BPAS - Birmingham Central

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had a proactive, systematic approach to learning. When people raised concerns about safety and ideas to improve, the primary response was always to learn and improve. There was strong awareness of the areas with the greatest safety risks. Solutions to risks were developed collaboratively. Managers investigated incidents thoroughly and the provider was open and transparent when things went wrong. Women were protected by a clear approach to safeguarding. Staff understood and managed risks. The facilities and equipment met the needs of women, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding. This meant people were safe and protected from avoidable harm.

This service scored 91 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders embedded, maintained, and sought to continuously improve a culture of openness and collaboration. Safety was everyone’s top priority. Systems and resources were available to support continuous learning in response to identified safety risks. Systematic approaches to learning were embedded, incorporated and supported an active, participatory learning processes. Staff were actively encouraged to raise concerns about safety and ideas to improve, and the value of learning was continually demonstrated and reinforced by leaders. There was evidence of improvements in delivery of care and treatment as a result of learning.

Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice. Due to the volume of women that were assessed each day there was a daily incident meeting, chaired by the quality matron and attended by the compliance lead and the managers from all the telemedical services across the organisation. As there were fewer women who received an assessment face to face at the clinic, meetings to monitor and manage incidents that occurred there took place twice a week. The meetings looked at incidents to ensure they had been correctly graded, and actions had been put in place to reduce the likelihood of similar incidents occurring again. Incidents that required action were assigned to a named person to ensure the actions were carried out within agreed timescales. If an incident required urgent action a separate meeting would be convened so immediate action could be taken. When urgent action was required, the meeting would include the organisation’s subject experts and safeguarding leads.

Staff told us about improvements made to the delivery of care and treatment as a result of incidents. For example, immediate action was taken following a software update that resulted in 16 patients from across the organisation having information shared with their GP despite not giving consent for this. A meeting was convened to look at what action was needed. As well as apologising to the patients under the duty of candour an interim measure for recording exactly what information could be shared was disseminated to all staff. This plan was put in place while a permanent change to the electronic patient record system was being organised.

Staff investigated incidents of infection and failed termination of pregnancy to look for learning. They used a root cause analysis approach to identify the fundamental causes of the problem with the goal of preventing recurrence.

Staff told us they received feedback from incidents they reported. They also had regular learning opportunities to discuss locally reported incidents along with incidents that had occurred in other parts of the organisation. Learning from the previous month’s incidents was shared on staff bulletin boards.

Staff told us they were encouraged and supported to raise concerns. They felt confident that they would always be treated with compassion and understanding, and would not be blamed, or treated negatively for reporting incidents or raising concerns. They understood raising concerns helped to proactively identify and manage risks before safety events happen.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people needed to speak to different members of the team.

Safety and continuity of care was a priority throughout people’s care journey. This happened through a collaborative, joined-up approach to safety that involved staff working with partner organisations to ensure women remained safe. There were clear referral pathways with agencies including early pregnancy assessment units, mental health services, domestic abuse support services, and sexual assault referral centres. Staff also worked collaboratively with agencies that supported people from different cultures.

People who were not found suitable for abortion treatment by the provider were either referred to the organisation’s specialist placement team or a specialist NHS team. NHS referrals included women with a gestation longer than 23 weeks and 6 days who required ante-natal care or other specialised pathways.

Women could choose to receive a discharge letter once they were confirmed suitable for a medical termination of pregnancy and a prescription for their medicines had been issued. Women could also agree to have a copy of the letter sent to their GP. The discharge letter could be used to advise health providers what medication had been taken in the event of a medical emergency.

There was an escalation process for staff to follow if patients became unwell in the clinic.

The organisation had a centralised aftercare team that could be contacted 24 hours a day 7 days a week. All women were advised to contact that team if they had any concerns during or after their termination of pregnancy.

The service worked well with people to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always shared concerns quickly and appropriately.

During the assessment process NMPs spoke to women about safeguarding. Staff explained if they had safeguarding concerns, they would make a referral to the relevant safeguarding team. They also advised women that if a safeguarding concern had been identified and they were unable to re-contact them, staff would escalate their concerns. For example, if a referral had been made to a safeguarding team and the NMP wanted to update the women about the referral or seek further information, but the women did not respond, the team would escalate their concern in case the woman was actively avoiding the safeguarding team.

