On the day of our visit, only women were attending the clinic. On this occasion therefore we did not look at the vasectomy service provided at this clinic.

Women who used the service told us that the staff were sensitive and sympathetic. They said that they did not feel pressurised, questioned or judged and that staff took time to provide very clear explanations of options and treatments available. One woman described the staff as " professional and unbiased". Another woman said that the way she was treated at Marie Stopes “made a bad experience bearable” and she was grateful that she was able to make appointments that were convenient to her. Women felt that their privacy and dignity were respected and they were treated with courtesy. The environment was described as “relaxed” and “not too clinical”.

Staff were trained to recognise the signs of abuse and support was available to people who had been abused. People who used the service could be assured that there were strict vetting procedures in place to ensure that they were not cared for or treated by unsuitable individuals. The clinic received regular feedback from people who used the service and this showed high levels of satisfaction. There were however effective systems in place to identify and act on areas for improvement.

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 treatment for the termination of pregnancy was not commenced unless two certificated opinions from doctors had been obtained.

MSI Bristol Centre is operated by Marie Stopes International. The Bristol service provides medical terminations up to nine weeks and four days gestation and surgical terminations up to 17 weeks and six days gestation. The Bristol centre is open four days per week and is supported by four satellite clinics in Gillingham, Poole, Bournemouth and West Mendip. Marie Stopes Bristol Centre also provides counselling, contraceptive services, including vasectomy and tests for sexually transmitted infection (STI). The satellite clinics offer: early medical terminations,medical terminations and surgical terminations counselling, STI screening and contraception. The satellite services are provided out of rented consultation rooms within GP practices. The services are provided to both NHS and private patients.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection of Marie Stopes Bristol Centre on 17 and 18 of August 2017 along with an announced inspection of the Poole satellite clinic on 22 August 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? 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.

We regulate termination of pregnancy, but we do not currently 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.

CQC undertook enforcement action following an inspection of the governance systems at the Marie Stopes International corporate (provider) level in late July and August 2016. There were breaches in regulation that were relevant to this location. These were reviewed as part of the Marie Strope International Brisol clinic inspection.

The breaches were in respect of:

- Regulation 11 Consent

- Regulation 12 Safe care and treatment.

- Regulation 13 Safeguarding service users from abuse and improper treatment.

- Regulation 17 Good governance.

- Regulation 20 Regulations relating to termination of pregnancies.

We found the following areas of good practice:

• Staff were patient focused, kind and caring and demonstrated that the individual needs of each patient was at the forefront of treatment and care provided.

• Patients consistently reported all staff treated them with kindness and compassion and that they felt involved in all aspects of their treatment and care.
• Staff demonstrated collaborative and supportive team working practices.

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

• Improvements were required to the main surgical recovery area to improve the privacy and dignity of patients.
• Improvements were required to the governance, audit and quality measures at MSI Bristol clinic. There was a lack of evidence of analysis of incidents, risks and of actions taken and learning shared to make safety and quality service improvements.
• Chaperoning requirements were set out in the MSI chaperone policy 2017. However, the policy was not followed as nurses normally worked as lone workers at the satellite clinics.
• Not all nurses had completed the providers mandatory training on consent. This meant there was a risk that not all registered nurses taking patient consent had completed the required training

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected MSI Bristol clinic. Details are at the end of the report.

Amanda Stanford

Interim Deputy Chief Inspector of Hospitals