Marie Stopes International Coventry is operated by Marie Stopes International (MSI). MSI Coventry was registered with the Care Quality Commission (CQC) in June 2016 and holds a license from the Department of Health to undertake termination of pregnancy (ToP) services in accordance with the Abortion Act 1967. Services are provided predominantly to NHS-funded patients referred by local clinical commissioning groups, as well as to private patients.

Regulated activities include medical ToP, surgical ToP, consultations, ultrasound scans, counselling, family planning, contraception advice, oral contraception and sexual health screening. Surgical ToP had not been provided at MSI Coventry since July 2017 and were not taking place at the time of our inspection.

Facilities at the MSI Coventry main site include a surgical treatment room with two recovery areas, two consulting rooms and an ultrasound scanner. Regulated activities are also provided at two satellite clinics, known as early medical units (EMUs). The EMUs are located at: Nuneaton and Stratford-Upon-Avon, where medical termination of pregnancy is offered.

We inspected this service using our comprehensive inspection methodology. We gave the provider three working days’ notice that we would be inspecting the service. We carried out the announced part of the inspection at MSI Coventry on 4 September 2017. We carried out an unannounced inspection at the EMU at Nuneaton on 14 September 2017. We did not visit the EMU at Stratford-upon-Avon as part of this inspection.

We observed activity levels, staff interaction with patients, and made checks on the environment and equipment. We spoke with seven members of staff including; MSI regional managers (there was no registered manager available), medical staff (by telephone as they were not onsite during our inspection), registered nurses, and administrative staff. We also spoke with seven patients. We reviewed 14 patient records including four patients who had used the surgical ToP services. Before and after our announced and unannounced inspection visits, we reviewed performance information submitted by the service.

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?

We have not provided a rating for this service.

We regulate termination of pregnancy services, 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.

We found the following areas of good practice:

• Serious incidents were investigated by a suitably trained panel at MSI UK, and acted upon.
• Policies for safeguarding of children and young people and safeguarding adults at risk were available. Staff received safeguarding training at appropriate levels.
• Patient records were accurate, complete, legible and up to date, and were maintained in accordance with the Data Protection Act 1998.
• There were locally agreed policies and standards that referred to evidence-based practice and against which performance was audited and reported upon.
• Learning and development was provided at an appropriate level to enable staff to develop and maintain their skills and competencies.
• Pain was assessed and treated in accordance with national guidelines.
• We saw good multi-disciplinary teamwork and collaboration with remote services at other MSI locations.
• There was consistent positive feedback from patients about the caring and non-judgmental attitude of staff, and we saw this in patient interaction we observed.
• Patient satisfaction was monitored. Four out of 15 indicators met the MSI target from April 2017 to July 2017, which was an improvement on the previous quarter’s ratings.
• The early medical abortion service met patients’ needs; however, the surgical service was being redirected to other MSI UK locations at the time of our inspection.
• Patients had access to telephone translation services for languages other than English.
• There were clear patient pathways for patients having a surgical or medical abortion and a clearly defined referral process for patients who required specialist services.
• Complaints were managed in accordance with MSI policies and in the required time frames.
• Staff spoke positively about the changes introduced by the new leadership team and the pace at which the changes had taken place.

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

• Staff told us there was no consistent system in place for patients or visitors to report to a receptionist or to sign in. On the day of the inspection there was a receptionist and sign in location available. However nursing staff told us they normally worked alone and there would not normally be a receptionist to greet patients.
• Incidents were reported however, limited evidence of learning was shown.
• Staff told us failures in information technology at MSI Coventry were not always reported as an incident, investigated, or immediately acted upon. This meant staff could not access internal monitoring and reporting systems.
• Medicines were not always securely stored. There were insufficient arrangements in place to monitor and reconcile the stock of medicines.
• Safety checklists for the resuscitation and anaesthetic equipment were not always complete.
• There were gaps in staff completion of mandatory training; mainly due to a large number of new starters.
• The staff appraisal process was not embedded.
• Patients had to attend another location of their choice to be fitted with reversible contraceptives.
• Average waiting times for procedures were outside of RCOG recommendations.
• Compliance with testing for sexually transmitted diseases was low.
• The premises at MSI Coventry were not entirely appropriate for the services being delivered, as the lift did not support the emergency transfer of patients from the building.
• Privacy was limited in the waiting area and the surgical recovery area at Coventry.
• There was limited oversight of the services. There was no registered manager at the time of our inspection; however, interim leadership arrangements were in place.
• Risk management was not always prioritised or resolved in a timely way.
• Lone working arrangements at MSI Coventry had not been reviewed since the surgical service had stopped.
• There were gaps in the governance of medicines management, for example limited evidence of corrective actions in response to identified risks such as security of medicines storage and the risk of misappropriation of prescribed medicines.
• Variations from the chaperoning policy were not reported as an incident and acted upon.
• There was limited evidence of any remedial action taken following incidents or of learning being shared.
• Many of the improvements to governance were in the early stages of development and needed time to be embedded in practice.

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 two requirement notices that affected termination of pregnancy services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals