Is the service safe?

• Authorisation for the supply and administration of medicines under patient group directions (PGDs) was not always carried out or documented in line with national or local guidelines.
• Cleaning schedules and checklists to monitor cleaning standards were not in place, and the national colour coding of cleaning equipment was not followed.
• Safety and maintenance checks were not carried out on all equipment used for the diagnosis and management of patient treatment and care.
• There was limited use of systems to record and report safety incidents between January 2015 and December 2015. However, we saw improvements had been made since the reporting period, and that the learning and actions required from incidents was shared with the staff and with other BPAS treatment units.
• The approach to anticipating managing day-to-day risks to people who used the service was reactive rather than pro-active, and tended to be led at a regional or corporate level rather than locally managed. Opportunities to prevent or minimise harm were missed.

• Patient records were stored securely, were legible and complete.
• All the patients undergoing termination of pregnancy were assessed for venous thromboembolism (VTE) to determine their individual risk of developing blood clots.
• There were sufficient numbers of suitably trained staff available to care for patients.
• Arrangements were in place to manage emergencies and transfer patients to another health care provider where needed and were known to all staff.

Is the service effective?

• Care took account of national best practice guidelines.
• The exception was the use of simultaneous administration of abortifacient drugs for early medical EMA, which is outside of current Royal College of Obstetrician and Gynaecologist (RCOG) guidance. We saw that a robust governance system was in place and had been followed to introduce this treatment option.
• The complication rate for simultaneous administration was approximately double that for medical EMA treatment when medicines were administered separately.
• Policies were accessible for staff.
• Patients were offered pain relief, prophylactic antibiotic treatments and post-termination of pregnancy contraceptives.
• Staff annual appraisal rates did not meet the organisational target of 100%.
• Counselling staff participated in group counselling supervision.
• The BPAS Aftercare Line, a telephone service, was accessible to patients 24 hours a day and for seven days a week.

Is the service caring?

• Staff were caring and compassionate and treated patients with dignity and respect.
• During the initial assessment, nurses and midwives explained to patients all the available methods for termination of pregnancy that were appropriate and safe. Staff considered gestational age and other clinical needs whilst suggesting these options.
• 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?

• 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.

• Patients were able to attend other local BPAS clinics for treatment if Finsbury Park was closed.

• The clinic did not offer surgical treatment and patients who chose this option were referred for treatment at another BPAS unit in London.

• There was a fast track appointment system for patients with a higher gestational age or complex needs.

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

• Patients were provided with information to help them to make decisions.

Is the services 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. However, local risks were not always identified or acted upon by people with the authority to do so.
• The culture within the service was caring, non-judgemental and supportive to patients. Staff spoke positively about the need for and value of the service to patients.
• Staff felt supported by their treatment unit manager and regional operations director.

People attending the service were given information which enabled them to make decisions about their care and treatment. Consent was always obtained prior to any procedures being carried out.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that people had risk assessments and treatment plans. There were appropriate arrangements in place to deal with medical emergencies.

We saw the provider had clear safeguarding policy in place which meant there was guidance to staff about how people were protected. We spoke to who demonstrated they had a clear understanding of their responsibilities to safeguard people using the service.

We checked the management of medicines and were satisfied that medicines were being managed appropriately.

We saw the organisation had appropriate recruitment procedures in place and all checks had been undertaken and were satisfactory before staff were allowed to start work. Staff told us they received good support from the organisation to help them undertake their roles.

We used a number of different methods to help us understand the experiences of people using the service, this included talking to staff and reviewing peoples feedback about the service.This was because the people using the service were anxious about their appointment or planned treatment and they were not able to tell us about their experiences. Peoples feedback included comments such as "the staff were so kind, understanding and professional'

Staff were observed to be welcoming but discreet when greeting people ensuring privacy and dignity were respected.

Peoples needs were discussed and risk assessed with them prior to their treatment to ensure their care was delivered safely and meet their individual requirements. People given time to consider whether to have treatment and appropriate information to allow them to make an informed decision.

Suitable arrangements were in place to ensure people using the service were safeguarded against the risk of abuse. The quality and safety of the service was continuously monitored by the provider through the use of audits and people's feedback . Staff were properly trained supervised and supported to provide care and treatment to people using the service.