the hospitals to assess whether the improvements which have been delivered on paper have been embedded in day to day operational practice.


At the end of February, the Panel conducted an interim assessment of the progress which the health board has made in the last six months and concluded that whilst there were no signs of regression, in comparison to previous reporting periods, the level of tangible progress has slowed. They also assessed progress against the ten ‘next steps’ actions which were highlighted in the September 2020 Progress Report and concluded that the majority of those remained work in progress and a substantial number, including some which are key enablers for longer term improvement, have been delayed or deferred due to the impact of COVID\-19\. 


Importantly, the Panel believes that despite the challenging circumstances in which the health board has been operating over the past twelve months, the maternity service has ‘kept its head above water’ in a way which would almost certainly not have been possible without the improvements of the past two years. In particular, there is no sign of regression in any of the key performance indicators (sickness absence excluded) and safe staffing levels have been maintained, despite the high levels of sickness absence which have been experienced. There is also evidence that the service has shown innovation and creativity in responding to the implications of COVID\-19, particularly in the way it has used social media and other forms of remote technology to engage and build co\-production with women and families using the service.


In the circumstances which have prevailed over the past twelve months and the last six months in particular, the Panel has advised me that the current pace of progress is entirely understandable in their view. The Panel has identified the key areas of focus to regain momentum over the coming months and determined that September would be an appropriate time to next provide a full report on progress.


In tandem, the Clinical Review Programme is continuing, albeit that the pace of that work has also been slightly impacted due to the pandemic. However the Panel will in the coming weeks conclude the reviews of those babies who sadly were stillborn. Arrangements are being finalised to share individual findings with women and families affected and to ensure all appropriate support is in place.


I will continue to keep Members informed.


 







Translation:


 
Rhoddais y wybodaeth ddiweddaraf i'r Aelodau am y cynnydd o ran gwasanaethau mamolaeth a newyddenedigol Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg ar 02 Chwefror. Roedd hyn yn dilyn cyhoeddi adroddiad thematig cyntaf y Panel Trosolwg Annibynnol ar Wasanaethau Mamolaeth, a oedd yn disgrifio'r themâu a'r dysgu sy'n deillio o gategori’r fam yn y Rhaglen Adolygu Clinigol. Fe wnes i gadarnhau hefyd fy mod wedi derbyn argymhelliad gan Mick Giannasi, Cadeirydd y Panel, y dylid ehangu aelodaeth y Panel i gynnwys arbenigedd yn y maes newyddenedigol. Gallaf bellach gadarnhau y bydd Dr Alan Fenton a Ms Kelly Harvey yn ymuno â'r Panel ar unwaith.


Mae Dr Fenton yn Neonatolegydd Ymgynghorol yn Newcastle ers 1995\. Mae wedi chwarae rhan bwysig yn y gwaith o ddatblygu gwasanaethau amenedigol ar y lefel genedlaethol a bu'n Llywydd Cymdeithas Meddygaeth Amenedigol Prydain yn 2014\-17\. Ef oedd y neonatolegydd yn nhîm craidd yr Adolygiad Mamolaeth Cenedlaethol (Genedigaethau Gwell) 2016 ac mae'n aelod o Gyngor Rhanddeiliaid y Rhaglen Trawsnewid Mamolaeth. Mae’n ymwneud â rhaglen gydweithredol MBRRACE\-UK ers 2018\.


Mae gan Ms Harvey dros 18 mlynedd o brofiad fel nyrs newyddenedigol ac Ymarferydd Nyrsio Newyddenedigol Uwch ac ar hyn o bryd mae'n nyrs arweiniol ar gyfer Rhwydwaith Newyddenedigol Gogledd\-orllewin Lloegr sy'n cynorthwyo’r gwaith o wella ansawdd a llywodraethiant ar draws ardal ddaearyddol ranbarthol. Yn ddiweddar, daeth yn aelod o Bwyllgor Gwaith Cymdeithas Nyrsys y Newydd\-anedig.


Mae'r ddau hefyd wedi bod yn ymwneud â Rhaglen Adolygu Clinigol IMSOP ers peth amser, fel aelodau o'r Panel Sicrhau Ansawdd, felly maent yn gwbl gyfarwydd â'r gwaith ac yn gallu ymuno fel aelodau llawn o’r Panel ar unwaith. Mae hyn yn amserol o ystyried bod yr adolygiadau newyddenedigol ar y gweill a bydd yn bwysig sicrhau, wrth i'r hyn a ddysgir ddod i'r amlwg, bod modd ei fwydo i'r rhaglen wella ehangach.


Law yn llaw â hyn, byddant yn dechrau drwy fwrw golwg fanwl ar y gwasanaeth newyddenedigol gan bwyso a mesur y gwasanaeth newyddenedigol presennol a'i gynllun gwella er mwyn rhoi sicrwydd bod gwasanaethau'n ddiogel, yn effeithiol, yn cael eu harwain yn dda ac \- yn bwysig – eu bod wedi’u hintegreiddio â'r gwasanaeth mamolaeth i ddarparu gwasanaeth di\-dor i fenywod a babanod. Mae'r bwrdd iechyd wedi croesawu'r datblygiad hwn a'r cyfle i fanteisio ar brofiad ac arbenigedd Dr Fenton a Ms Harvey i lywio'r gwelliannau y maent yn eu gwneud ar eu taith i ddarparu gwasanaethau mamolaeth a newyddenedigol o safon uchel.


