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Marie Stopes International Bristol Centre


Inspection carried out on 17, 18 and 22 August 2017

During a routine inspection

MSI Bristol Centre is operated by Marie Stopes International. The Bristol service provides medical terminations up to nine weeks and four days gestation and surgical terminations up to 17 weeks and six days gestation. The Bristol centre is open four days per week and is supported by four satellite clinics in Gillingham, Poole, Bournemouth and West Mendip. Marie Stopes Bristol Centre also provides counselling, contraceptive services, including vasectomy and tests for sexually transmitted infection (STI). The satellite clinics offer: early medical terminations,medical terminations and surgical terminations counselling, STI screening and contraception. The satellite services are provided out of rented consultation rooms within GP practices. The services are provided to both NHS and private patients.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection of Marie Stopes Bristol Centre on 17 and 18 of August 2017 along with an announced inspection of the Poole satellite clinic on 22 August 2017.

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.

We regulate termination of pregnancy, but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

CQC undertook enforcement action following an inspection of the governance systems at the Marie Stopes International corporate (provider) level in late July and August 2016. There were breaches in regulation that were relevant to this location. These were reviewed as part of the Marie Strope International Brisol clinic inspection.

The breaches were in respect of:

- Regulation 11 Consent

- Regulation 12 Safe care and treatment.

- Regulation 13 Safeguarding service users from abuse and improper treatment.

- Regulation 17 Good governance.

- Regulation 20 Regulations relating to termination of pregnancies.

We found the following areas of good practice:

  • Staff were patient focused, kind and caring and demonstrated that the individual needs of each patient was at the forefront of treatment and care provided.

  • Patients consistently reported all staff treated them with kindness and compassion and that they felt involved in all aspects of their treatment and care.
  • Staff demonstrated collaborative and supportive team working practices.

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

  • Improvements were required to the main surgical recovery area to improve the privacy and dignity of patients.
  • Improvements were required to the governance, audit and quality measures at MSI Bristol clinic. There was a lack of evidence of analysis of incidents, risks and of actions taken and learning shared to make safety and quality service improvements.
  • Chaperoning requirements were set out in the MSI chaperone policy 2017. However, the policy was not followed as nurses normally worked as lone workers at the satellite clinics.
  • Not all nurses had completed the providers mandatory training on consent. This meant there was a risk that not all registered nurses taking patient consent had completed the required training

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected MSI Bristol clinic. Details are at the end of the report.

Amanda Stanford

Interim Deputy Chief Inspector of Hospitals

Inspection carried out on 5, 6 and 13 November 2015

During a routine inspection

Are services safe at this hospital?

There were systems in place to ensure all reported incidents were investigated. Staff were clear on the process for incident reporting and felt able to report appropriately.

There were processes in place to assess and respond to patients’ risk.

The staff were up to date with mandatory training and staff had been trained to recognise and act upon suspicions of abuse.

We did not see evidence of a medicines stock control. Staff were unable to account for medicines prescribed against medicines given. Expired medication was not disposed of correctly or recorded appropriately.

We were told that the administration staff had at times sat with patients if they become upset or need to talk through their decisions.

Are services effective at this hospital?

Care and treatment was delivered using evidence based and national guidelines. Staff received training to equip them with the knowledge and skills to care for the patients receiving care in the centre.

Patients received effective pain relief and information about pain management on discharge home. Outcomes of the patients’ care and service delivery were monitored in accordance to guidelines. Staff had a good understanding of the importance of providing full treatment explanations and options in order for patients to be able to make informed decisions prior to giving their consent.

Are services caring at this hospital?

Patients were treated with respect and compassion while they receive care and treatment. Patients told us how they had been listened to; they felt safe and were treated with kindness.

We were concerned that patients did not have full access to privacy and dignity when being cared for in the recovery area following surgical procedures.

Are services responsive at this hospital?

We found the service to be responsive to meeting people’s needs and requirements. Patients did not wait longer than three days for consultations and were offered appointments to suit them. Options were given, if requested, on the disposal of foetal remains following the guidelines as set out by the Human Tissue Authority.

Complaints and concerns were acted upon and changes had been made to the service as a result of some comments made. Staff were involved in the learning from complaints. There was written information available to make a complaint but there were no leaflets available for patients to take away with them.

