Staff were professional and discreet. People's privacy and dignity were respected through the use of private consulting, counselling and treatment rooms. People said "I was very happy with the treatment and care, it was good that I could have everything on the same day, I didn't want to wait any longer". People received information about treatment options available and the associated risks.

Care was planned with people to reflect their individual needs and ensure their well being and safety by trained and qualified staff. People said "the advisor was sensitive to my reasons for wanting a termination and they even moved my appointment time to help me".

Treatment was provided in a clean and appropriately equipped environment to enable staff to safely perform surgical procedures and minimise the risk of infection to people using the service. Services were routinely monitored and assessed to identify and minimise risks.

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.

People using the service receive good information booklets specially produced to help them understand what the service provides.

For those using the service encouragement is given to complete client feedback surveys following treatment. Results reported high satisfaction level for all those that have used the service.

The service was awarded the “You’re Welcome” quality accreditation in 2009. This involved input from young people that used the service making unannounced visits and doing “mystery shopper exercises”.

Professional staff are present from time of a peron's first consultations to give counselling and professional support, this enables one to consider all options available. People are able to decide what is right for them without feeling under pressure, make their own decisions; they are able to change their mind at any stage up to the time of the procedure.

Individuals are informed on the things they should do prior to prepare for treatment where anaesthetics are used.

People have confidence in the service; it has built a reputation of supporting people with unplanned pregnancies for many years.

We heard that the service delivers the outcomes expected of it, the following comments received from those that had experienced treatment, “Staff are so helpful and understanding,” “Sensitivity was displayed by all involved in my treatment”.

Improvements were required to ensure a safe service was provided and that effective leadership supported this. This was because:

• Procedures for recognising and responding to the deteriorating person had not been addressed in a timely manner.

• Infection prevention control (IPC) procedures did not adhere to The Health and Social Care Act 2008, Code of Practice on the prevention and control of infections and related guidance or associated national guidelines.

• Systems to manage and monitor the prevention and control of infection were not fully implemented and acted upon. The cleaning arrangements for the operating theatre were not specified and the floor was not to the required standard of appearance and cleanliness.

• Attention was required for recording accurate information in the controlled drug register.

• The storage of temperature controlled medicines and other medicines were not sufficiently safe.

• The local governance and quality monitoring processes did not always identify and take actions to address shortcomings where best practice was not being adhered.

• There was work to do to ensure effective working relationships across all staff grades, and that staff were able to see issues raised were addressed in a timely manner.

• There was some engagement with the public and staff but a top down approach meant it was less easy to be innovative at a local location level.

However, positive aspects of the service were identified with regard to safety, effectiveness, responsiveness, caring, and leadership. This included:

• Treatment was mostly delivered in accordance with professional guidelines, which were accessible to staff.

• Audit and outcomes for clients were monitored to ensure effective pathways were achieved.

• Training specific for individual roles was provided to staff to ensure they were able to meet the needs of the patients they cared for.

• Staff ensured vulnerable individuals were referred to external agencies in line with safeguarding protocols.

• Patients were offered appropriate pain relief, precautionary antibiotic treatments, and post-abortion contraceptives.

• The privacy, dignity, and respect of patients was fully considered in all aspects of the consultation and treatment pathways. Patients’ choices were mostly respected and they had a chance to speak with a nurse or midwife on their own to make sure they were not being pressurised to make a decision.

• Patients received information in a sensitive manner and were treated with kindness and compassion. Staff provided attention to their emotional and social needs.

• The service was accessible and afforded flexibility and choice.

• Complaints were minimal but where raised were responded to in a timely manner.

• Performance targets were generally indicative of an efficient and responsive service.

• Staff understood the organisational strategy and ethos.

• Organisational governance arrangements meant there was some oversight of performance, incidents, and complaints.

• Senior staff understood their responsibilities under the duty of candour regulation.

• Whilst there was no local risk register, there was work in progress to identify location specific risks.

• Staff were supported to develop their skills and were provided with service specific information through a range of methods.

• People who used the service, as well as staff were encouraged to feedback on the service in order to make improvements.