A health board criticised for severe maternity failings put too much emphasis on targets instead of patient safety, according to a new review.
It found wider failings in Cwm Taf Morgannwg health board’s governance.
Healthcare Inspectorate Wales (HIW) and the Wales Audit Office (WAO) also found a high level of risk to patient safety was accepted as the norm in some departments.
The health board said work was under way to address the issues raised.
The report was not an assessment of front-line care, but spoke to staff about procedures for reporting and learning from problems.
It found Cwm Taf Morgannwg health board had not given enough attention to the safety of its services, in contrast to a strong focus on targets and financial controls.
What did the auditor general say about targets?
Adrian Crompton, the auditor general for Wales, said while finance and performance targets were “vitally important”, the review raised questions about how the performance of the health service was assessed.
“This piece of work suggests one part of the health service perhaps over-prioritised these issues and has taken its eye off the ball in respect of issues related to patient care,” he said.
The regulator HIW found examples where working at high levels of risk had become “normalised”.
On visits to the emergency departments at the Prince Charles and Royal Glamorgan hospitals, the review found “areas of concern which we felt could pose an immediate risk to the safety of patients”, including issues around nurse and doctor staffing levels and the safety and dignity of managing patients in corridors.
“Staff said they had repeatedly raised concerns and now felt they could do no more to escalate their concerns,” the report said.
The review found there was a muddled system and a lack of leadership as to who was in charge of safety at various levels and no formal process for learning from problems.
For example, staff may not have been aware that other parts of the organisation had been inspected and needed improvement.
What concerned Healthcare Inspectorate Wales most?
The review found gaps in how information and incidents were reported to the board.
Kate Chamberlain, chief executive of HIW, said what concerned them most was “the lack of clarity about how front-line staff… can escalate their concerns and make them known”.
“It is absolutely fundamental to patient safety that there should be a good flow of information,” she said.
The report said there still appeared to be a culture of fear and blame in some parts of the organisation relating to the reporting of incidents.
A quarter of the staff who answered the review’s survey felt the organisation blamed or punished people who were involved in errors, near misses or incidents, and nearly half of the respondents felt managers would not act on feedback from staff.
The report also raised concerns the health board had not addressed weaknesses identified in a previous HIW report in 2012.
Mr Crompton said the two organisations were already planning the joint review before the recent maternity failings emerged.
But the review found some cause for optimism given the new set of managers.
In December the two organisations will meet the Welsh Government to give their recommendation on whether the whole health board needs to be put into special measures.
At present it is one step down from special measures and the maternity unit is already at the highest level of oversight.
What is the response of the health board?
Sharon Hopkins, interim chief executive of the health board, welcomed the review and accepted all 14 of the recommendations made,
Ms Hopkins told BBC Radio Wales Breakfast she was “confident care in maternity services is improving”.
“You can never say 100% of the time somebody’s experience will be absolutely as we would like it.,” she said.
“But I think we can be confident with what we are doing now, and how hard people are working, that care in maternity services is of a good quality, and improving all the time.”
She said improvements included making the structure of the organisation better, increasing “engagement with staff and partners” and strengthening governance arrangements.
In October an independent review panel said there was a “very long way to go” before maternity services at a health board could be declared safe.
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