Are services well led at this hospital?

The Bristol Centre was well led, staff felt valued and respected and enjoyed working there. There was a good governance framework with information being passed to the board and information being disseminated to the local team. We found the HSA forms to be completed appropriately in accordance with The Abortion Act 1967 (as amended) and The Abortion Regulations 1991.Information about each termination of pregnancy was sent to the Department of Health in a timely and secure manner.

There was a good response (50%) from the patient feedback which was directly used to improve the services provided.

We saw several areas of outstanding practice including:

  • Staff were described and observed as being non-judgemental

  • The service provided was tailored completely according to patient’s needs.

  • The service was highly responsive to individual needs

However, there were also areas of practice where the provider should make improvements:

  • Improve the control of medicines and disposal of expired drugs.

  • Improve the design of the World Health Organisation surgical checklist and include observations of practice in the audit process.

  • Provide visible information for patients and visitors detailing how to raise complaints or concerns.

  • Improve the privacy and dignity within the recovery area.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 29, 31 October 2013

During a routine inspection

We visited the Bristol centre over two days and spoke with three women attending the clinic for treatment. They were mostly satisfied with the service they had received. One person told us “it has been a really positive experience; very professional, very quick and easy”. Another person told us “everybody, including the receptionist has been very friendly and personable”. One woman, who was attending the clinic for the second time, told us that on her first visit she did not feel she had been treated sympathetically and that staff had been chatting amongst themselves rather than focussing on her. She felt she had been treated more sympathetically on her second visit and had been given kind reassurance. People told us that they had been given appointments quickly which they were grateful for. Although we did not visit the two satellite clinics on this occasion, we looked at feedback captured by the provider for all three centres during the period July to September 2013. These showed very high levels of satisfaction.

People told us they were given information about their treatment, including side effects and risks associated with treatment. They told us they felt supported to make decisions and did not feel judged or pressurised into making a decision. We looked at a sample of treatment records and saw that people’s consent to treatment had been recorded.

People told us the Bristol clinic was clean, comfortable and welcoming. One person commented that they liked the’ non-clinical feel’ of the environment. We inspected the building and looked at maintenance records. We found the building was appropriately designed and laid out to ensure accessibility, comfort and dignity. All areas were clean, well maintained, bright and welcoming. Records confirmed that regular safety checks, servicing and maintenance were carried out.

We spoke with staff and looked at their records to see how they were supported. Staff told us they felt well supported by managers and their peers. They told us they received regular training and supervision. They talked about the ‘open door policy’ operated in the clinic, which meant that they could speak with managers at any time if they had any concerns or felt they needed support. Training and supervision records were however not well maintained and there was no overview of performance in this area.

People told us they felt able to complain if they were not happy about any aspect of their care or treatment. The complaints procedure was well publicised, although the information provided to people using the service was incomplete. It did not provide advice on sources of support when making a complaint or where to direct their complaint for external adjudication if people remained dissatisfied. The clinic had received only one complaint during 2013. This had been investigated and the complainant had been kept informed of the progress of the investigation and provided with a detailed response. We were satisfied that a thorough investigation had taken place and appropriate remedial actions were being considered.

Inspection carried out on 17 January 2013

During a routine inspection

On the day of our visit, only women were attending the clinic. On this occasion therefore we did not look at the vasectomy service provided at this clinic.

Women who used the service told us that the staff were sensitive and sympathetic. They said that they did not feel pressurised, questioned or judged and that staff took time to provide very clear explanations of options and treatments available. One woman described the staff as " professional and unbiased". Another woman said that the way she was treated at Marie Stopes “made a bad experience bearable” and she was grateful that she was able to make appointments that were convenient to her. Women felt that their privacy and dignity were respected and they were treated with courtesy. The environment was described as “relaxed” and “not too clinical”.

Staff were trained to recognise the signs of abuse and support was available to people who had been abused. People who used the service could be assured that there were strict vetting procedures in place to ensure that they were not cared for or treated by unsuitable individuals. The clinic received regular feedback from people who used the service and this showed high levels of satisfaction. There were however effective systems in place to identify and act on areas for improvement.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that treatment for the termination of pregnancy was not commenced unless two certificated opinions from doctors had been obtained.