BPAS Birmingham Central is part of the national charitable organisation British Pregnancy Advisory Service (BPAS).

The service was registered as a single speciality termination of pregnancy service. BPAS Birmingham Central provided consultations and medical terminations of pregnancy up to 10 weeks gestation. It provided support, information, treatment and aftercare for people seeking help with regulating their fertility and associated sexual health needs. Its main activity was termination of pregnancy.

We carried out an announced inspection of this service on 19 May 2016 and attended. This formed part of the first wave of inspection of services that provide a termination of pregnancy. This inspection was carried out using the Care Quality Commission’s methodology.

To get to the heart of patients’ experiences of care, we always ask the following five questions of every service and provider:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to peoples’ needs?

• Is it well-led?

Are services safe at this service

• The service had a culture of safety. Staff reported incidents and incidents were logged, investigated and learned from.

• Quality and safety audits were completed by the clinic and submitted monthly to the regional clinical lead.

• Staff followed procedures in place for good hygiene and control of infection, safe storage and administration of medication, safeguarding children and vulnerable adults, assessing and responding to clinical risk for patients and record keeping.

• There were sufficient nurses and doctors available to treat patients.

• Staff were aware of their duty of candour responsibility.

• One area of the clinic used solely by staff could not be effectively cleaned for control of infection.

Are services effective at this service

• Treatment was based on up to date good practice and staff followed policies and procedures.

• Managers regularly audited clinical practice to maintain good standards of patient care and continuously improve outcomes for patients.

• Staff were competent, well trained and experienced with access to information systems. They worked collaboratively for the benefit of patients.

• Staff gave patients good information on which to base their decisions and spent time explaining options and procedures.

• The service did not participate in any relevant local audit programme or peer review to bench mark its outcomes against other similar provider services. The provider told us it took whatever opportunities to bench it was offered by NHS services.

• There was not a clear best interest decision making protocol in practice for women with learning disabilities who may need it or signposting to an independent advocacy service.

Are services caring at this service

• Staff in all roles treated patients and those close to them with kindness and respect and put them at ease.

• Nurses asked about and respected patients’ wishes about sharing information with a partner or family members or carers.

• Nurses checked along the way that patients were sure of their decision. Additional information and counselling could be offered or the procedure postponed if they were unsure.

• BPAS offered ongoing counselling support to all patients and patients under 18 years old were counselled prior to treatment as a matter of policy.

Are services responsive at this service

• The clinic opened six days each week and was situated in the city centre near to transport links.

• Patients could book appointments through a national telephone service that ran a flexible appointment system to offer as much choice as possible to patients.

• Patients were generally offered an appointment within seven calendar days of contact with the service and seen promptly when they arrived at the clinic. Most patients had their procedure within 10 working days of making a decision to proceed.

• Translation services were available and there was a free ongoing counselling service for patients.

• The clinic encouraged patients to give feedback on the service.

• Access to this clinic was difficult for patients with disabilities and means to support patients with a learning disability to understand and give informed consent to procedures were limited.

Are services well led at this service

• Staff were committed to the BPAS vision of women being in control of their fertility.

• The provider had an effective governance framework for reviewing the quality and safety of care. Performance and quality data such as incidents, complaints, policy and legislative updates were discussed at national and regional meetings.

• Clinic performance was measured through audits and reported on a monthly dashboard to the regional operations director. Action plans were developed for areas that required improvement.

• The clinic was well run by a manager registered with the CQC and staff felt confident about speaking up, learning from incidents and trying out new ways to improve the service. The registered manager had easy access to directors in the organisation for support and advice.

• Staff encouraged patients to give feedback about the service they received and contribute to improving the service.

We saw several areas of good practice including:

• The provider organisation had consulted a sample of young people in designing the safeguarding risk assessment. This improved the effectiveness of questions to identify young women who were isolated, at risk of abuse or exploitation.

However, there were also areas in which the provider needs to make improvements.

Importantly, the provider must:

• Ensure that protocols are put into practice for obtaining consent for all patients including access to best interest decisions for those who may lack capacity to consent, including such patients with learning disability.

In addition the provider should:

• Put in place a local contingency plan for business continuity in the case of prolonged loss of premises due to major incident.

• Review the environment of the staff locker room and make improvements where necessary to ensure effective cleaning of the surfaces and floors.

• Consider participating in relevant local or national audit programmes or peer review to bench mark outcomes against other similar provider services.

• Ensure that where patient’s consent to simultaneous administration of abortion medication for medical abortions, they are clearly informed this method could increase the risk of failure.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We spoke with three people who were using the service on the day of our inspection, a relative and staff that supported them. People told us that they were happy with the care, treatment and support they received at the clinic. A person using the service told us, “Today has been a positive experience.”

People told us that they had been fully involved in the decision to use the service. They told us that they had made decisions about the treatment they received after staff had explained their care, treatment and support choices to them. People also told us that they had been given time to consider the information prior to treatment so that they had the option to withdraw their consent if they wanted to. A person using the service told us “I have received all of the information and staff have left it totally up to me to decide if I want to go ahead with the treatment or not.”

People told us that they were listened to and treated with respect by staff working at the clinic. People using the service told us, “Staff have been very respectful to me. They have gone beyond what I would have expected,” and, “Staff have been brilliant. They have taken their time and my appointment has not been rushed.”

Arrangements were in place so that people using the service were protected against the risk of abuse. This included arrangements for both adults and children.

Systems were in place to identify and monitor the quality of the service provided at the clinic and to manage risks to people’s safety, health and welfare. People using the service were involved in this process, so that they had opportunities to discuss the quality of service they received.

During our inspection, we asked the local authority commissioning team about the quality of service provided at the clinic. They told us that they did not have any concerns about the quality aspects of the service.

People using the service told us that they were happy with the care they received at the clinic. They told us that their care and support needs were being met. Comments included: “I have no concerns whatsoever with the treatment I have had here” and “Staff are really friendly, they are really easy to talk to and are very supportive.”

People told us that staff explained their care, treatment and support choices to them. This meant that they had the opportunity to be involved in making decisions about their care. A person using the service told us “The staff have explained everything to me. They have explained what procedures I can choose to have.”

People told us that they were listened to and treated with respect by staff working at the clinic. They told us that their dignity had been respected. A person using the service told us “Staff haven’t judged me. They have treated me with respect.”

During our inspection, we asked the commissioning team at the local primary care trust about the quality of the service the clinic provided. They did not have any information to share with us about the quality aspects of the service.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.