We carried out an inspection of the Central Health Clinic on 10 September 2014. This was part of a planned inspection of the University Hospitals Bristol NHS Foundation Trust. The Central Health Clinic operates a number of smaller clinics located within the community. These clinics operate in the same way as the Central Health Clinic and are staffed by a core team, therefore we did not inspect the smaller satellite clinics.

We found the service provided a good quality of care to people who used it.

Our key findings were as follows:

• Safeguarding procedures were in place and staff were knowledgeable regarding their responsibilities for safeguarding children and adults.
• The department was clean and tidy and infection control policies and procedures were in place and followed to ensure the safety of people who visited the department and staff who worked there.
• Care and treatment were provided in line with regional and national guidelines.
• Feedback from people who used the service was sought and the outcomes audited. Action had been taken in response to suggestions made by people who used the service.
• People’s privacy, dignity and confidentiality were respected at all times.
• People who attended the service were positive in their comments about their care and treatment and all said that they would recommend the service to their friends.
• Services were available to people over six days each week and clinics were led by trained and competent staff.
• The department had a clear vision and strategy and staff were positive and proud regarding their work.
• Staff worked as part of an integrated multidisciplinary team, which had positive outcomes for patients.
• Risk management systems were in operation and identified risks were escalated appropriately within the trust.

We saw several areas of outstanding practice, including the following:

• The staff worked well as a multidisciplinary team, both internally (within the department) and with external partners and organisations, for example with Barnardo’s on a project working to combat child sex exploitation and with the police in the sexual referral centre.
• The Bristol Central Health Clinic provided an integrated sexual health service that ensured easy access to services where the majority of sexual health and contraceptive needs could be met in one clinic, by health professionals who worked together collaboratively.
• The service had responded to the needs of people in the local communities for accessible clinics by providing extended opening times, a variety of locations, walk-in clinics and a facility for people to book appointments by texting from their mobile telephones.

However, there were also areas of practice where the trust needs to make improvements. The provider should:

• Ensure that patients’ electronic records are consistently completed appropriately to provide full and detailed information regarding the person’s care and treatment.
• Ensure that regular formal supervision and clinical supervision for staff take place in a planned way.

Professor Sir Mike Richards

Chief Inspector of Hospitals

We visited the service on 4 October 2012. The purpose of this inspection was to check that improvements had been made to achieve compliance with outcome 21. During our visit 20 March 2012 we found that there was a lack of proper information about people in so far as certificates of opinion (HSA1 forms ), required as part of the management of the regulated activity of termination of pregnancy, were not properly maintained.

We received an action plan from the trust on 9July 2012 about the improvements in place to ensure that proper information about people in so far as certificates of opinion (HSA1 forms), required as part of the management of the regulated activity of termination of pregnancy, were being properly maintained.

We were told that an audit to test compliance was also being carried out by the trust on 30 September 2012.

During this visit we did not involve people who used the service, but we spoke with registered nurses, a nurse manager and a doctor who worked in the clinic. They told us about the new systems in place to ensure that the procedure for two doctors to provide their certified opinion, formed “in good faith”, that at least one and the same ground for a termination of pregnancy was met.

Staff told us that there were no presigned certificates of opinion (HSA1 forms) used in the clinic. We also asked to see a sample of patients medical records. We looked at these records and we found no presigned certificates of opinion (HSA1 forms.

We did not speak to people who used this service as part of this review. We looked at a sample of medical forms. This was to check that current practice ensured that treatment for the termination of pregnancy was not commenced unless two certificated opinions from doctors had been obtained.