Independent Report into the handling of the Secondee Consultant Midwife Report into Maternity Services, Cwm Taf University Health Board December 2019

Organisational Culture
The Board should commission external support to establish an appropriate organisational culture based on listening to staff, patients and stakeholders. It is understood work has already commenced in this area.

Review of Standing Orders.
The Welsh Government have recently circulated revised model Standing orders for health bodies in Wales. The Board should specifically consider the sections on “Decisions reserved for the Board” and the “Scheme of Delegation” to ensure there is clarity on such issues as the authority to commission service reviews and Executive portfolios.
The Board could also mandate through Standing Orders that any external reports are brought to the attention of the Board or the appropriate Board Committee, possibly at draft stage. One option is for the Board to consider developing an appropriate escalation framework to set out its expectations in this area.

Board Assurance Framework
The Audit Committee should review the Board Assurance Framework and Risk Register to satisfy itself that these are robust in the light of the events set out in this report.

Non Officer member training – It is important that Non Officer Members receive the appropriate level of training and development to assist them in knowing how to ask critical questions of the executive. Consideration should be given to establishing a formal programme to include risk management. This would help them triangulate the information provided to them. This should be supported by Non Officer Member walkabouts.
The Board could also consider establishing a formal buddying arrangement between individual Non Officer Members and a designated Executive Director to share knowledge and experience.

Board Development sessions – The Board should set out how it wishes to use these sessions and ensure no decisions are made that should be made by the Board in its formal meetings.

Board Reporting
• Sub committees – When considering the establishment of sub committees to Board Committees the Board should consider reporting timescales and escalation arrangements to ensure the Board is advised of key issues as early as possible.
• Referencing – Board reports that refer to previous Board discussions should reference the minute number and previous meeting date to allow Members to cross reference information. Similarly if action plans are updated between meetings (eg the Maternity Improvement Plan) the changes should be highlighted for ease of reference.
• Tabled reports – The Board should set out the occasions when tabled reports are acceptable. Draft presentations should be sent out with Board/Committee papers, except in exceptional circumstances agreed in advance with the meeting Chair.

Openness – The Board should consider what issues it should consider “In Committee”. Good practice would indicate that the reasons for considering a matter “In Committee” are:
• When individual patient confidentiality could be compromised;
• When a matter is commercially sensitive;
• When a draft report is being considered prior to future publication.
Consideration should be given to including the reason why a report should be considered “In Committee” in the covering paper to a report.