BPAS - Birmingham Central

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We found people were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. People were involved in planning their care and understood options around choosing to not receive treatment.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure women were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to changes in people’s needs.

Women’s care reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. Staff made sure care and treatment was tailored to women including by making reasonable adjustments so women could access the service in a way and at a time that suited them. For example, women who worked could be offered appointments in the evening or weekend, and neurodiverse women could have longer appointments to give them time to process information and ask questions if they needed it.

Staff ensured women understood their care and treatment options which included not having a termination of pregnancy. Staff told us they were responsive to people and would support them, “in the moment” to meet their changing needs. For example, people who had a longer gestation of pregnancy than expected which meant they could no longer have their preferred abortion treatment, or people who were undecided about abortion treatment.

Staff ensured they involved both women seeking treatment, and those close to them in planning and making shared decisions where the women wanted this to happen. This meant treatment was centred around the women and their needs.

We listened to a call where a women wanted to know about their treatment options but was scared about making the wrong decision. The midwife explained the treatment options but said that the decision to go ahead with treatment, or not, could be made in the woman’s own time. They went on to explain the timeframes that abortion treatment could take place in and reassured the person they still had time to make the decision that was right for them. They told the woman they would email them leaflets about treatment options and timeframes so they did not have to remember all the information they were getting all at once. They offered a referral to pre-abortion counselling.

Staff aimed to reduce unnecessary multiple appointments where possible. For example, some women who were choosing a termination due to fetal abnormality may have already undertaken numerous medical tests and been involved with several medical services before clinic staff saw them. To save the women having to repeat information about the tests already taken and avoid the repetition of procedures or tests, a single member of staff was assigned to work with the women. This included booking the appointment, carrying out the assessment, and giving information on seeing and holding the baby following a surgical termination and disposal of fetal remains.

If women expressed a preference to be seen by a female member of staff, including sonographers and interpreters, the service would endeavour to meet this request. However, if women were referred for a surgical termination, they were advised that some of the doctors might be male.

The service understood the diverse health and care needs of people, so care was joined-up, flexible and supported choice and continuity.

Women’s care and treatment was delivered in a way that meet their assessed needs. Most telephone appointment slots were for 60 minutes. There were longer appointments available for young people and people who required an interpreter. Young people were given a longer assessment appointment to ensure a thorough assessment of their understanding of abortion treatment could be made. The longer appointment was also used to get a clear picture of any potential safeguarding issues. Appointment slots of 90 minutes were also reserved for people who required an interpreter as more time was needed for the interpretation process.

Young people were prioritised for appointment slots outside of school hours. In the telemedical hub a set number of appointments were reserved each day for young people. The appointments for young people and people requiring an interpreter were opened up to everyone if they were not filled.

Face to face appointments were booked for 70 minutes to allow time for the assessment and additional tests that might be required, for example a blood pressure test or blood pressure monitoring.

Staff aimed to reduce unnecessary multiple appointments where possible. For example, some women who were choosing a termination due to fetal abnormality may have already undertaken numerous medical tests and been involved with several medical services before they were seen by clinic staff. To save the women having to repeat information about the tests already taken and avoid the repetition of procedures or tests, a single member of staff was assigned to work with the women. This included booking the appointment, carrying out the assessment, and giving information on seeing and holding the baby following a surgical termination and disposal of fetal remains.

The organisation was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided online and written information about the services they offered including abortion treatment, screening for sexually transmitted disease and contraception. Written information was also available in easy read formats.

There were videos on the organisation’s website that talked through what the service offered as well as step-by-step instructions for using abortion treatment at home, and information about surgical treatment. The step-by-step instructions included what the pack of medication looked like, how to use the medication, the use of pain relief, and what to expect during and after treatment. All the web-based videos had closed captions, and some had British Sign Language interpretation.

Women undergoing medical abortion treatment were given a leaflet with detailed step by step instruction of how and when to use their medicine, how long treatment would take and what would happen afterwards. The leaflet also provided information about the risks involved in treatment and what to do if something did not feel right or in case of emergency. The leaflets were available in brail and electronic versions of the leaflet were available in 60 languages other than English.

