‘Serious concern’ black and ethnic minority pregnant women treated differently at Wales’ biggest hospital

There is “serious concern” that black, Asian, and ethnic minority women are being treated differently at Wales’ largest hospital. A report released on Wednesday said the maternity department at the University Hospital of Wales in Cardiff needs “urgent improvement” after a number of issues relating to patient safety and staff morale were identified by inspectors.

One of the concerns identified by inspectors from Healthcare Inspectorate Wales was the feeling from some black, Asian, and ethnic minority women that they were being treated differently. Inspectors said this was of “serious concern” and the health board have since implemented a number of initiatives to improve their experience. The report said it is vital these improvements are sustained.

The report was released following an expectation which was carried out in March 2023,after an unannounced inspection in November 2022 identified a number of concerns around patient safety. The report said while some improvements had been made in the several months between the two visits there were still a number of issues that needed addressing. However the report commended how hard staff worked in the conditions that they were in, adding that staff members went “above and beyond” to ensure their patients were well cared for.

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During their inspection in November 2022 inspectors issued patient surveys to women on the ward. Inspectors spoke to one black woman on the ward who said she felt she was not listened to or provided with the same level of information or care as other patients. She told inspectors this had negatively affected their experience.

A patient survey issued by inspectors also received responses of a similar nature. One person’s experience said: “It felt that some of the midwives were treating me in a different way because I’m an immigrant.” Another said: “I have wondered since if my experience with the midwife….. was due to my race. I’m a Black British African.” Since the November 2022 inspection immediate improvements relating to this issue were needed. Staff have received equality and diversity training.

The issues raised with inspectors are particularly concerning due to the increased mortality rates black pregnant women face while compared with white pregnant women. According to the Royal College of Midwives black pregnant women are five times more likely, and Asian women twice as likely, to die during pregnancy and childbirth than white women.

A House of Commons committee report published in April 2023 found that “microaggressions” were a factor in the care that some black pregnant women received such as “black women having a lower pain threshold” and that some women were often viewed as “not like me”.

Other issues identified in the inspections include:

• a period of low staff levels leading to low staff morale as they work extremely hard to meet patient needs in a challenging staffing environment;
• patients raised concerns about staff availability and sufficient support which was affecting the ability of staff to protect dignity and privacy of patients;

• general infection prevention and control measures were not sufficiently robust in all areas;

• medicine not being stored securely, a visibly dirty theatre and treatment areas, the availability of life-saving equipment, insufficient plans in place to protect the safety and dignity of patients, and insufficient management and security of confidential patient information, and;

• lack of effective support for staff on the midwife unit.

Problems were also identified with the relationship between staff on the maternity unit and management and leaders. Midwifery staff gave positive feedback about their immediate line managers but inspectors found the wider leadership and governance arrangements were not having a sufficiently effective or supportive impact on the maternity unit. Some improvements were identified in the follow-up inspection in March.

Healthcare Inspectorate Wales chief executive Alun Jones said: “Our work has highlighted significant challenges within the maternity services at Cardiff and Vale University health board. Whilst there were some improvements identified during our return inspection in March the scale of issues and pace of change was not sufficient and as a result further urgent action was required. I hope this report will accelerate the measures taken to drive forward timely improvements for not only expectant and new mothers but also staff within the maternity unit. We will be working with the health board to ensure robust improvements are made and evidenced.”

If you would like to share your experience of maternity care at any of Wales’ hospitals you can get in touch with our health editor at lydia.stephens@walesonline.co.uk.