BPAS Cannock is part of the provider group British Pregnancy Advisory Service (BPAS).

The service is registered as a single specialty termination of pregnancy service. BPAS Cannock provides a range of termination of pregnancy services for early medical abortion (EMA) up to nine weeks pregnancy, medical abortions (MA) between weeks 9-10 pregnancy and surgical abortions up to 15 weeks and 6 days gestation. Surgical terminations are carried out using general anaesthetic and vacuum aspiration. The service also provides pregnancy testing, unplanned pregnancy counselling/consultation, abortion aftercare, sexually transmitted infection testing, contraceptive advice, contraception supply and vasectomies.

We carried out this announced comprehensive inspection on 14 May 2016, as part of our independent healthcare inspection programme. The inspection was conducted using the Care Quality Commission’s new methodology. The inspection team included three inspectors.

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:

Are services safe at this service?

• 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.
• The service had sufficient numbers of suitably trained staff available to care for patients. However, due to some mandatory training being completed within the NHS, BPAS did not always have formal records of completion.
• The service used the World Health Organisation (WHO) Five Steps to Safer Surgery to minimise risks to patients having surgical operations.
• There were reliable systems, processes and practices in place to highlight and safeguard patients from abuse.
• Arrangements were in place to manage emergencies and transfer patients to another health care provider where needed.

Are services effective at this service

• Staff generally provided care in line with national best practice guidelines.
• The provider monitored complication rates. Between January and April 2016, BPAS Cannock recorded zero complications for surgical treatments. Out of 171 simultaneous medical abortions, seven minor complications were recorded. Of the five non-simultaneous medical abortions, zero complications were recorded for this time period.
• There were appropriate arrangements in place to record patients’ written consent including patients less than sixteen years. However, we saw that information regarding the slightly raised risk of complications arising from simultaneous administration of abortifacient medication was not verbally discussed when patients’ chose this treatment.
• The service employed medical doctors including surgeons and anaesthetists under practice privileges at BPAS Cannock. Doctors provided evidence of General Medical Counsel (GMC) registration, indemnity insurance, qualifications and evidence of annual appraisal / revalidation to the provider. This ensured doctors were suitably experienced and qualified to undertake procedures at BPAS Cannock.

Are services caring at this service

• We observed that staff treated patients in a very caring, compassionate and supportive manner. Staff responded to patient’s individual needs in visibly person centred way.
• Patients consistently reported that the care they had received had been to a very high standard and staff were kind, helpful and non-judgemental.
• The service used a patient satisfaction survey called ‘Your Opinion Counts’. Analysis of feedback from the survey between April 2015 and December 2015 showed an overall satisfaction with care of 9.7 out of ten. The survey identified that 99% of patients surveyed would recommend the service (225 patients).

Are services responsive at this service

• Patients could book appointments through the BPAS telephone booking service, which was open 24 hours a day throughout the year. This also enabled patients to choose the location they attended.
• There was a fast track appointment system for patients with a higher gestational age or complex needs.
• There were appropriate systems in place to raise and act upon concerns and complaints within the organisation.
• BPAS Cannock used Big Word, a telephone interpretation service, for those patients who did not speak English.

Are services well led at this service

• Staff displayed the values and expected behaviours of the service.
• The culture within the service was caring, non-judgemental and supportive to patients.
• Staff felt supported by the manager and regional operations director.
• There were effective corporate governance arrangements to manage risk and quality. This included an audit programme and an established system to cascade learning. The provider did not always identify local risks such as the raised risk of retained products of pregnancy associated with simultaneous administration of EMA medications. However, following the inspection we were assured that the treatment manager had received training, and was maintaining a local risk register.
• We observed in medical records checked that terminations were only carried out following agreement of two doctors in line with the Abortion Act 1967.
• The provider ensured that services were monitored and audited in line with Required Operating Procedures (RSOP) 16. This included monitoring waiting times, rates of complications, failure rates, patient experience and complaints and critical incidents.

We saw there were areas where the provider needed to make improvements.

• The provider must ensure that explicit information about the effectiveness of medicines to induce abortion given at the same time (also called ‘simultaneous’ abortifacient medicines) is identified during the consent process to ensure that patients were able to provide ‘informed consent.

In addition the provider should:

• Ensure that, when staff receive mandatory training from another provider, there is confirmation of this available.

Professor Sir Mike Richards

Chief Inspector of Hospitals

During this inspection we spoke with ten people who used the service and five members of staff. We also spoke with the registered manager.

People who used the service told us that they had received plenty of information about the service and the options they had.

We observed that staff maintained people’s dignity and that people were cared for sensitively and compassionately. One person we spoke with said: “Could you thank them for me. The staff here have been amazing all the way through this. They have all been so kind to me”.

We found that the unit was clean and tidy throughout. We observed staff cleaned trollies and chairs thoroughly before reuse. Suitable steps were taken to prevent the risk of infection.

Medicines were kept in locked cabinets. However the medicine cabinets were situated in an open bay within the day case unit. Staff assured us that this was a staff only area of the unit and that the day case unit was properly locked when not in use.

The service carried out suitable quality monitoring and auditing to monitor the quality of service offered and to include feedback from the people who used it.

We spoke with four people who used the service and seven members of staff. This included a member of the medical team and a member of the administration team.

We saw that people had access to information about every stage of their treatment. Clear and valid consent processes were in place and best practice guidelines were followed where required. One person we spoke with told us, “They don’t lie to you”. We saw that detailed booklets in a format that was suitable for people of all abilities were provided. One person we spoke with told us, “They gave me plenty of information and support”.

We saw that people were cared for sensitively both individually and collectively. One person we spoke with told us, “They have all been really friendly”.

We saw that staff had suitable opportunities to continue their professional development. One member of staff told us, “It’s a great company to work for. They are always offering us training opportunities”.

We found that the service conducted a wide range of audits to monitor the quality of service delivered. We saw that there was a proactive feedback system and that people were encouraged to raise concerns or complaints if they wanted to.

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.