Women were asked to complete a satisfaction survey following their treatment. The response rate was low, with only 75 responses in January 2025, 63 responses in February, and 120 responses in March. However, 100% of respondents said the information they were given about abortion treatment was understandable, and they were given enough time to ask questions. The responses also demonstrated 95.6% of women said they were given enough information about their aftercare. The comments given were typically positive. For example, one woman said, “every step was clearly explained and I felt very supported.”

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

From March 2024 to March 2025 the number of complaints made reflected 0.4% of women who had accessed treatment through the telemedical hub and 0.5% of patients who had accessed treatment through the clinic.

Women were asked to complete a satisfaction survey following their treatment. They were sent a text with a free text response to share their comments and concerns about the service. Managers met monthly to look at the feedback and consider how changes to service delivery could improve women’s experience of treatment. Trends and themes in feedback were also shared with staff so they could be addressed through quality improvement projects.

The service made sure that people could access the care, support and treatment they needed when they needed it.

Women had equal access to care, treatment and support because the provider complied with legal equality and human rights requirements, including avoiding discrimination, considering the needs of people with different protected characteristics and making reasonable adjustments.

The service was designed to make it accessible and timely for people who were most likely to have difficulty accessing care. When there were barriers, the service worked to remove them. Most referrals were made from women directly accessing treatment themselves (less than 1% of referrals were made by a woman’s GP). Information about how to access the service was displayed on the organisation’s website. The website had a facility which meant it could be translated into 60 of the most commonly spoken languages in the United Kingdom. The website also had functions to enable users with vision impairment to use assistive technology, including a text only version of the website.

To ensure treatment was accessible to as many women as possible there was information on the providers website about requesting additional support for people who needed it. People with communication needs were asked to let the booking team, helpline teams, or clinic staff know. A textphone service was also provided for calls to the booking team and helplines.

Managers ensured women could access the service out of hours to enable wider access as required. The service offered evening and weekend face to face and telephone assessment appointments.

The capacity team worked within the telemedical hub to monitor demand on the service. Each day they held back some 90-minute appointment slots for women under the age of 18 and for women who required an interpreter. If these slots had not been booked about an hour before their start time they would be opened up so they could be allocated to anyone looking for an appointment. These appointments could also be used if another hub had a high level of demand for appointments for women under 18 or for those requiring an interpreter.

The clinic had a lift so it could be accessed by wheelchair users. However, they did not have a hoist so women who could not manoeuvre themselves onto the couch could not access some treatments at the clinic.

There were multiple waiting areas to ensure patient flow and to promote people’s anonymity and confidentiality. There was enough space to enable people to bring their partner, a friend, or a family member to their appointment. Each waiting area had its own toilet.

The women we spoke to said, “the clinic smells nice”, there was, “a calm atmosphere”. They also said the clinic was easy to find.

Access to treatment was delivered in line with national guidance, including the National Institute for Health and Care Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists. The guidance recommends assessment for abortion should be accessed within 7 days of making contact with an abortion service. Completion of abortion treatment should take place within 14 days of the initial contact for most women.

Managers of the telemedical hub told us they have never had to cancel a women’s appointment. If the local team had sudden sickness absence they would reach out to 1 of the other telemedical hubs and ask for their support. They described a reciprocal agreement across the 5 hubs. The telemedical hub and clinic also worked together to reduce the impact of sickness and delays for face-to-face patients. The clinic supported with short notice urgent appointments that were required following a telephone consultation.

Women made initial contact with the organisation’s booking centre. If the booking centre identified quick access to a telemedical or clinic appointment was required, this would be passed to the accelerated booking team. This team would contact managers to look at how this appointment could be expedited.

