12-13 April 2016 and 27 April 2016
During an inspection looking at part of the service
BPAS Leeds is part of the British Pregnancy Advisory Service. BPAS Leeds opened as a consultation centre in 1970. BPAS Leeds provided termination of pregnancy services, pre and post termination counselling as well as contraception advice and screening for sexually transmitted diseases. The clinic had provided surgical abortions under local anaesthetic until June 2015 when the consultant left the organisation and this part of the service was suspended. The organisation intends to resume this service when the vacant post has been filled. At the time of the inspection, the service was providing medical abortions up to 10 weeks gestation.
We made an announced inspected of the service on 12-13 April 2016 and an unannounced inspection on 27 April 2016 as part of our independent healthcare inspection programme.
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, which it provides.
Are services safe at this service?
There was a culture of reporting and learning from incidents across the organisation and within the local services. Staff we spoke with demonstrated an excellent understanding of safeguarding adults and children and knew what actions they needed to take in cases of suspected abuse. All patients received a private initial consultation without anyone else present to safeguard against possible coercion or abuse and to give them the opportunity to disclose such information in a safe environment. All staff had completed training to level 3 in safeguarding for children and adults.
Staffing was sufficient and appropriate to meet the needs of patients in their care. Staff ensured medicines were stored and administered safely. Pathway documents and clinical risk assessments were completed fully and legibly. Staff completed and submitted all Department of Health documentation as required.
Are services effective at this service?
Care was provided in line with national best practice guidelines with the exception of the use of simultaneous administration of abortifacient drugs for early medical abortion (EMA), which is outside of current Royal College of Obstetrician and Gynaecologist (RCOG) guidance. However, patients were given up to date information about the risks and benefits of this treatment before giving consent and the organisation was monitoring outcomes from this treatment to build on their evidence base.
We observed that patient assessments were thorough and staff followed pathway guidance. Pain relieving medications were routinely prescribed for patients to take at home following their procedure or initiation of treatment.
Observation and assessment of staff competence was an integral part of pathway audit. Staff always made sure patients gave their consent in writing and adhered to Fraser guidelines in respect of children and young people. There were good links with local safeguarding teams, the local NHS hospital and other agencies.
Are services caring at this service?
Senior managers and staff involved and treated patients with compassion, kindness, dignity, and respect. The results of the BPAS ‘Client Satisfaction’ reports showed 100% of patients at BPAS Leeds were ‘extremely likely’ or ‘likely’ to recommend the service to others. Satisfaction reports showed high levels of patient satisfaction. Client Care Coordinators (CCCs) and nursing staff gave appropriate emotional support to patients. Staff provided all patients with a counselling service before and after termination of pregnancy if required or requested. There was access to specialist advice and support when needed. We saw examples where staff had gone out of their way to support patients in difficult situations.
Are services responsive at this service?
Service planning monitored activity and staff scheduled sufficient clinics to meet demand. The service had access to a learning disability specialist who provided advice and support to staff caring for people with these needs. Staff made sure they had enough information and could get further advice when necessary. The service met waiting time guidelines and patients could choose a date or alternative venue for their procedure. The service shared learning from complaints across the organisation, nationally, regionally and locally and staff gave examples of this during the inspection.
Are services well led at this service?
The organisation had a clear mission to provide safe and effective care for termination of pregnancy. Senior managers had a clear vision and strategy for this service and there was strong local leadership of the service. Quality of care and patient experience was seen as the responsibility of all staff.
There were effective governance systems in place and staff received feedback from governance and quality committees. Staff felt supported by their managers and were confident they could raise concerns and have them dealt with appropriately. The organisation had a proactive approach to staff and public engagement.
The service met Department of Health requirements regarding compliance with the Abortion Act 1967 and the ‘Required Standard Operating Procedures 2014’.
Our key findings were as follows:
- Staffing levels, medicines’ management and record keeping were good.
- Staff followed policies and procedures.
- Care was provided in line with national best practice guidelines with the exception of the use of simultaneous administration of abortifacient drugs for early medical abortion (EMA), which is outside of current Royal College of Obstetrician and Gynaecologist (RCOG) guidance. However, patients were given up to date information about the risks and benefits of this treatment before giving consent and the organisation was monitoring outcomes from this treatment to further develop an evidence base.
- There was enough equipment to allow staff to carry out their duties. The service had processes for checking and maintaining equipment.
- Staff understood their responsibilities to raise concerns and report incidents and near misses.
- There was evidence of a culture of learning and service improvement.
- There were systems for the effective management of staff which included an annual appraisal and support for revalidation
- The service had a rolling programme of local clinical audits. Managers monitored and benchmarked performance of all units across the organisation using a performance dashboard.
- Leaders were aware of their responsibilities to promote patient and staff safety and wellbeing.
- Leaders were supportive and the culture encouraged candour, openness, and honesty.
We saw several areas of good practice including:
- Staff went out of their way to provide a caring and holistic service to their patients. They did this by working well with local agencies to provide additional support and services where appropriate and by acting as an intermediary for patients who lacked confidence to make initial contact with other agencies.
- Regular, direct observation of staff practice was an integral part of the BPAS approach to ensuring staff maintained an expert level of competence in their individual roles.
- The provider ensured that all patients received a private initial consultation without anyone else present to protect patients against possible coercion or abuse and to give them the opportunity to disclose such information in a safe environment.
- Staff had access to a specialist placement team who would arrange referral to appropriate providers for patients with complex or additional medical needs, who did not meet usual acceptance criteria.
- Staff knew their own role, remit for safeguarding children and vulnerable adults, and had a heightened awareness of the needs and vulnerabilities of children and young people using their service.
- Completion of records complied with prescribed practice and was consistently of a high standard.