Brook Manchester has previously been inspected by the Care Quality Commission on 14 June 2014. The Care Quality Commission inspected against five core standards and found the unit to be compliant

Brook Manchester has provided confidential sexual health services, support and advice to young people since 1972.

Brook Manchester is recognised as a level 2 contraception and sexual health service (CASH).The Department of Health’s National Strategy for Sexual Health and HIV for England 2001 set out what services should provide at each recognised level. As a level 2 service Brook Manchester provided contraception, emergency contraception, condom distribution, screening for sexual transmitted infections, pregnancy testing, termination of pregnancy referrals and counselling.

Brook Manchester provided a sex and relationship education and training programme to young people and professionals engaged in working with young people.

Support, guidance and advice was provided to young people who were transitioning to adult services for their ongoing care and treatment.

The service operated from a main clinic in the centre of Manchester and outreach support was provided within schools and colleges around the Manchester area. Staff included reception staff, registered nurses, clinical support workers, health and well-being specialists, and counsellors.

The clinic reported 2551 attendees between the reporting period of October 2016 and January 2017, of those 791 patients were first appointments. The service provided clinics six days a week on Mondays to Saturdays in the main clinic and weekly drop in clinics at schools and colleges around the area.

We inspected the clinic as part of our routine comprehensive inspection programme for independent community healthcare services. We carried out an announced inspection visit on 15 February 2017 and an unannounced inspection on 23 February 2017.

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?

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

Our key findings were as follow:

• Brook Manchester had systems in place for reporting risk and safeguarding patients from abuse.
• Medical equipment was checked and maintained and we saw stickers and logs to confirm that electrical equipment had been tested across all areas.
• Patient records were stored securely at the clinic and access was limited to those individuals who needed to use them. This ensured that patient confidentiality was maintained at all times.
• Staff treated young people with dignity and respect and informed them of information to help them make choices. Young people we spoke with told us they staff were friendly and compassionate. During consultations we observed staff deliver care in a caring, compassionate and supportive way.
• Staff had access to policies and procedures such as the British Association of Sexual Health and HIV (BASHH), the Faculty of Sexual and Reproductive Healthcare (FSRH) and the Royal College of Obstetricians and Gynaecologists (RCOG); these were available on the intranet.

• We observed a number of pathways in place, which included onward referral processes for example: female genital mutilation, drug and alcohol, and emergency crisis mental health team, and the escalation process for complaints.
• The clinic was responsive to the needs of the local population; it was located in the Centre of Manchester with good transport links.
• The service was available six days a week between Monday and Saturday and offered a drop in or appointment service.
• For the six month period from 1 July 2016 to 31 December 2016, 3986 contacts were made to the Brook Manchester clinic. Of these contacts 81.8% were seen within 30 minutes with 55.8% seen within 10 minutes.
• The Brook website had 24 hour access to ‘Ask Brook’ which provided information on a range of topics including termination of pregnancy, staying safe on line, and contraception. Young people and staff had access to a language line which provided a telephone interpretation service for young people attending the service whose first language was not English.
• There were processes in place to support young people with learning difficulties which included working with other services involved in their care.
• Young people had access to information within the clinics on how to make a complaint. Staff were aware of the process for dealing with complaints however: there had been no complaints received by the service in the 12 months prior to our inspection.
• Robust systems were in place to ensure staff held the appropriate certification and experience for their roles. We reviewed eight staff records that confirmed staff were fit and proper persons.
• Staff that worked at the clinic felt appreciated and valued, they discussed with us the different ways Brook recognised staff for their hard work.
• The culture in the clinic was a supportive one; colleagues had an open door policy, allowing one another to ask for help or support.

However,

• Not all clinical staff who contributed to assessing, planning and evaluating the needs of a child or young person had completed level three safeguarding training as recommended in the Intercollegiate Document (2014) and by Brook’s safeguarding committee.
• There were no audits available to determine if Patient Group Directives (PGDs) had been adhered to when medication was dispensed.
• The practice in place for storage of specimens did not reflect Brook Policy and specimens were kept in the reception area which was used by staff.
• There was no dirty utility area in the clinic or designated separate area for storage of contaminated waste. Bodily fluids were being disposed of in the orange bags within the treatment rooms and although this was in a container the fluid was not solidified as per Brooks Safe Disposal of Waste Policy and could present a risk of infection when being transported. Staff informed us that it was rare that these bags needed storing due to becoming full however; the room where they would be stored along with used sharp bins was in an area that stored clean equipment and sterile equipment.

• There were governance structures in place, which included a risk register but the register did not have any specific risks relating to Brook Manchester. Practice we observed at the time of our inspection did not reflect Brook policies and procedures in relation to handling specimens, and storage and disposal of waste
• We observed that allergy status was not always recorded on the young persons’ records. The records we reviewed suggested that young people attending the clinic for condoms were not asked if they had an allergy to latex.

• Registered managers from different areas did not meet on a regular basis; this meant that they missed opportunities to share best practice and improvements.
• Robust pathways were in place to feedback audit results to staff, staff were keen to learn and improve their service. However recommendations from audits were not always followed up and therefore the service were unable to check if practice had improved.

• We were not assured that audits were robust as audits had not addressed issues when practice did not follow Brook Policies.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report

Professor Sir Mike Richards

Chief Inspector of Hospitals

Professor Sir Mike Richards

Chief Inspector of Hospitals

Our inspection was undertaken at Brook Manchester clinic based in Manchester city centre. During the inspection we looked at the arrangements the service had in place for assessing people’s needs and service delivery. Care plan records were maintained using both paper and a secure electronic system. We found the information was safe and remained confidential to those with authorised access.

We looked at the records of two people. We noted they had been fully involved in their assessment and had consented to the support being provided. The care plans had documented evidence that the service had discussed the care and treatment choices available to them. Both people had been involved in a face to face consultation as part of the decision making process.

We looked at staff training records, staff supervision arrangements and the service’s complaints procedure. We did this because we wanted to identify that appropriate arrangements were in place to support staff members. We also wanted to ensure people using the service felt listened to.

We spoke with one young person attending the clinic. The person said, “This is my first experience attending the clinic. I have found it a very convenient service. I didn’t have to make an appointment I just walked in and they agreed to see me”.

The provider was consulting people about their service through their quality monitoring procedures. We saw people had provided feedback about their experience of the service.