If a woman needed financial support to access the service a request for funding was made to their integrated care board (ICB). This could be for help with transport costs or cost associated with an overnight stay required for treatment.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff had a good understanding of the people who used their service that were most likely to experience inequality in experience or outcomes, and they took steps to minimise barriers to inclusion and positive experiences. Data collected from the provider demonstrated that women of different ages, religious and spiritual backgrounds, as well as women from a diverse range of ethnic backgrounds accessed the service. The data also showed the service was used by women with physical disabilities and mental illnesses, women with a learning disability, and heterosexual, bisexual, and lesbian women. Staff received training to support them to work with a diverse range of women, including those with protected characteristics.

The service took action to prevent or minimise the inequality in experience or outcomes for people. They did this by making reasonable adjustments for people and providing culturally appropriate care.

Staff worked in partnership with other agencies to improve equity in access and outcomes. For example, they worked with professional translator to improve the experience of treatment for people whose first language was not English, including for people who used British Sign Language or Makaton.

Where waiting times were longer in the telemedical hub, managers reviewed this and reallocated appointments “to avoid a postcode lottery”. If there was more demand in one area than another or if one area had a high level of sickness, the hubs would provide support for each other.

When treatment did not meet the expectations of women staff worked to ensure changes were introduced to improve treatment outcomes for all women. For example, in response to women’s feedback about their experience of pain the team completed a research project on this. Feedback from women who used the clinic and telemedical service in January, February and March 2025 showed 68.3% of them felt the leaflet they had been given fully prepared them for the pain they were going to experience. A slightly lower number of women (66.28%) said the website had fully prepared them for this. In addition to this a significant proportion of women felt moderately prepared by both the leaflet and the website. However, a small number of women continued to report they felt unprepared for the amount of pain they experienced.

A deep dive into the feedback data revealed that the women most likely to experience more pain than expected had not had a previous birth, miscarriage, or a previous termination of pregnancy. In light of these findings this patient group would be given additional information about what to expect. The provider updated some of the videos designed to prepare women for treatment on the website and improved some of the information in the step by step leaflet all women were given a copy of. For example, they introduced images of blood loss to give a visual interpretation of what a heavy blood flow looks like rather than leaving this up to an individual’s interpretation. We heard NMPs being descriptive about blood loss to improve women’s understanding of the procedure and to help them gain a realistic expectation of what their treatment might look and feel like.

Staff were waiting for the end of that quarter’s feedback so they could measure the improvement the new videos and leaflet made. However, staff were aware it was likely they still had more work to do to improve women’s understanding of how much pain they might expect to experience.

Some women had unsuccessful treatment outcome (failed abortion treatment). When this was reported back to the provider staff carried out an investigation into what went wrong to help reduce the likelihood of things going wrong for other women. The investigations showed there were several reasons this might happen, but mostly it was because women had not used their medicine as directed. To increase the number of successful abortions NMPs asked women to repeat back to them instructions for using their medicines to ensure women understood the directions they had been given. NMPs spent extra time with women to explain to how to use their medicine when they thought this was necessary.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Women were not asked to make a decision about having treatment until they felt ready to do this. Women were given advice and information about terminating their pregnancy, including the timescales within which medical and surgical abortions could take place. However, they were not under any pressure to make a decision within a timescale. The options of having a termination of pregnancy, adoption, or going ahead with the pregnancy were discussed. Women were offered counselling to help them make a decision, and they could be sent information to help them to make a choice in their own time without the pressure of remembering the treatment choices that had been discussed.

Women were advised they could make use of the organisation’s post abortion treatment counselling at any point after the procedure.

To meet local needs and improve health outcomes women were given advice about sexual health screening and signposted to their local sexual health services. Women were also asked about contraception and given information and advice about their contraception options taking their personal circumstances and beliefs into account.

The provider could start women on some contraceptive medicines. Although, at the time of our inspection none of the clinic staff were trained to fit coils. A coil, also known as an intrauterine device or intrauterine system, is a small, T-shaped device inserted into the uterus to prevent pregnancy. It is a long-acting reversible contraception. However, staff could signpost women to other services who could fit coils. Staff could insert contraceptive implants using a device which facilitated a no touch technique. The contraceptive implant is a small, flexible rod inserted under the skin of the upper arm that releases the hormone progestogen to prevent ovulation for up to three years.