Referrals made to safeguarding teams included for homelessness, late disclosure of pregnancy, and coercive partners. Referrals to the Multi-Agency Risk Assessment Conference were made if staff identified high risk domestic abuse cases. There was a process for monitoring safeguarding concerns raised by the clinic and telemedical teams.

There was a strong understanding of safeguarding and how to take appropriate action. Staff told us about the type of reasons they would make safeguarding referrals for and gave examples of the times they had done this. One staff member gave an example of a missed opportunity to safeguard a person. When things had not gone as well as planned, staff had a debrief so action plans could be developed and learning shared to improve processes.

Information about safeguarding services was readily available for staff. There was a process to ensure staff in the clinic and telephone hub could make almost immediate contact with a safeguarding lead or a senior lead through a computer-based chat function. NMPs could request and receive support from safeguarding leads if issues arose during the assessment process. The chat function was available to NMPs throughout the duration of their shifts.

Staff received training in safeguarding adults and safeguarding children in line with national intercollegiate guidance.

An automatic safeguarding referral was made for all women under the age of 16. Women under the age of 13 were seen by a specialist young person’s team. All women under the age of 18 using the telemedical service had part of their assessment conducted over a video call. This was to help NMPs assess if women were being coerced into having abortion treatment. Additional questions were included in the assessment process for young women to assess their sexual safety.

All young women under the age of 16 were asked to come into the clinic to be scanned prior to being found suitable for abortion treatment. This was to ensure the reported gestation of pregnancy was correct. It also determined if they were being supported by an appropriate adult and were acting in their own self-interest. This assessment also enabled staff to revisit any areas they have may have been concerned about during the telephone assessment. Women between the age of 16 and 18 were triaged to determine if a scan was necessary.

The service always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Women were given information about risks and complications involved in having a medical termination of pregnancy, and assessed to ensure medical abortion treatment was legal, suitable and safe for them. Women were asked to consent to treatment and acknowledge they understood the risks.

Women were assessed to determine if they were high risk for complications. To help reduce risks related to medical termination of pregnancy, women were assessed to establish the gestation of pregnancy. Understanding the gestation of pregnancy was also a legal requirement for having a medical termination of pregnancy as this could only be carried out by women in their own home if their pregnancy was less than 10 weeks gestation. If there was any doubt about the length of gestation, women were asked to attend the clinic for an ultrasound scan to determine the length of pregnancy. NMPs explained to women it was illegal for them to supply medication to terminate a pregnancy above 10 weeks gestation. They also advised if a medical termination took place after 10 weeks gestation it could result in increased risk to their health.

To ensure safe and effective treatment women were referred for an ultrasound scan if there was uncertainty about their gestation of pregnancy or there was a history of ectopic pregnancy. All women under the age of 16 were referred for an ultrasound scan because it is more difficult to accurately date length of gestation from information about menstrual cycles in young women. If a woman had had a termination of pregnancy within the previous 3 months, they were also routinely referred for an ultrasound scan.

Staff had access to an online suitability tool. The tool showed which medical conditions and medicines were contra-indicated for a medical termination. The organisation also had a ‘suitability team’. This was a team of doctors that could review a woman’s medical history if there was any uncertainty regarding their suitability for treatment. Women were also assessed for risk of venous thromboembolism (VTE), which included taking a family history of VTE.

Important information was displayed in red font to ensure staff could see this information quickly. This included information about allergies, safeguarding forms, concerns around female genital mutilation, and the age of the woman seeking treatment.

Staff assessed if women’s blood pressure, blood test results, and body mass index were within clinically safe limits. People who were assessed as being outside clinically safe levels were referred to the medical team (consultant doctors) for further assessment. The medical team reviewed this information remotely and made a judgement about the person’s suitability for treatment.

The service used a structured tool, the SBAR, to communicate important messages to staff and improve patient safety (an SBAR structures information into 4 categories, situation, background, assessment, and recommendation). SBARs provide a clear framework for sharing information to help reduce misunderstanding and errors. SBARs were communicated to staff by email. Staff told us they were required to sign to say they had read and understood important messages.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

Equipment used to deliver care and treatment was suitable for the intended purpose, stored securely and used properly.

The clinic consulting rooms were bright and airy and visibly clean. They were suitably furnished and contained enough equipment to keep people safe.

The client satisfaction report from January to March 2025 showed that 100% of women who were seen in the clinic thought their treatment was carried out in a clean and safe environment.

Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care. Staff told us they checked equipment, including the ultrasound machines and computers, at the start of each day.

