Staff reported incidents and incidents were logged, investigated and learned from. The quality and safety of the services provided at the clinic were checked regularly by the manager who had to send this information to senior managers and the clinical team which is then reported to the Board that ran the organisation.

We found services at the clinic were effective. Patient’s care and treatment was based on up to date good practice. Staff followed BPAS policies and procedures that supported legal requirements.

Managers regularly checked clinical practice to maintain good standards of patient care and continuously improve outcomes for patients. Doctors and nurses followed recognised safe surgical procedures. Staff employed at the clinic including doctors, nurses, administrators and receptionists were competent, well trained and experienced.

Staff gave patients good information on which to base their decisions and give informed consent. They spent time explaining options and procedures and giving advice on contraception. However, we also found it was not made clear enough to patients the increased risk of abortion failure posed by some methods. Also, there was not a clear mental capacity assessment protocol in practice for women with learning disabilities or help to access an independent advocacy service.

All staff treated patients and those close to them with kindness and respect and put them at ease. Nurses asked about and respected patients’ wishes about sharing information with a partner or family members or carers and nurses checked along the way that patients were sure of their decision. A booklet called ‘My BPAS Guide’ was given to every BPAS patient and BPAS offered on going counselling support to all patients with patients under 18 years old counselled before treatment as a matter of policy.

The clinic opened four days each week and was near to a train station and local bus routes. Patients could book appointments through a national telephone service that ran a flexible appointment system to offer as much choice as possible to patients. Patients were generally offered an appointment within five days and treatment within ten working days of first contact with the service. The clinic had facilities on the ground floor and translation services were available. There was a free on going counselling service for patients. However support offered to patients with a learning disability to understand and give informed consent to procedures was limited.

The clinic was well run by a manager registered with the CQC and staff were committed to the BPAS vision of women being in control of their fertility. The service was patient centred and caring. There was an effective governance framework for reviewing the quality and safety of care. Performance and quality data such as incidents, complaints, policy and legislative updates were discussed at national and regional meetings. However

it was not made sufficiently clear to patients that consenting to the simultaneous administration of abortifacients could increase the risk of failure for the patient.

We spoke with two people who were using the service on the day of our inspection and the staff that supported them. People told us that they were happy with the care, treatment and support they received at the clinic. A person who was using the service told us, “I feel that my appointment has not been rushed. Staff gave me extra time to recover because I did not feel well.”

People told us that they had been fully involved in the decision to use the service. They told us that they had made decisions about the treatment they received after staff had explained their care, treatment and support choices to them. People also told us that they had been given time to consider the information prior to treatment so that they had the option to withdraw their consent if they wanted to. A person who was using the service told us, “Staff took the time to answer any questions that I had.”

People told us that they were listened to and treated with respect by staff working at the clinic. A person who was using the service told us, “The staff have all been very kind to me. They have made a difficult situation as easy as it can be.”

Robust arrangements were in place for staff recruitment and on-going checks of staff’s eligibility and fitness to work at the clinic were undertaken. This meant that people using the service could be confident that staff had been assessed as being suitable to work at the clinic.

People told us that they would be confident to raise any concerns with the clinic staff, should the need for this arise. The number of recent complaints received was low and we found that these had been handled and managed in a timely and appropriate manner. A person who was using the service told us, “I would talk to any of the staff here if I had any concerns.”

During our inspection, we asked the commissioning team about the quality of service provided at the clinic. They told us that they did not have any concerns about the quality aspects of the service.

People using the service told us that they were happy with the care they received at the clinic. They told us that their care and support needs were being met. Comments included: “I have had an excellent service here. Everyone has been so kind,” and “Staff have explained about my procedure and the expected length of time that I will be at the clinic today.”

People told us that staff explained their care, treatment and support choices to them. This meant that they had the opportunity to be involved in making decisions about their care. A person using the service told us “They explained everything in depth. Staff put my mind at ease about everything.”

People told us that they were listened to and treated with respect by staff working at the clinic. They told us that their dignity had been respected.

During our inspection, we asked the commissioning team at the local primary care trust about the quality of the service the clinic provided. They did not have any information to share with us about the quality aspects of the service.

People who used the service told us that they were happy with the care they received at the clinic and that their care and support needs were being met. They told us that staff explained their care, treatment and support choices to them and that they had the opportunity to be involved in making decisions about their care. People told us “The staff have kept me informed about what is going on and have given me enough time to change my mind if I want to” and “they gave me different choices of contraception and explained the side effects”.

People told us that they were listened to and treated with respect by staff working at the clinic. They told us that their dignity had been respected and that staff were available when they needed them. People told us “I did not feel like I lost my dignity”, “they have always been checking on me today, there are plenty of staff around” and “there are lots of female staff which is good”.

People told us that the clinic was clean and they had no concerns about cleanliness.

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.