Roeddwn hefyd am hysbysu'r Aelodau fy mod wedi derbyn argymhelliad gan Gadeirydd y Panel i ohirio llunio eu hadroddiad cynnydd llawn nesaf. Mae Mr Giannasi wedi ysgrifennu ataf yn ddiweddar yn nodi'r rhesymeg dros hyn. Pan adroddodd y Panel ddiwethaf ym mis Medi 2020, daeth i'r casgliad bod y bwrdd iechyd wedi gwneud yn hynod o dda i gynnal ffocws a momentwm ei Raglen Gwella Gwasanaethau Mamolaeth a Newyddenedigol yn ystod ton gyntaf y pandemig COVID\-19\.


Mae'r Panel wedi parhau i oruchwylio'r rhaglen wella drwy gydol y cyfnod diwethaf hwn. Fodd bynnag, mae eu holl waith yn dal i gael ei wneud yn rhithwir ac maent wedi rhoi gwybod ei bod wedi dod yn fwyfwy anodd asesu tystiolaeth o welliant mewn ffordd gadarn a thrylwyr oherwydd nad ydynt yn gallu cyfarfod â staff wyneb yn wyneb ac ymweld â'r ysbytai i farnu a yw'r gwelliannau sydd wedi'u cyflawni ar bapur yn cael eu rhoi ar waith mewn ymarfer gweithredol o ddydd i ddydd.


Ddiwedd mis Chwefror, cynhaliodd y Panel asesiad interim o'r cynnydd y mae'r bwrdd iechyd wedi'i wneud yn ystod y chwe mis diwethaf a daethant i'r casgliad, er nad oedd unrhyw arwyddion o gam yn ôl o'i gymharu â chyfnodau adrodd blaenorol, fod cyflymder y cynnydd pendant wedi arafu. Fe wnaethant hefyd asesu cynnydd yn erbyn deg cam gweithredu y 'camau nesaf' a amlinellwyd yn Adroddiad Cynnydd Medi 2020 a daethant i'r casgliad bod y rhan fwyaf o'r rheini'n dal ar y gweill a bod nifer sylweddol, gan gynnwys rhai sy'n alluogwyr allweddol ar gyfer gwelliant tymor hwy, wedi'u gohirio neu eu hatal dros dro oherwydd effaith COVID\-19\. 


Yn bwysig, mae'r Panel o’r farn, er gwaethaf yr amgylchiadau heriol y mae'r bwrdd iechyd wedi bod yn gweithredu ynddynt dros y deuddeg mis diwethaf, fod y gwasanaeth mamolaeth wedi 'cadw ei ben uwchben y  dŵr' mewn ffordd na fyddai bron yn sicr wedi bod yn bosibl heb welliannau'r ddwy flynedd ddiwethaf. Yn benodol, nid oes unrhyw arwydd o gam yn ôl yn unrhyw un o'r dangosyddion perfformiad allweddol (heb gynnwys absenoldeb oherwydd salwch) ac mae lefelau staffio diogel wedi'u cynnal, er gwaethaf y gyfradd uchel o absenoldeb oherwydd salwch. Mae tystiolaeth hefyd bod y gwasanaeth wedi bod yn arloesol a chreadigol wrth ymateb i oblygiadau COVID\-19, yn enwedig yn y ffordd y mae wedi defnyddio’r cyfryngau cymdeithasol a mathau eraill o dechnoleg o bell i ymgysylltu a chydweithio â’r menywod a’r teuluoedd sy'n defnyddio'r gwasanaeth.


O ystyried amgylchiadau’r deuddeg mis diwethaf, a'r chwe mis diwethaf yn benodol, mae'r Panel wedi dweud wrthyf fod cyflymder presennol y cynnydd yn gwbl ddealladwy yn eu barn hwy. Mae'r Panel wedi nodi'r meysydd ffocws allweddol ar gyfer adennill momentwm dros y misoedd nesaf ac mae o’r farn y byddai mis Medi yn adeg briodol i ddarparu’r adroddiad llawn nesaf ar y cynnydd.


Law yn llaw â hynny, mae'r Rhaglen Adolygu Clinigol yn parhau, er bod cyflymder y gwaith hwnnw hefyd wedi dioddef ychydig o effaith oherwydd y pandemig. Fodd bynnag, yn ystod yr wythnosau nesaf bydd y Panel yn cwblhau'r adolygiadau o'r babanod hynny a oedd yn farw\-anedig gwaetha’r modd. Mae trefniadau'n cael eu cwblhau i rannu’r canfyddiadau unigol â’r menywod a’r teuluoedd yr effeithiwyd arnynt ac i sicrhau bod yr holl gymorth priodol ar gael.


Byddaf yn parhau i roi’r wybodaeth ddiweddaraf i’r Aelodau.