The resuscitation trolley was fully equipped and checked regularly by staff. The audit of resuscitation trolley checks demonstrated 98% compliance with the frequency of checks and condition of the emergency equipment, including the use by date of consumables.

The service made sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

To ensure all staff working in the service were familiar with policies and procedures, the organisation employed continuity staff. Continuity staff were nurses or midwifes substantively employed by the organisation to provide cover wherever it was required across the Midlands. At the time of our assessment the clinic had 2 vacancies being covered by continuity staff. There were no vacancies in the hub.

A team of doctors were employed by the organisation and could be contacted at all times through an online messaging platform.

To ensure managers had sight of emerging risk, they kept in contact with staff who worked remotely through an online group instant messaging platform.

Staff used an online system to complete mandatory training. The system reminded them of any new or refresher training they needed to complete. Managers monitored compliance with training and ensured staff were allocated time to complete any outstanding training requirements. All staff had an annual appraisal, and NMPs were expected to participate in safeguarding supervision and group and individual clinical supervision sessions. Compliance with mandatory training including safeguarding training, appraisals, and supervision was consistently above the organisational compliance target.

All new staff received an induction. Clinical staff were supernumerary for their first 8 weeks so they could shadow other NMPs to understand and feel confident in their new role.

To maintain safe staffing levels in the hub and avoid cancelling appointments, staff supported staff shortages in other parts of the country by increasing the number of assessments they performed. This was a reciprocal arrangement that benefited all 5 of the BPAS telemedical teams across England.

Staff were given development opportunities. For example, nurses and midwifes working in the clinic could receive additional competency-based training in ultrasound scanning, contraception counselling, and the insertion of contraceptive devices. If NMPs wanted to progress into a senior role, they were provided with managerial development opportunities.

There was a process for managers to follow to check that all staff had an up-to-date Disclosure and Barring Service check and, where applicable, had kept their nursing or midwifery registration up to date.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of infection spread and shared concerns with appropriate agencies promptly.

Information about the risk of infection was shared appropriately with relevant partners, including agencies, women using the service and visitors.

Housekeeping staff cleaned the clinic daily. The cleaning schedule for the clinic was visible and showed that all areas were cleaned in line with the schedule.

Staff cleaned equipment in between each patient.

The provider had an infection prevention and control (IPC) lead. The clinic and telemedical hub had IPC champions who undertook regular audits. The IPC lead had overall responsibility for infection prevention and control including reviewing the audits. Compliance with the infection prevention and control audit for March 2025 was 96%. The hand hygiene audit measured hand washing technique and frequency of handwashing demonstrate 100% compliance.

Clinical and domestic waste bins were clearly labelled and emptied regularly. Sharps bins were stored safely.

The service made sure that medicines and treatments were safe and met women’s needs, capacities and preferences. Staff involved women in planning treatment, including when changes happened.

Medicines for an early medical abortion sent to women by post were sent from their registered pharmacy partner. We saw an example of the pack containing medicine sent by post. The boxes had labels to clearly show what they contained and how and when the medicine needed to be used. An information booklet was also included in the pack which contained information about the medication and step by step instructions about how and when to use the medication. Women assessed as suitable for an early medical abortion in the clinic were issued with a pack containing medicine from the onsite medicines store. The packs were stored safely and could only be accessed by a nominated NMP.

Accurate, up-to-date information about women’s medicines was available, particularly when they move between health settings, in line with current national guidance. For example, if a women required emergency medical treatment. Women could choose to have an email containing details of their treatment in case of emergency. However, not all women wanted this information sending to them.

There were appropriate arrangements for the safe management, use and oversight of medicines including controlled drugs (CDs). Medicines could only be accessed by authorised people including CDs. CDs are drugs or chemicals whose manufacture, possession, and use are regulated by the government to prevent them from being abused.

Medication guidance, including guidance on contraception, was available for staff on notice boards in clinic rooms. This was to ensure staff were able to get the information they needed quickly and easily.

Fridge and room temperature checks were performed daily to ensure medicines were being stored in line with the manufacturer’s guidance.

Medicines management audits showed high levels of compliance. Overall compliance for the medicines management audits in January was 99%, 97% in February, and 97% in March. Management of CDs and other stock drugs consistently demonstrated 100% compliance with the medicines management policy. When compliance with medicines audits were below 100% an action plan was developed to ensure compliance increased.