People using the service were provided clear information on treatment options and follow up care. Consultations were conducted privately and provided advice and counselling as well as medical examination and treatment. We saw that equality and diversity had been taken into account.

Signed consent to treatment was obtained in all cases after consultation and after an informed decision had been made about treatment.

We spoke to one person who told us that she felt well informed and was given clear explanations about treatment options and risks, follow up care and contraception. She told us that all the staff at the clinic were caring and supportive, saying, “They’re very kind, really nice. They give you all the information you need”

There were suitable arrangements for clinical emergencies with rapid response alarms, staff training in life support and appropriate fire safety procedures at the premises.

Infection control policies and procedures were in place to monitor and audit infection control and minimise the risk of infection to those using the service, and adequate standards of hygiene and cleanliness were apparent.

Staff had appropriate induction and training with a system of regular staff appraisals.

The provider had systems in place to monitor and assure the quality of the service, including regular audits, satisfaction surveys and a clear complaints procedure. Results of a recent survey showed very high levels of satisfaction with the service.

During our visit we spoke with one person who uses the service and six staff. We also looked at feedback the service had received from people who had completed a survey about their experiences of using the service. The service asked people to complete this prior to leaving the centre following their treatment.

Feedback from people who use the service was that they generally felt the staff were friendly and made them feel comfortable. They said that their treatment was explained to them and they were informed of any risks involved. We saw staff being respectful towards people and speaking to people calmly and discreetly.

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.

Patients using the service did not wish to speak to us when we carried out the inspection. We have therefore used our observations and patient feedback and responses in the Provider satisfaction survey to give their views of the service.

The majority of patients were satisfied they were treated with dignity and respect; one person commented “I was treated with the utmost respect from all members of staff”. Patients did feedback that they experienced long waits for their appointments and treatment which caused them additional anxiety.

Patient feedback on the service included statements on how safe and supported patients felt during their care and treatment at the centre. They made comments such as “they made me feel very at ease, explained everything and were very compassionate” and “all staff are very professional and friendly”.

The Marie Stopes West London Centre is operated by Marie Stopes UK International, which is a specialist reproductive healthcare organisation and registered charity. The West London centre is based in Ealing.

The service provides medical and surgical termination of pregnancy services, screening for sexually transmitted diseases, contraception advice and counselling.

The service provides surgical terminations up to 23 weeks plus six days gestation, and medical abortions up to nine weeks plus four days gestation. They also perform non-scalpel vasectomies. The service treats NHS and private patients.

We inspected this service using our comprehensive inspection methodology under Section 60 of the Health and Social Care Act 2008. The provider was given 23 days’ notice of this inspection. We carried out the announced inspection on 6 and 7 July 2017. We also visited one early medical pregnancy unit (EMU) providing satellite services at Wembley on 6 July 2017. At the time of our inspection, the operations manager was in the process of registering as the registered manager with the CQC.

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.

CQC undertook enforcement action, following an inspection of the governance systems at the MSI corporate (provider) level in late July and August 2016. There were several breaches in regulation that were relevant to this location, which we have followed up as part of this inspection.

The breaches were in respect of:

Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment

Regulation 17 HSCA (RA) Regulations 2014 Good governance.

Services we do not rate

We regulate termination of pregnancy 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:

• Processes and procedures for daily infection prevention and control (IPC) were in place with regular cleaning checks introduced.
• The policies in place to ensure optimum standards of care and patient safety had been updated and were in line with the latest guidance. Staff were able to access these easily.
• Staff on the ward were passionate about their job and believed in what they did. They spoke to patients in a manner in which they would like to be spoken to and were caring and compassionate.
• Staff communication with one another and with the public was good. Staff had a good understanding of safeguarding and female genital mutilation (FGM).
• We found management responsive to issues raised at the inspection and we found that managers had made improvements to processes since the last inspection.
• A revised audit programme had been introduced since the last inspection. We saw individual examples of improvements made and team meeting minutes included discussions of audit scores and arising actions.

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

• Staff had variable knowledge of the duty of candour.

• Some staff expressed concern about the availability of training.

• Usage of the World Health Organisation (WHO) and ‘five steps to safer surgery’ checklist was not always consistent.

• Although improvements had been made to local governance this was hampered by some disjointed and poor communication from corporate management.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements to help the service improve. We issued a requirement notices in relation to the World Health Organisation (WHO) and ‘five steps to safer surgery’ checklist. Details are at the end of this report.

Amanda Stanford

Deputy Chief Inspector of Hospitals