BPAS - Merseyside

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, well being and communication needs with them.

Staff used a range of tools to assess and review women’s treatment needs. The tools were standardised, so staff understood how to use them. The assessment process enabled staff to understand women’s holistic needs and offer referral to support services.

Staff could make internal referrals to the provider’s counselling service to support women making abortion choices. They could also provide information about external services which supported victims of domestic abuse, violence or sexual assault.

Staff encouraged young women to consider who might be a supportive adult they could approach for support. They asked if they felt safe with the person, they had an intimate relationship with and if they were being asked to do things they were unhappy with as part of the safeguarding assessment. Staff were aware this might be the first time young women had considered their sexual safety so they gave them additional time to reflect and respond.

We scored the service as 3. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The organisation had a clinical advisory group which reviewed policies to ensure they incorporated up to date clinical practice. Polices were stored on the organisations intranet and staff were given protected time to read them and review any updates.

The service had processes to deliver care in line with legislation and best practice. Managers had meetings with colleagues to review standards of care across the clinics.

The electronic patient record had several risk assessments to complete to ensure women received safe care and treatment.

Audits were completed from the electronic patient record as part of local clinical compliance. Monthly audits were completed for hand washing, uniform, IPC, consent, consultation, medicines and ultrasound. Quarterly audits were completed for patient group directives (PGD), remains and monthly form assessment.

We scored the service as 3. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The electronic patient record could be accessed by relevant staff in the organisation. Women could choose when and where to have their termination of pregnancy depending on the type of appointment (medical or surgical). We saw women were seen in different clinics depending on their preferences and service availability.

Staff worked closely with external teams including safeguarding and sexual health services.

There were formal service level agreements and handover procedures to enable safe and swift transfer of cases to local and regional NHS hospitals for emergency treatment, ectopic pregnancy or NHS care and support with late terminations for high risk women.

We scored the service as 3. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The assessment included a discussion around women’s sexual health. Women were asked about contraception and were advised how they could access this.

Women were signposted to other services for contraception and sexually transmitted infection testing when not available through BPAS Merseyside.

Young women and those whose circumstances may have made them vulnerable were offered additional support. The BPAS safeguarding team worked closely with local social services and other supporting organisations.

We scored the service as 3. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service completed audits for patient outcomes and standards, including waiting times and number of women who proceeded to each type of treatment. The service undertook regular monthly audits of records. A dashboard recorded compliance rates. Transfers to the local hospital were reviewed to ensure policy was followed and learning was identified.

Women were given a pregnancy test to use 3 weeks after they had a medical termination. A gap of 3 weeks allowed time for pregnancy hormones to decrease significantly. If women had a positive pregnancy test, they were advised to call the organisation's helpline so a follow up appointment could be arranged. The success rate of medical terminations was monitored by the organisation to improve outcomes for women. The service saw patients who had had treatment at other BPAS locations and required further treatment.

We scored the service as 3. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood how to gain consent from children (person aged under 18 years) regarding their care and treatment. They used Gillick competence and Fraser guidelines to assess their ability to consent to abortion treatment and sexual health advice and treatment. Gillick competence is concerned with determining a child (person under 16 years) has capacity to consent through assessment of their intelligence, competence and understanding to fully appreciate what’s involved in their treatment. Fraser guidelines are used specifically to decide if a child could consent to contraceptive or sexual health advice and treatment.

Staff understood how to access women’s capacity to consent to treatment. If a women lacked capacity to make decisions about her treatment, the case would be managed by the organisation's safeguarding team.

Managers audited the consultation process to monitor the consent process.

Staff discussed the options following treatment and women were consented regarding the disposal of foetal remains.

For women whose first language was not English an interpreter service was available. This was booked in advance, and a longer appointment was given.