We spoke with four people who used the service and they told us they had experienced appropriate treatment and care when they visited the service. One person said, “The staff have been lovely, they really put me at ease and have reassured me throughout. They explained everything and even showed me a diagram. I know I have received the best treatment for me.” Another person said, “The staff are really nice. They have looked after me and made me comfortable.”

People who used the service were given appropriate information to help them understand their treatment. Before people received care or treatment they were asked for their consent. One person said, “They explained everything during the consultation and then went through everything again when I arrived for my treatment.”

People were protected from unsafe or unsuitable equipment because the provider had arrangements in place to make sure people had access to appropriate equipment during their care and treatment.

Appropriate checks were undertaken before staff began work. Staff we spoke with said the staff and management team worked well together and people who used the service were supported by suitably skilled and experienced staff.

People were supported by the provider to make comments about their care and treatment. Concerns and complaints were investigated and resolved where possible to their satisfaction.

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.

We spoke to people who used the service and looked at comment forms that people who use the service had completed. Most people were happy with the service they received. Comments included:

“Very good service, they went through everything at the consultation, all my options, choices and after care.”

“I wasn’t being judged or looked down on.”

“I have been looked after very well.”

“I was very happy with how I was dealt with by staff.”

“Staff were in no hurry to get me to leave until I felt ready.”

“I was extremely scared and they put me at ease.”

“The after care was really good.”

In general, comments received showed that people had confidence in the staff; that they felt safe and ‘in good hands’. They said:

“I have been given friendly and professional help.”

“The staff seem to know what they are doing, they have been able to answer every one of my questions.”

People said they thought the clinic was clean and tidy.

Some people had commented that waiting times at the clinic were too long and had also commented on the attitude of individual staff members as being ’cold’ and ‘rude’. We saw evidence that these comments were fully investigated and addressed as needed.

Leeds Centre is operated by Marie Stopes International. The service provides a surgical treatment room and eight day-case beds at its main centre location. Other locations, including early medical abortion units (EMU) and vasectomy units provide consultation rooms.

MSI Leeds provides medical and surgical termination of pregnancy services, pre and post termination counselling as well as contraception advice and screening for sexually transmitted diseases. The service provides early medical abortions (EMA) up to nine weeks and four days gestation and surgical termination of pregnancy up to 18 weeks and six days gestation. The service also undertakes non-scalpel vasectomies. The service treats NHS and private patients.

We inspected this service using our comprehensive inspection methodology and carried out the announced part of the inspection on 13 and 14 July 2017, along with an unannounced visit to the service on 28 July 2017.

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 question as outstanding, good, requires improvement or inadequate.

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.

Since our last inspection in 2016, we have noted the following improvements at MSI Leeds Centre:

• A new system for incident reporting and the implementation and monitoring of surgical safety checklists
• The introduction of early warning scores for detecting deteriorating patients
• Improved clinical governance and monitoring of patient outcomes, risks and complaints.
• Improved communication with locality managers and the MSI executive management team.

We found the following areas of good practice:

• Record keeping and risk assessments were of a consistently high standard.
• Staff we spoke with demonstrated they understood the principles of safeguarding adults and children and knew what actions they needed to take in cases of suspected abuse.
• World Health Organisation (WHO) and five steps to safer surgery checklists were completed for all patients undergoing surgical procedures.
• There were locally agreed and up to date policies and standards that referred to evidence based practice and against which performance was audited.
• Records indicated that pain was assessed and treated in accordance with national guidelines.
• Staff treated patients attending for consultation and procedures with compassion and respect, were non-directive and non-judgemental.
• We found the service to be responsive to meeting people’s needs and requirements.
• Complaints and concerns were acted upon and changes had been made to the service following comments from patients.
• Staff spoke positively about the changes to the local, regional and national procedures introduced by the management team since our 2016 inspection.
• Staff felt supported and valued by their managers and the organisation.

However, we also found the following issues that the service provider needs to improve:

• At the time of inspection, nursing staff providing patient consultation had not received up to date training regarding contraception.
• Monitoring of mandatory training compliance via the training matrix was not effective, as the matrix was not kept up to date.
• Termination of pregnancy early warning scores (TEWS) to monitor and act upon any clinical deterioration had been introduced but we found this was not yet fully embedded

Following this inspection, we told the provider that it must take action to improve:

• The provider must enable all staff to complete training that is necessary for them to fulfil their roles. This includes contraception competence training and updates.

We issued the provider with one requirement notice. In addition, we told the provider it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)