We spoke with three managers, three other members of staff, and three women who used the service. No men used the service on the day of our visit, and therefore we were not able to speak with them. We did not visit the Hemel Hempstead centre on this occasion.

People were protected against the risks of receiving inappropriate or unsafe care. Care and treatment met the service users' individual needs, and reflected published research evidence and good practice guidance.

The premises were clean and hygienic.The prevention and control of infection was in accordance with guidelines issued by the Department of Health. People were protected against identifiable risks of acquiring a health associated infection.

There were arrangements in place to ensure that people were protected against the risks associated with the unsafe use and management of medicines.

There were effective procedures in place to ensure that people employed to carry out the service were of good health and good character, and had the necessary qualifications, skills and experience for the work to be performed.

Feedback about the quality of the service was provided by people who used the service and staff, and through audit of practice, and outcomes were acted upon.

One patient who had used the service told us that “the first time she spoke to the nurse she felt relaxed”. She told us that it was a good experience. She added that she felt she had been treated as an individual, as the member of staff was interested in her and what she did.

Patients who use the service told us that their privacy and dignity was maintained throughout. All consultations were carried out in individual consulting rooms.

Staff told us they received an annual appraisal and undertook mandatory training. A part of the mandatory training included the completion of safeguarding training for children, young people and adults at risk.

We found evidence that the unit assessed and monitored the quality of services effectively.

We spoke with one patient who said that “the consultation had been perfect”. She added that staff had been respectful and had treated her as an individual.

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.

Marie Stopes International (MSI) Central London is part of the provider group Marie Stopes International, a not for profit organisation that provides termination of pregnancy service.

MSI Central London was registered with the Care Quality Commission (CQC) in October 2010.

Regulated services are provided at Whitfield Street, Central London and at three early medical units (EMUs), known as satellite clinics: Watford, Hemel Hempstead, and The Whittington Hospital in London.

Services include: early medical abortion (EMA) up to 9 weeks and 3 days, surgical termination of pregnancy (ToP) without anaesthesia or with sedation anaesthesia up to 11 weeks and 6 days, consultations, ultrasound scans, counselling and support, family planning and advice on contraceptive options, and contraception. In addition, vasectomy (male sterilisation) performed under local anaesthetic, well woman screening, well man screening, and sexually transmitted infection testing and screening are also provided.

The organisation provides services to adults and young people above the age of 15. 

We had previously inspected MSI Central London in April 2016 when we highlighted numerous concerns. This inspection was carried out to follow up on any previously raised concerns and to assess any improvements made by the provider.

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? Where we have a legal duty to do so we rate services’ performance against each key questions. However, we have not provided a rating for this service.

We regulate termination of pregnancy services, but CQC does not currently have a legal duty to award ratings for those services that provide solely or mainly termination of pregnancy (ToP) services. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

Since our last inspection in 2016, we have noted the following improvements at MSI Central London: a new system for incident reporting, improvements to the environment, replacing carpets with washable flooring, the implementation and monitoring of surgical safety checklists, the management of early warning scores in deteriorating patients, improved clinical governance and monitoring of patient outcomes, risks and complaints, and improved communication with locality managers and the MSI executive management team.

We told the provider MUST take following actions to meet the regulations:

• The provider must ensure fire safety checks and evacuations are carried out.
• The provider must ensure there are processes in place to ensure that equipment is serviced and maintained in line with manufacturer’s guidance for both clinical and non-clinical equipment.

We also said the provider SHOULD:

• Carry out and act upon investigation and analysis of staff satisfaction.
• Ensure patient feedback is consistently obtained and used to improve the service.
• Enable all staff to complete training that is necessary for them to fulfil their role(s), including mandatory training and relevant skills training.
• Ensure there are arrangements to monitor and reconcile the stock of medicines.
• Ensure patients' privacy is respected at all times including when they are in the waiting area and recovery lounge. 
• Ensure all staff, including medical staff, are appraised regularly and suitable records of revalidation and appraisal are kept.

Professor Edward Baker

Chief Inspector of Hospitals