Archived: BPAS - Brierley Hill

Updated 10 July 2017

BPAS is a national provider of medical and surgical termination of pregnancy services. BPAS Brierley Hill is part of the national charitable organisation British Pregnancy Advisory Service (BPAS). BPAS provides medical and surgical termination of pregnancy services.

BPAS Brierley Hill opened in 2013. The service was providing consultation and medical abortion treatments up to 10 weeks gestation. The clinic was nurse led. Patients travelled for treatment.

BPAS Brierley Hill had contracts with clinical commissioning groups (CCGs) in the Black Country area to provide a termination of pregnancy service. Most patients were funded via the NHS; some patients chose to self-pay for services.

BPAS Brierley Hill provided support, information, treatment and aftercare for people seeking help with regulating their fertility and associated sexual health needs. Its main activity was termination of pregnancy. The clinic ran in a suite of rooms on the first floor of a modern purpose built health and social care centre. The centre was also used by other services however; the BPAS clinic had its own waiting room.

The manager of the service was registered with the CQC and also managed a service in central Birmingham and in south Birmingham.

We inspected this service as part of our Comprehensive Inspection programme of acute medical services. We inspected termination of pregnancy services.

Updated 10 July 2017

BPAS Brierley Hill is part of the national charitable organisation British Pregnancy Advisory Service (BPAS). BPAS provides medical and surgical termination of pregnancy services.

BPAS Brierley Hill provided a medical termination of pregnancy service in Brierley Hill West Midlands. BPAS Brierley Hill has contracts with clinical commissioning groups (CCGs) in the Black Country area to provide a termination of pregnancy service. Most patients are funded via the NHS, some patients choose to self-pay for services and the clinic offered services to paying overseas patients.

BPAS Brierley Hill provided support, information, treatment and aftercare for people seeking help with regulating their fertility and associated sexual health needs. Its main activity was termination of pregnancy.

We inspected but did not provide ratings for this service.

Are services safe at this service?

• Incidents and risks were reported and managed appropriately. Lessons learned and actions to be taken were cascaded to front line staff.
• Nursing and medical staffing numbers were sufficient and appropriate to meet the needs of patients in their care.
• Staff complied with best practice with regard to cleanliness and infection control. The clinic environment and equipment were clean and suitable for use; standards were monitored through audits and risk assessments such as health and safety risk assessments.
• Staff were aware of their safeguarding responsibilities, including to patients that were under the age of sixteen years old.
• Medicines were stored, prescribed and administered safely and in keeping with the Abortion Act 1967. Some aspects of audit arrangements for medication particularly those medicines used to bring about a termination of pregnancy were not consistently robust.

Are services effective at this service?

• Treatment was based on up to date good practice and staff followed policies and procedures.
• Patients were prescribed appropriate pain relief, preventative antibiotics and post termination of pregnancy contraceptives.
• There were processes in place for implementing and monitoring evidence based guidance.
• The clinic undertook audits recommended by Royal College of Obstetricians and Gynaecology (RCOG).
• Consent was gained in line with Department of Health guidelines for most patients. The provider had policies, procedures and guidelines for staff to support these. However protocols to assess capacity and support for patients who lack capacity to consent including those with a learning disability were not robust in practice. The risks involved in simultaneous administration of termination of pregnancy medication were not made sufficiently clear to patients. The provider informed us this was put right immediately after our inspection visit.
• Each patient had an ultrasound performed to confirm the pregnancy and gestation stage so that the correct treatment could be recommended.
• Pre and post termination of pregnancy counselling was offered and a telephone advice line for patients was available 24 hours a day.
• Nursing staff were trained and assessed as competent for general nursing practice and specific competencies pertaining to their roles.

Are services caring at this service?

• Staff treated patients attending for consultation and termination of pregnancy with compassion, dignity and respect. There was a focus on the needs of patients.
• A ‘client care coordinator’ met with all patients on their own to establish that the patient was not being pressurised to make a decision. Patients’ preferences for sharing information was established, respected and reviewed throughout their care.
• If patients needed time to make a decision, the staff supported this.
• All patients considering termination of pregnancy had access to counselling before and after procedures.

Are services responsive at this service?

