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Inspection Summary


Overall summary & rating

Good

Updated 5 September 2019

BPAS Peterborough is operated by British Pregnancy Advisory Service. BPAS Peterborough provides consultation and early medical abortion (EMA) and medical termination of pregnancy up to 10 weeks gestation and surgical termination of pregnancy up to 13 weeks gestation. There is one treatment room where surgical termination of pregnancy by vacuum aspiration is undertaken, with the options of local anaesthetic and/or conscious sedation for pain management. This is performed as day case surgery and no overnight accommodation is provided. The service had two ultrasound screening rooms and five consultation rooms.

The service provides termination of pregnancy, sexual health screening and family planning services. We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 16 May 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 did not previously rate this service. We rated it as Good overall.

We found the following areas of good practice:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • The nursing team were highly committed to giving patients a personalised service. Care was delivered by an exceptional team.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders and staff actively and openly engaged with patients, staff and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services. Leaders encouraged innovation.

We found areas of outstanding practice:

  • Staff always took people’s personal, cultural, social and religious needs into account and found innovative ways to meet them. For example, using alternative equipment so that the patient wouldn’t have to hear the sound of a vacuum to alleviate their anxiety about the noise and allowing patients to be accompanied by a relative.
  • Consideration of patient’s dignity was consistently embedded within all staff member’s practice. One patient had returned to the treatment unit on the day of our inspection after bleeding heavily, staff ensured provided her with reassurance and clothing to ensure she was comfortable leaving the treatment unit.

We found areas of practice that require improvement:

  • Waiting times from referral to treatment were not in line with national standards.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)

Inspection areas

Safe

Good

Updated 5 September 2019

We rated safe as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste appropriately.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

However, we also found the following issues that the service provider needed to improve:

  • The service did not consistently follow best practice when prescribing, giving, recording and disposing of medicines. Medicines were drawn up in advance of surgical lists, against national guidance. Controlled drug records showed that they were not always disposed of in line with BPAS policy. Nurses signed the anaesthetic record during surgical termination of pregnancy when it should have been the surgeon to denote that they were prescribing them.

Effective

Good

Updated 5 September 2019

We rated effective as Good because:

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients.
  • Staff gave patients practical support and advice to lead healthier lives.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Caring

Good

Updated 5 September 2019

We rated caring as Good because:

  • Staff within the service were highly motivated to offer care that was kind and promoted patient’s dignity. All interactions between staff, patients and their relatives that we observed were caring, respectful and supportive.
  • Staff within the service had the patient’s wellbeing and comfort at the forefront of their minds during all interactions that we observed. We observed a patient receiving an anti-D injection prior to their treatment, the nurse had called ahead for the drug to be removed from the fridge five minutes prior to the injection so that it wouldn’t be too cold when injected in the patient’s arm.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Requires improvement

Updated 5 September 2019

We rated responsive as Requires improvement because:

  • People could not always access the service when they needed it. A high proportion of patients waited longer than two weeks from first contact to treatment which was outside of Required Standard Operating Procedures (RSOP) as specified by the Department of Health. Actions had been put into place to reduce this.

However, we also saw:

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.

Well-led

Good

Updated 5 September 2019

We rated well led as Good because:

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders and teams identified and escalated relevant risks and issues and identified actions to reduce their impact.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients. All staff were committed to continually learning and improving services.

However, we also found:

  • We were not assured that there were effective governance systems in place to monitor medicines management within the organisation. There were not effective processes in place to monitor medicines practices to ensure they complied with policy. Monthly audits had not identified concerns with signing practices we had identified on our inspection or identified that staff were not always drawing up medicines in line with policy.
  • The Provider had a formalised strategy which set out the service’s goals and ambitions for the following year. However, staff within BPAS Peterborough were not aware of the formal strategy but were aware of wider projects and innovations within the service.
Checks on specific services

Termination of pregnancy

Good

Updated 5 September 2019

BPAS Peterborough is operated by the British Pregnancy Advisory Service (BPAS). It comprises of one main location in Peterborough and one satellite location in Cambridge.

The service provides termination of pregnancy as a single speciality service.