The Care Quality Commission
  • Hospital
  • Independent hospital

BPAS - Birmingham South

Overall: Requires improvement read more about inspection ratings

Robert Clinic, 162 Station Road, Birmingham, West Midlands, B30 1DB 0345 730 4030

Provided and run by:
British Pregnancy Advisory Service

All Inspections

12 July 2022

During an inspection looking at part of the service

BPAS Birmingham South is operated by the national charity British Pregnancy Advisory Service (BPAS). BPAS Birmingham South is also known as the Robert Clinic.

We inspected BPAS Birmingham South in response to information we had received about the service. We used our focussed inspection methodology and we did not inspect all aspects of the care provided. We only inspected the safe and well led key questions during this inspection. BPAS Birmingham South had a comprehensive inspection in September 2019 where it was rated good overall.

From June 2021 to May 2022, the service completed 1142 medical abortions and 1525 surgical abortions.

We rated it as requires improvement because:

  • Not all notifiable events were reported in line with mandatory legal reporting regulations.
  • The service was not using a specific paediatric early warning score tool for use with children under the age of 16 years undergoing surgical terminations of pregnancy.
  • Governance arrangements were not sufficiently robust or effective to always identify concerns and risks.
  • Pregnancy remains were not always stored following the provider's policy or best practice.
  • Not all staff had completed their mandatory training.
  • Emergency equipment and intravenous medicines were not stored securely.

However

  • The service had enough staff to care for women and keep them safe. Staff had training in key skills, understood how to protect women from abuse, and managed safety well. The service controlled infection risk well. Staff kept good care records. The service learned lessons from incidents.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued and strong teamworking was evident. All staff were clear about their roles and accountabilities. The service engaged well with women to plan and manage services and all staff were committed to improving services.

18 September 2019

During a routine inspection

BPAS Birmingham South is part of the national charitable organisation British Pregnancy Advisory Service (BPAS).

BPAS Birmingham South provided support, information, treatment and aftercare for patients seeking help with regulating their fertility and associated sexual health needs. Its main activity is termination of pregnancy. BPAS Birmingham South offered a service to women within the West Midlands via a national telephone appointment service. It provides medical and surgical terminations of pregnancy. The service provides early medical abortion up to 10 weeks gestation but predominantly provide surgical treatment under local anaesthetic and conscious sedation up to 14+6 weeks. The service also provides sexually transmitted infections screening and vasectomies.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 18 September 2019.

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.

Services we rate

We rated this service as Good overall.

We found the following areas of good practice:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff kept good care records. The service managed safety incidents well and learned lessons from them.

  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.

  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients

    We also found the following areas of improvement:

  • Records were not always stored securely.

  • Waiting times from referral to treatment were not in line with national guidance. The service did not provide treatment to all patients once they had decided to proceed within 10 days.

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 BPAS Birmingham South. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

26 May 2016

During a routine inspection

Staff reported incidents and incidents were logged, investigated and learned from. The quality and safety of the services provided at the clinic were checked regularly by the manager who had to send this information to senior managers and the clinical team which is then reported to the Board that ran the organisation.

We found services at the clinic were effective. Patient’s care and treatment was based on up to date good practice. Staff followed BPAS policies and procedures that supported legal requirements.

Managers regularly checked clinical practice to maintain good standards of patient care and continuously improve outcomes for patients. Doctors and nurses followed recognised safe surgical procedures. Staff employed at the clinic including doctors, nurses, administrators and receptionists were competent, well trained and experienced.

Staff gave patients good information on which to base their decisions and give informed consent. They spent time explaining options and procedures and giving advice on contraception. However, we also found it was not made clear enough to patients the increased risk of abortion failure posed by some methods. Also, there was not a clear mental capacity assessment protocol in practice for women with learning disabilities or help to access an independent advocacy service.

