BPAS Northampton Central is operated by British Pregnancy Advisory Service (BPAS). BPAS is a not-for-profit organisation with 73 treatment units across the UK. Services are commissioned to provide termination of pregnancy services, support, information, treatment and aftercare for patients seeking help with regulating their fertility and associated sexual health needs.

BPAS Northampton Central has contracts with two clinical commissioning groups to provide a range of services by doctors and nurses to patients living in Northamptonshire. This includes:

• Pregnancy testing.
• Unplanned pregnancy counselling.
• Early medical abortion ( EMA).
• Surgical abortion under local anaesthetic with or without conscious sedation.
• Abortion aftercare.
• Sexually transmitted infection testing and treatment.
• Contraceptive advice.
• Contraception supply.

Most patients are funded by the NHS, whilst some patients choose to pay for services themselves.

We inspected this service using our comprehensive inspection methodology and undertook an announced visit at BPAS Northampton Central on 1 May 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate termination of pregnancy services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• There were clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from avoidable harm and abuse. This included use of the five safer steps to surgery checks designed to prevent avoidable mistakes.
• Emergency equipment was easily located, accessible, and ready for use. Staff were trained to use it.
• Staff were trained and competent to monitor and act upon any deterioration in the patient’s condition and used an early warning score to aid the process.
• There was a business continuity plan in the event of emergencies. Staff understood their individual responsibilities in managing this.
• All department of health documentation was completed and monitored in accordance with the required standard operating procedures.
• Policies were regularly reviewed to ensure they reflected the most up-to-date national guidance.
• Learning and development was completed by staff to develop and maintain their knowledge, skills and competencies.
• The service offered face-to-face and telephone counselling to patients before and after their termination of pregnancy.
• There was good collaborative working with external agencies, such as the NHS and the local safeguarding team.
• Staff gained informed consent in line with department of health guidelines through each part of a patient’s treatment pathway.
• Staff cared for patients with compassion, kindness, dignity and respect.. Patients told us that staff provided them with information at each visit, and that they felt included and involved in all aspects of their treatment and care.
• All consultations were carried out in private rooms with no interruptions from other patients or staff.
• The service worked within the recommended department of health time frames from decision to proceed to termination of pregnancy.
• Consultations were undertaken either face to face or by telephone with flexibility to re-arrange appointments at very short notice to meet the needs of patients.
• There was a clearly defined referral process for patients who required specialist services.
• A telephone advice line was provided 24 hours a day and seven days a week.
• Patients’ needs were assessed and assistance for patients with a learning disability or complex needs was available. The premises were accessible to wheelchair users or people with limited mobility.
• There was an active review of complaints in accordance with BPAS policies and required time frames.
• The service had risk management and governance systems in place to ensure it complied with the statutory requirements of the Abortion Act.
• There was a clear leadership structure. Managers were accessible and visible and held a regular presence at the treatment unit.
• The local leadership team was knowledgeable about the service’s performance, priorities, and the challenges it faced. The team was taking some action to address them.

However we also found the following areas where the provider needed to improve:

• There was no training provided for life support for patients under the age of 18. However, staff were able to describe their specific responsibilities in managing an emergency involving a patient under the age of 18.
• Female genital mutilation (FGM) was not routinely risk assessed or discussed with patients over 18.
• Medicines were not always securely stored.
• Patient group directions (PGDs) were used to supply and administer medicines for cervical preparation in surgical abortion. PGDs should ensure that it contains all relevant information to administer this medication.
• Privacy was limited in the recovery area due to the close proximity of recliner chairs.
• Staff did not make women aware about how information from the HSA4 form was used to inform the department of health when an abortion had been performed was used for statistical purposes.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region), on behalf of the Chief Inspector of Hospitals