MSI Reproductive Choices Regional Treatment Centre - Bristol

Updated 10 November 2017

MSI Bristol Centre is operated by Marie Stopes International. The service opened during November 2009 and is based in the city of Bristol. The centre primarily serves communities spanning five clinical commissioning groups in the south west of England. Marie Stopes International (MSI) Bristol Centre also accepts patient referrals from outside this area.

The service has had a registered manager in post since 2009. At the time of the inspection, there was significant organisational change and the two most senior managers had been redeployed to other areas of the service. The service was being supported by the regional director and deputy chief nurse for an interim period whilst additional recruitment plans were completed. This was planned to include a new registered manager application.

MSI Bristol Centre is a nurse led service with medical input which provides early medical abortion (abortion pill) and surgical termination treatments. The clinic also provides: counselling and tests for sexually transmitted infections (STI) and contraceptive services, including vasectomy. The Bristol Centre is supported by four satellite clinics in: Bournemouth, Gillingham, Poole and West Mendip. The satellite clinics provide: early medical terminations, medical terminations and surgical terminations, counselling, STI screening and contraception.

Regulation 20 of the Health and Social Care Act 2008 Care Quality Commission (Registration) Regulations 2009 applies to all non NHS bodies that carry out a termination of pregnancy. Regulation 20 sets out the specific legal reguirements in relation to termination of pregnancy that must be met. In addition, every independent place where treatment for termination of pregnancy is carried out must be an Approved place (meet specific requirements) and is required to follow all (28) of the Department of Health’s Required Standard Operating Procedures (RSOPs).

We inspected MSI Bristol Centre on the 17 and 18 August 2017 and the Poole satellite service on 22 August 2017.

MSI Bristol Centre is registered to provide the following regulated activities:

• Diagnostic and screening procedures.
• Treatment of disease, disorder or injury.
• Family Planning.
• Surgical Procedures.
• Termination of pregnancies

The service had previously been inspected during November 2015. At this time the service was meeting all standards of quality and safety it was inspected against.

We inspected MSI Bristol Centre using our comprehensive inspection methodology.

Updated 10 November 2017

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

Updated 10 November 2017

We regulate this service but we do not currently have a legal duty to rate when it is provided as an independent healthcare single speciality service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary. We have a duty to rate this service when it is provided as a core service in an independent hospital.