All staff treated patients and those close to them with kindness and respect and put them at ease. Nurses asked about and respected patients’ wishes about sharing information with a partner or family members or carers and nurses checked along the way that patients were sure of their decision. A booklet called ‘My BPAS Guide’ was given to every BPAS patient and BPAS offered on going counselling support to all patients with patients under 18 years old counselled before treatment as a matter of policy.

The clinic opened four days each week and was near to a train station and local bus routes. Patients could book appointments through a national telephone service that ran a flexible appointment system to offer as much choice as possible to patients. Patients were generally offered an appointment within five days and treatment within ten working days of first contact with the service. The clinic had facilities on the ground floor and translation services were available. There was a free on going counselling service for patients. However support offered to patients with a learning disability to understand and give informed consent to procedures was limited.

The clinic was well run by a manager registered with the CQC and staff were committed to the BPAS vision of women being in control of their fertility. The service was patient centred and caring. There was an effective governance framework for reviewing the quality and safety of care. Performance and quality data such as incidents, complaints, policy and legislative updates were discussed at national and regional meetings. However it was not made sufficiently clear to patients that consenting to the simultaneous administration of abortifacients could increase the risk of failure for the patient.

5 September 2013

During a routine inspection

We spoke with two people who were using the service on the day of our inspection and the staff that supported them. People told us that they were happy with the care, treatment and support they received at the clinic. A person who was using the service told us, 'I feel that my appointment has not been rushed. Staff gave me extra time to recover because I did not feel well.'

People told us that they had been fully involved in the decision to use the service. They told us that they had made decisions about the treatment they received after staff had explained their care, treatment and support choices to them. People also told us that they had been given time to consider the information prior to treatment so that they had the option to withdraw their consent if they wanted to. A person who was using the service told us, 'Staff took the time to answer any questions that I had.'

People told us that they were listened to and treated with respect by staff working at the clinic. A person who was using the service told us, 'The staff have all been very kind to me. They have made a difficult situation as easy as it can be.'

Robust arrangements were in place for staff recruitment and on-going checks of staff's eligibility and fitness to work at the clinic were undertaken. This meant that people using the service could be confident that staff had been assessed as being suitable to work at the clinic.

People told us that they would be confident to raise any concerns with the clinic staff, should the need for this arise. The number of recent complaints received was low and we found that these had been handled and managed in a timely and appropriate manner. A person who was using the service told us, 'I would talk to any of the staff here if I had any concerns.'

During our inspection, we asked the commissioning team about the quality of service provided at the clinic. They told us that they did not have any concerns about the quality aspects of the service.

25 October 2012

During a routine inspection

People using the service told us that they were happy with the care they received at the clinic. They told us that their care and support needs were being met. Comments included: 'I have had an excellent service here. Everyone has been so kind,' and 'Staff have explained about my procedure and the expected length of time that I will be at the clinic today.'

People told us that staff explained their care, treatment and support choices to them. This meant that they had the opportunity to be involved in making decisions about their care. A person using the service told us 'They explained everything in depth. Staff put my mind at ease about everything.'

People told us that they were listened to and treated with respect by staff working at the clinic. They told us that their dignity had been respected.

During our inspection, we asked the commissioning team at the local primary care trust about the quality of the service the clinic provided. They did not have any information to share with us about the quality aspects of the service.

20 March and 18 September 2012

During a themed inspection looking at Termination of Pregnancy Services

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 no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

18 November 2011

During a routine inspection

People who used the service told us that they were happy with the care they received at the clinic and that their care and support needs were being met. They told us that staff explained their care, treatment and support choices to them and that they had the opportunity to be involved in making decisions about their care. People told us 'The staff have kept me informed about what is going on and have given me enough time to change my mind if I want to' and 'they gave me different choices of contraception and explained the side effects'.

People told us that they were listened to and treated with respect by staff working at the clinic. They told us that their dignity had been respected and that staff were available when they needed them. People told us 'I did not feel like I lost my dignity', 'they have always been checking on me today, there are plenty of staff around' and 'there are lots of female staff which is good'.

People told us that the clinic was clean and they had no concerns about cleanliness.