MSI One Call is operated by Marie Stopes International.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced on 7 September 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.

MSI One Call is the main contact centre for all MSI services in the UK. It provides the following: centralised patient booking, telephone consultation pre assessment, post procedure support and advice line and telephone counselling for patients attending any MSI clinics nationwide. MSI One Call is open 24 hours per day, seven days per weeks and is the first point of call for any patients wishing to access any of the clinic services provided at any MSI location.

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 outstanding practice:

• MSI One Call had an outstanding major incident plan. This included the provision of a duplicate call centre site, equipped to provide the most current IT systems required to keep the service running. The alternative site had the ability to be fully functional within two hours, minimising the impact on patient services.
• Patient feedback was sought continuously and analysis of this was completed by an independent, external provider. There was consistent, positive patient feedback that that MSI One Call provided an ‘exceptional’ service.
• MSI One Call facilitated and supported the provision of independent, qualified clinical counsellors for the benefit of the whole MSI service. The counsellors’ provided free, therapeutic therapy sessions to patients’ pre and post treatment. The amount of counselling was not limited but based solely on patient’s individual needs.

We found the following areas of good practice:

• The lead clinical staff for safeguarding vulnerable adults and children had advanced training, knowledge and experience and provided effective support to all staff at the call centre.
• There was a flexible staff work pattern which enabled the service to have sufficient staff at all times in response to changeable patient call numbers.
• Patients’ had their needs risk assessed by staff who understood what processes and policy they were required to follow.
• The building and working environment was secure and promoted patient privacy and staff safety and comfort.
• New staff completed a competency based training course at the start of employment. Systems were in place to provide ongoing staff training and support.
• There was evidence of effective team working and staff had a clear understanding of their own responsibilities and those of colleagues.
• Staff demonstrated a non-judgemental, kind and supportive approach to patients. Staff provided a patient led service; providing information, advice and support based solely in response to what patients called to enquire about.
• MSI One Call supported other MSI services to find interpreters to support with patient appointments.
• The centre was staffed and open 24 hours per day, seven days per week. Patients were offered a choice of treatment options at locations and times to suit them.
• Telephone counselling was offered to all patients who contacted any MSI service nationwide.
• There was a stable senior management team who had appropriate skills, qualifications and experience to provide effective leadership across the whole service.
• Senior staff had a clear understanding of quality and risk management issues related to the service. Action plans were documented and issues were kept under regular review.
• Processes were in place to obtain patient feedback and this was used to make service improvements.
• Staff were kept informed of local and national issues related to their roles. Staff reported a positive working culture and felt supported by senior staff

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

• All staff should be supported to have in date mandatory training.
• All staff should be supported to have an annual appraisal.

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

Amanda Stanford

Interim Deputy Chief Inspector of Hospitals

Marie Stopes International One Call is the contact centre for Marie Stopes International (MSI). It provides centralised booking and call centre facilities. It is open 24 hours every day of the week, including weekends. It is the first point of call for all patients and makes bookings at the appropriate centre. We inspected the MSI One Call centre as concerns were raised through our inspection of locations and the head office of MSI. We undertook an unannounced inspection of the MSI One call centre on 12 August 2016.

We have not published a rating for this service. CQC does not currently have a legal duty to award ratings for those hospitals that provide solely or mainly termination of pregnancy services. We found that local governance arrangements were in place and that the service was well led at a local level.

Are services safe at this service

• Staff we spoke with were aware of how to report incidents and were aware of investigations and learning arising from incidents at the centre.
• The environment was visibly clean and had been made safe from trip hazards.
• Staffing was appropriate to the needs of patients calling the centre.
• We reviewed records which were clear and concise.
• Staff we spoke with knew who to approach if they or the patient had a concern.
• Safeguarding training to level 3 for children was not in place at the time of inspection but was planned.

Are services effective at this service

• Care offered was based on national guidance.
• Pain relief was well managed as part of the telephone assessment and reassurance provided.
• Staff had received training and were assessed as being competent to fulfil the roles that they undertook.
• The service was offered 24 hours every day.

Are services caring at this service

• Staff put the patient at the centre of care providing a compassionate non-judgemental service.
• Staff respected the confidential and sensitive nature of the service.
• Patients were treated with dignity and respect.
• Counselling was offered to all patients either via telephone or on a face to face basis in the clinics.

Are services responsive at this service

• Services were planned to meet the needs of patients in that advice, support and booking facilities were available throughout the 24 hour period.
• Calls were answered in a timely manner and redirected as necessary.
• Outbound calls were made within agreed timeframes.
• The centre monitors complaints but we could not be assured that learning had been implemented as a result of complaints made.

Are services well led at this service

• Senior staff understood the business of MSI and had a good appreciation of working in the call centre environment.
• Local governance arrangements were able to identify issues and resolve these quickly.
• There were systems in place to ensure that calls were handled appropriately through audits and where deficits were identified these were addressed.
• The different teams within the call centre worked well together to support patients using the service.
• Staff within the call centre felt supported by their managers.

Our key findings were as follows:

• The centre was well managed locally and teams within the centre worked well together
• Staff working at the centre put the patient at the centre of care. They experienced job satisfaction from helping women in difficult times.
• Senior managers understood the processes of the centre and were diligent in auditing and monitoring calls to ensure that patients received a good service.

However, there were also areas of where the provider needs to make improvements.

In addition the provider should:

• Review the level of safeguarding training to ensure that staff can fulfil their roles.
• Review the use of others to translate for patients to ensure best practice.

Professor Sir Mike Richards

​Chief Inspector of Hospitals

We did not speak with people who used the service as part of this review but we were able to listen to telephone calls to and from people who were considering abortion treatment or who had terminated their pregnancy and were seeking post-operative advice. We looked at satisfaction data captured by the centre. The most recently published data showed high levels of satisfaction, with between 90% an 97% of respondents responding positively to the questions asked. We observed staff to be friendly, respectful and reassuring.

People's needs were assessed and their personal choices considered when treatment was planned. There were strict protocols followed to ensure that accurate information was captured for each person. There were evidence based systems to ensure that risks or contra-indications to treatment were highlighted and acted upon.

The service received few complaints but there were systems in place to ensure that any dissatisfaction with the service was investigated so that improvements could be made. The complaints procedure was publicised, although the information provided to people using the service was incomplete. It did not provide advice on sources of support when making a complaint or where to direct their complaint for external adjudication if people remained dissatisfied.

We looked at a sample of staff records to see whether the provider operated effective recruitment procedures. Records were mostly complete and evidenced that relevant checks had been undertaken before staff began work.

Detailed and accurate medical records were maintained and standards of record keeping were regularly audited.

We did not speak with people who used the service as part of this review but we were able to listen to telephone calls to and from people who were considering abortion treatment, or who had terminated their pregnancy and were seeking post operative advice. We looked at client satisfaction data captured by the centre. The most recently published data showed high levels of satisfaction, with 95% of respondents rating their overall experience 'excellent' or 'very good'. People reported that staff were supportive and understanding and that they were given all the information they needed in a way that they could understand. We observed staff to be clear, respectful and non judgmental.

People's needs were assessed and their personal choices considered when treatment was planned. There were strict protocols followed to ensure that accurate information was captured for each person using the service. There were evidence based systems used to ensure that risks or contra-indications to treatment were highlighted and acted upon.

Staff demonstrated a good understanding of the term 'abuse' and their responsibility to report any concerns of this nature. There were protocols in place to ensure that young people who requested treatment received counselling and support.

Staff told us they enjoyed working for Marie Stopes One Call and they felt well supported with regular training and supervision. There were effective systems in pace to monitor quality and safety.