BPAS Leicester City is operated by British Pregnancy Advisory Service (BPAS). BPAS is a not-for-profit organisation with 73 treatment units across the UK. Services are commissioned to provide termination of pregnancy services, support, information, treatment and aftercare for patients seeking help with regulating their fertility and associated sexual health needs.

BPAS Leicester City has contracts with three clinical commissioning groups to provide a range of services to patients living in Leicestershire. These include;

• Pregnancy testing

• Unplanned pregnancy counselling/consultation

• Medical abortion

• Surgical abortion under local anaesthetic/conscious sedation

• Abortion aftercare

• Miscarriage management

• Sexually transmitted infection testing and treatment

• Contraceptive advice

• Contraception supply

Most patients are funded by the NHS, whilst some patients choose to pay for services themselves.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection of BPAS Leicester City on 19 July 2018. We did not inspect the satellite location at BPAS Solihull.

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? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate termination of pregnancy services but at the time of announcing the inspection we did not 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. At out next inspection of this service we will have the legal duty to rate.

We found the following areas of good practice:

• There were clearly defined systems and processes to keep patients protected from avoidable harm, including appropriate levels of staffing, infection control and the use of a surgical checklist.

• Staff understood their roles and responsibilities regarding safeguarding vulnerable adults and children, had received appropriate levels of safeguarding training and could tell us about examples of where they had identified and raised concerns.

• Staff kept appropriate records of patients’ care and treatment. Paper and electronic records were clear, up to date and available to all staff providing care.

• Staff were trained to use the emergency equipment which was readily accessible and ready for use.

• The treatment unit provided care and treatment based on latest evidence and national guidance and within the requirements of relevant legislation and monitored outcomes and audit data by use of a quality dashboard.

• Staff were supported to develop and maintain their knowledge, skills and competencies.

• Staff understood their responsibilities under the Mental Capacity Act 2005 and gained informed consent from patients at each stage of the patient’s care.

• Staff with different roles worked together as a team to benefit patients. Midwives, nurses and support staff supported each other to provide good care for patients.

• Staff understood and respected the personal, cultural, social and religious needs of patients and those important to them. Patients and their escorts we spoke with told us they were treated with dignity, kindness and respect.

• Staff provided emotional support to patients to minimise their distress and always respected patients’ privacy and dignity.

• Staff gave patients detailed verbal and written information to ensure they were well informed about their care and treatment.

• The services provided reflected the needs of the population served and mostly ensured flexibility, choice and continuity of care.

• Staff assessed patients’ individual needs and made adjustments for patients with complex needs.

• Complaints were reviewed in accordance with BPAS policies and timescales.

• There was a clear leadership structure. Regional managers were accessible and visible and regularly visited the treatment unit.

• Local leaders understood the performance, risks and priorities of the service.

• Staff were proud of the service they offered and there was a visible patient-centred culture.

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

• The admission process for patients attending the treatment unit was not robust.

• Although medicines were generally managed in a way that kept people protected for avoidable harm, there was no system of monitoring the temperature within the room where medicines were stored.

• Patients who used the service described the initial part of the process as slow and not all patients were happy with the choice of treatment they were able to access.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region), on behalf of the Chief Inspector of Hospitals