We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming. We carried out this inspection to check on the care and welfare of people using the service.

We saw there was a range of information available about sexual health and terminations. This could be provided in different formats upon request. Interpreting services were available for people during any consultation and prior to any treatment.

People using the service told us the staff were friendly and approachable and spoke to them in a respectful way. They told us they felt the service delivered care in a way that met their needs.

People told us they had discussed the treatment options available to them and felt they were able to make informed choice. Records demonstrated people had consented to any treatment.

The staff had received the necessary checks to ensure they were suitable to work with people who may be considered vulnerable.

The visit was part of a responsive review programme of locations operated by Fraterdrive Ltd, following concerns raised in relation to record keeping and breaches of the Abortion Act 1967, at another location. We did not speak with people who used the service on this occasion.

National Unplanned Pregnancy Advisory Service Stoke is part of the provider group National Unplanned Pregnancy Advisory Service (previously Fraterdrive).

CQC registered the service in August 2012 as a single specialty termination of pregnancy service providing early medical abortion (EMA) up to a gestation of 63 days (nine weeks) and surgical abortion under local anaesthetic less than 70 days gestation. The service also provides pregnancy testing, unplanned pregnancy counselling and consultation, abortion aftercare, sexually transmitted infection testing, and contraceptive advice and contraception supply.

We carried out this announced comprehensive inspection on 8 and 15 June 2016, as part of the first wave of inspection of services providing a termination of pregnancy service. The inspection was conducted using the Care Quality Commission’s new methodology.

We have not provided ratings for this service. We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities it provides.

Our key findings were as follows:

Is the service safe?

• There were appropriate arrangements in place to highlight incidents and patient safety concerns. The provider had established systems to ensure that learning from incidents was shared throughout the organisation and staff group. Staff understood the principles of being open with patients when things went wrong.

• There were reliable systems, processes and practices in place to keep people safeguarded from abuse.

• Medicines were safely ordered, supplied, and stored in accordance with manufacturers’ instructions, and administered only when they had been prescribed for a named patient.

• There were sufficient numbers of staff available to care for patients.

• The service employed medical doctors including surgeons and anaesthetists under practice privileges. We saw that doctors who worked at the treatment unit had provided the relevant documentary evidence to demonstrate they were suitably experienced and qualified to undertake procedures at the treatment unit.

• There were suitable arrangements in place for staff mandatory training.

• Records were securely stored, well maintained and completed with clear dates, times and designation of the person documenting.

• The service used a World Health Organisation (WHO) Safer Surgical Checklist to minimise risks to patients having surgical operations. However, it had not been fully completed in one patient’s records of the seven we looked at.

• Arrangements were in place to manage emergencies and transfer patients to another health care provider where needed.

Is the service effective?

• Staff provided care in line with national best practice guidelines.

• Policies were accessible for all staff, were up to date, and kept under review.

• The National Unplanned Pregnancy Advisory Service (NUPAS) monitored complication rates, which were within expected ranges at the Stoke clinic.

• Staff appropriately offered patients pain relief, prophylactic antibiotic treatments and post-abortion contraceptives.

• There were appropriate arrangements in place to record patients’ written consent including patients who were less than sixteen years old.

Is the service caring?

• Staff were caring, compassionate, and treated patients with dignity, understanding, and respect.

• Patients considering termination of pregnancy had access to pre and post termination counselling, with no time limits attached, but were not obliged to use the counselling service.

Is the service responsive?

• Staff provided patients with the right level of information to help them to make decisions.

• The NUPAS advice line telephone service was accessible to patients 24 hours a day and seven days a week.

• The clinic was responsive to patient need and would open for additional sessions if needed.

• The service provided services at two locations, which made access easier for patients.

• The service did not provide treatment for patients with complex medical conditions but made referrals for them to be treated elsewhere.

• There were appropriate systems in place to raise and act upon concerns and complaints within the organisation.

• An interpreter service was available to enable staff to communicate with patients whose first language was not English.

Is the service well led?

• There were effective corporate governance arrangements to manage risk and quality. This included an audit programme and an established system to cascade learning.

• Staff felt supported by their registered manager and senior managers.

• The culture within the service was caring, non-judgmental and supportive to patients. Staff spoke positively about the need for, and the value of the service provided to patients.

• The service was active in engaging with staff, patients and the wider public.

• Staff spoke positively about the high quality care and services they provided for patients and were proud to work for NUPAS.

There were areas of practice where the provider needs to make improvements.

• The provider should consider systems of working that more fully mitigate the risk of managing an emergency within the small recovery rooms.

• The provider should ensure that the World Health Organisation (WHO) Safe Surgical Checklist to minimise risks to patients having surgical operations is completed.

Professor Sir Mike Richards

Chief Inspector of Hospitals