• Pre and post-procedure checks and tests were carried out at the clinic to ensure continuity of care.
• Waiting times were within the guidelines set by the Department of Health and agreed by the local Clinical Commissioning Groups.
• Interpreting and counselling services were available to all patients and the clinic was accessible for those with disabilities.
• The service had good links with the sexual health service within which it was situated.
• Patients could be offered a provisional same day service, where they were booked on the same day for an appointment, assessment, ultrasound scan and received treatment.
• Complaints were responded to appropriately and within service agreed timescales.

Are services well led at this service?

• Senior managers had a clear vision and strategy for this service and staff were able to demonstrate the service’s common aims to us.
• There was strong local leadership of the service and quality of care and patient experience was seen as the responsibility of all staff.
• Staff were proud of the service they provided and were aware of the requirements RCOG’s clinical guidelines.
• Staff felt supported to carry out their roles and were confident to raise concerns with their managers.
• Patients were encouraged to provide feedback through a satisfaction survey, and the results were positive.
• There was a clear system of governance in place at national and regional levels and clinical governance was well managed to ensure service quality and performance was monitored and actions taken when needed. Governance forums were used to discuss quality and risk issues and monitor the service was adhering to legal requirements such as completion and submission of legal documentation (HSA1 and HSA4 forms).
• Comments, concerns and complaints were shared with staff.
• The provider had reviewed treatment programmes. When possible it had introduced new regimes to provide women with greater choice and flexibility.

.We saw several areas of good practice including:

• A sample of young people had been consulted in designing the safeguarding risk assessment. This improved the effectiveness of questions to identify young women who were isolated, at risk of abuse or exploitation.

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

Importantly, the provider must:

• Put into practice protocols for all patients who may lack capacity to consent.
• Improve the audit arrangements in place for medication particularly abortifacient medicines.
• Improve practice in respect of the administration of an intramuscular medication
• Improve practice in respect of use of ‘anti-d’ (a blood product derivative drug used to prevent formation of antibodies).

In addition the provider should:

• Consider developing a formal, local contingency plan for business continuity in the case of prolonged loss of premises due to major incident.
• Consider participating in relevant local or national audit programmes or peer review to bench mark outcomes against other similar services.
• Make clear on the consent form when simultaneous termination of pregnancy medication was administered the risks involved.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 10 July 2017

We have not provided ratings for this service. We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities it provides.

Staff reported incidents and incidents were logged, investigated and learned from. The manager who sent this information to senior managers and the clinical team which is then reported to the Board that ran the organisation checked the quality and safety of the services provided at the clinic regularly. Doctors, nurses and midwives followed recognised safe medical procedures. Staff followed procedures in place for good hygiene and control of infection, safeguarding children and vulnerable adults, assessing and responding to clinical risk for patients and record keeping. Some aspects of safe management of medication needed to be improved.

Patients care and treatment was evidence-based and in line with good practice. Staff followed BPAS policies and procedures, developed to take account of national guidance including the Required Standard Operating Procedures (RSOP) from the Department of Health. The use of simultaneous administration of abortifacient drugs for early medical abortion (EMA) is outside of current Royal College of Obstetrician and Gynaecologist (RCOG) guidance and staff did not make sufficiently clear to patients when consenting to this method, it could increase the risk of failure.

Managers regularly checked clinical practice to maintain good standards of patient care and continuously improve outcomes for patients. Staff employed at the clinic were competent, well trained and experienced. Staff gave patients good information on which to base their decisions and obtained informed consent, with the exception of the increased risks associated with simultaneous administration of abortifacient medication. The provider informed us it responded to our feedback and put this right immediately after our inspection visit. They spent time explaining options and procedures and giving advice on contraception. However, 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 around sharing information with a partner or family members or carers. 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 ongoing counselling support to all patients. Patients under 18 years old were counselled before treatment as a matter of policy.

The clinic opened three days each week including two evenings. 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 a few days and treatment within ten working days of access to the service. The clinic was in an accessible, modern building. Translation services were available. Counselling services were available 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 all committed to the BPAS vision of women being in control of their fertility. The service was patient centred. BPAS had effective arrangements in place to manage quality and risk issues and monitor the service was adhering to legal requirements such as completion and submission of legal documentation (HSA1 and HSA4 forms). When possible it had introduced new regimes to provide women with greater choice and flexibility.

However we also found, it was not made sufficiently clear on the patient consent form, when simultaneous abortion medication was administered rather than having the medications with an interval of 24 hours or more between, that this method could increase the failure rate for a patient. The provider since assured us that the practice of nurses verbally communicating this information to patients was reinforced immediately after our inspection visit.

Start here...