British Pregnancy Advisory Service (BPAS) provides a termination of pregnancy service in Southampton, under contract with an NHS trust. This contract commenced in January 2012. The contract permits BPAS Southampton to use premises shared with the NHS sexual health service.

BPAS Southampton provides a range of termination of pregnancy services. These include pregnancy testing, unplanned pregnancy counselling, early medical abortion, abortion aftercare, sexually transmitted infection testing and treatment, contraceptive advice and contraception supply. The provider had recently stopped offering surgical abortions at this location as part of an area wide reconfiguration.

We carried out this comprehensive inspection in April 2016 as part of our second wave of termination of pregnancy service inspections. The inspection was conducted using the Care Quality Commission’s new methodology. We did not provide ratings for this service.

The inspection team comprised two inspectors and a specialist advisor. The advisor was both a registered midwife and divisional director of midwifery and nursing at an NHS Hospital. The inspection took place on 27 April 2016.

Our key findings were as follows:

Safe

• There were processes in place to report, investigate and monitor incidents. Staff understood their roles and responsibilities in relation to reporting of incidents.
• Staff had completed training in safeguarding adults and children and understood how to identify and report concerns. These included concerns relating to child sexual exploitation and female genital mutilation.
• There were enough staff with the right mix of skills to deliver the agreed services at BPAS Southampton.
• The treatment unit was visibly clean, staff followed policies, and guidelines in relation to hand hygiene and infection control audits. There was a high level of compliance with infection control and environmental audits.
• Staff ensured equipment had been safety checked and carried out appropriate checks. Medicines were managed safely.
• Staff created clear, legible records and audits showed a high level of compliance a selection each month. Records were securely stored.
• Every woman attending the clinic completed a medical history and staff carried out a comprehensive risk assessment to ensure they were suitable for an early medical abortion.

Effective

• Staff provided care and treatment that took account of best practice policies and evidence based guidelines. The service had agreed standards of delivery and monitored performance against key indicators. Policies and procedures were based on Royal College of Obstetricians and Gynaecology (RCOG) guidance and the Required Standard Operating Procedures (RSOP) guidance from the Department of Health.
• The provider trained staff for their roles and clinical staff had competency passports to demonstrate their skill levels. Staff received annual appraisals and regular ‘job chats’ with their managers.
• There was effective multidisciplinary working between the staff at Southampton’s nurse-led unit and BPAS doctors based in other locations. Staff had built effective links with NHS staff based at the host location, local safeguarding leads and the voluntary sector.
• Data was submitted monthly on 11 key standards, relating to the quality and safety of the service. Southampton unit showed compliance with all standards for the past year.
• Consent from patients was appropriately obtained, including those under 18 and children under 16 years of age. This included a check that patients and children made independent, informed choices about their treatment.

Caring

• Staff provided care with compassion and sensitivity and offered patients the time they needed to make a decision.
• Staff were non-judgemental and provided person-centred care. They were careful to support patients to make their own decisions based on an understanding of options.
• Patients said they were treated with privacy and dignity and that said staff involved them and their partners appropriately.
• The service provided after-care counselling support, or signposted patients to specialist services.

• The service was planned and delivered to meet the needs of the local population, based on the analysis of activity with commissioners. Both self-referrals and referral form professionals were accepted. Patients were able to access services in a timely manner, in line with the recommended target of 10 days from initial contact to treatment.
• Staff used an electronic system for doctors to sign the HSA1 forms remotely. This meant that staff could provide treatment promptly, particularly when patients opted for a simultaneous early medical abortion (EMA).
• The BPAS guide provided information about the disposal of pregnancy remains, although as patients who had an EMA passed their pregnancy at home, staff did not routinely discuss options for the disposal of pregnancy remains.
• People were given information how to complain and raise concerns, although there had been no formal complaints in the past year.

Well led

• Staff were passionate about improving services for patients and understood the BPAS values and aims.
• There was an effective governance framework for reviewing the quality and safety of care. This also promoted a quality and safety culture. This structure supported a flow of information across the region and learning from complaints, incidents and feedback from clients. A local risk register to identify and mange local service specific risks was in place
• There were robust systems to ensure the service adhered to legislation relating to abortions. The certificate of approval for carrying out termination of pregnancy (issued by the Department of Health) was on display in the waiting area.

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

The provider should:

• Keep patients informed of the most current outcome information when they making a decision about the type of medical abortion to have.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We did not speak with people who were receiving a service as they were in the middle of treatments and this may have caused unnecessary distress. We saw people were treated with respect and were seen having relaxed conversations with staff indicating they felt at ease and could ask questions about their care. We saw quality review surveys people had completed which showed they were very happy with the service they had received.

People who used the service understood the care and treatment choices available to them and received written information to support their decision making. They experienced effective, safe and appropriate care and treatment which meet their needs and protected their rights. The provider had the necessary systems in place which ensured people were cared for in a clean and hygienic environment. People were cared for by staff who had been appropriately recruited and completed relevant training to deliver care and treatment safely and to an appropriate standard. Records were stored safely and people’s right to confidentiality were protected.

We found that people were given all the information they needed to make a decision about their care. One person said ‘’they explained everything to me because I knew nothing.’’

The clinic provided a nurse led early medical termination service. We reviewed six care records and noted that they were person centred. People were always given the time to reflect on and review their decision to proceed with treatment. Records showed that people had been involved in decision making throughout the process.

We observed that people were treated with professionalism and discretion. One person told us ‘’they were friendly and kind.’’

Safeguarding policies and procedures were in place and accessible to staff. Staff told us they had received up to date training. In discussion with staff it was evident that they were well versed in the importance of safeguarding.

Staff told us they felt supported by the provider and that they had received relevant training to support them in their roles. We were told that the registered manager had not been in post since 2011. The new clinic manager, appointed July 2012, was awaiting the outcome of her application for registered manager.

Staff told us that the provider had a number of systems in place to assess and monitor the quality of services provided. We were told by staff that there were regular audits. The provider may find it useful to note that there was no information at the clinic to support this.