We carried out an inspection of bpas Luton on 2 May 2013 and observed a relaxed environment with people treated in a professional and respectful manner. At the time of our inspection, very few people were booked into the service, but we did speak with someone as they were leaving following their care and treatment; they told us they were very happy with the care provided and attitude of staff.

We looked at the processes in place for obtaining people’s consent to care and treatment, and found this was managed in line with national information and good practice guidance.

We found the provider had safe systems for managing medicines within the service, and also had comprehensive procedures for managing any concerns or complaints related to the service.

British Pregnancy Advisory Service (BPAS) provides a medical and surgical termination of pregnancy service in Luton, Bedfordshire.

BPAS Luton has contracts with clinical commissioning groups (CCGs) in the Luton, Hertfordshire and Bedfordshire areas to provide a range of termination of pregnancy services. This includes pregnancy testing, unplanned pregnancy counselling, early medical abortion, early surgical abortion, abortion aftercare, sexually transmitted infection testing and treatment, contraceptive advice and contraception supply.

Most patients are funded by the NHS, some patients choose to pay for services themselves and in addition, the clinic offers services to paying overseas patients.

We did not provide ratings for this service.

Are services safe at this service?

• Incidents and risks were reported and managed appropriately. Lessons learned and actions to be taken were cascaded to front line staff.

• Nursing and medical staffing numbers were sufficient and appropriate to meet the needs of patients in their care.

• Staff complied with best practice with regard to cleanliness and infection control. Service cleanliness audit results were consistently high at over 95%.

• Staff were aware of their safeguarding responsibilities, including to patients that were under the age of sixteen years old.

• Medicines were stored and prescribed safely. If a doctor was not on site, prescription charts were signed remotely by doctors working on other BPAS sites.

• Staff employed followed Royal College of Obstetricians and Gynaecology (RCOG) guidelines, The Abortion Act 1967, (as amended) The Abortion Regulations 1991, tand the DoH Required Standard Operating procedures (RSOPS).

• Medicines to induce abortion were prescribed by a doctor as required by law, after HSA1 forms had been signed. The HSA1 form is signed by two doctors, prior to any treatment being commenced after they have decided ‘in good faith’, that a woman meets the legal requirements for an abortion. This is a requirement of The Abortion Act 1967.

Are services effective at this service?

• Care was provided in line with national and statutory guidelines.

• Patients were prescribed appropriate pain relief, prophylactic (preventative) antibiotics and post-abortion contraceptives.

• There were processes in place for implementing and monitoring evidence based guidance.

• The clinic performed audits recommended by Royal College of Obstetricians and Gynaecology (RCOG) such as infection control, consent to treatment, discussions about options for abortion and contraception.

• Consent was gained in line with Department of Health (DH) guidelines. Written consent was obtained in all cases.

• Each woman had an ultrasound performed to confirm the pregnancy and gestation so that the correct treatment could be recommended.

• We saw that medical records were complete.

• Pre and post-abortion counselling was provided.

• A telephone advice line for patients was available 24 hours a day.

• Nursing staff were trained and assessed as competent for general nursing practice and specific competencies pertaining to their roles.

• A treatment doctor performed surgical terminations at the clinic.

Are services caring at this service?

• Staff treated patients attending for consultation and termination of pregnancy with compassion, dignity and respect.

• There was a focus on the needs of patients.

• All consultations were held in private rooms which ensured the patients’ dignity and privacy.

• The client care coordinator met with all patients on their own to establish that the patient was not being pressurised to make a decision. Patients’ preferences for sharing information with their partner or family members were established, respected and reviewed throughout their care.

• If patients needed time to make a decision, the staff supported this.

• < > patients considering termination of pregnancy had access to pre-termination counselling and post-termination counselling was provided if required.

  Pre and post-procedure checks and tests were carried out at the clinic to ensure continuity of care.

• Waiting times were consistently within the guidelines set by the DH. Patients told us they were able to access the clinic quickly and did not experience long waits.

• Interpreting and counselling services were available to all patients and the clinic was accessible for those living with disabilities.

• Most patients were offered testing for sexually transmitted infections before treatment.

• Patients could be offered a provisional same day service, where they were booked on the same day for an appointment, assessment, ultrasound scan and received treatment.

• Complaints were responded to appropriately and within service agreed timescales.

Is this a well led service?

• Senior managers had a clear vision and strategy for this service but some staff were unable to demonstrate the service’s common aims with us during individual interviews.

• There was strong local leadership of the service and quality of care and patient experience was seen as the responsibility of all staff.

• Staff were proud of the service they provided and were aware of the requirements of DH RSOPs and RCOG’s Clinical Guidelines.

• Staff felt supported to carry out their roles and were confident to raise concerns with their managers.

• Patients were encouraged to provide feedback through a satisfaction survey, and the results were positive.

• Clinical governance was well managed and DH documentation had been completed and submitted correctly.

• Comments, concerns and complaints were shared with staff.

We saw several areas of outstanding practice including:

• BPAS Luton offered a ‘provisional same day’ service, where patients could be booked on the same day for an appointment, assessment, ultrasound scan and receive treatment.

• The clinic could assist patients from Northern Ireland and overseas to access registered charities for assistance with payment for treatments.

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

Action the clinic SHOULD take to improve:

• Review the online policies and procedures to ensure all policies are up-to-date and old versions are archived.

• Ensure staff do not keep personal copies of patients’ confidential information.

• Ensure staff wear appropriate personal protective equipment.

• Ensure the laundering of theatre clothing complies with the Association of Perioperative Practice 2011.

• Ensure stock levels are checked comprehensively and stock rotation ensures that no out- of-date supplies are present in treatment rooms.

• Ensure that resuscitation equipment is stored securely when not in use and is not easily accessible to visitors to the clinic.

• Ensure up-to-date copies of the British National Formulary (BNF) are available at the clinic so that any prescribing reflects latest guidelines. The BNF is a pharmaceutical reference book.

• Review the process for checking the call bell systems to ensure they are in working order.

• Review systems and processes in place to minimise the risk of exposure to verbal abuse and threatening behaviours, so that staff working at BPAS Luton clinic feel safe at all times.

Professor Sir Mike Richards

Chief Inspector of Hospitals