MSI Reproductive Choices Regional Treatment Centre - Bristol

On this page

• 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 women and communities had the best possible outcomes because their needs were assessed. We checked women’s care, support and treatment reflected these needs and any protected equality characteristics to ensure women 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.

Women were involved in assessments of their needs. Staff took account of women’s communication, personal and health needs. Care provided to women was based on the latest evidence and good practice. Staff made sure women understood their care and treatment to enable them to give informed consent.

At the last assessment this key question was not rated. At this assessment the rating is outstanding. This meant women’s outcomes were consistently good.

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed an exceptional standard. The service always made sure women’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing, and communication needs with them.

Staff used a range of tools to assess and review women’s treatment needs. The assessment process enabled the Nurse and Midwife Practitioners (N/MPs) to understand women’s holistic needs and offer information about or make an onwards referral to internal or external support services. For example, they could give information about external services to support victims of domestic abuse violence or sexual assault. They could also make internal referrals to the organisation’s counselling services for support with women’s abortion choices.

Women were asked about their communication needs when they first contacted the service. If required, women were provided with support by the service to overcome communication barriers.

The provider worked closely with a local charity supporting adults with a disability as part of a quality improvement project to improve accessibility for women with disabilities. The charity visited the providers premises and made 12 recommendations to improve accessibility. Some of the changes made included the provision of noise cancelling headphones, clearer signage with easier to understand language and more prominent disabled toilet signs. There was a plan for the charity to return to deliver bespoke training for staff on disability and autism awareness.

The provider prepared women with a learning disability for treatment by providing a healthcare/hospital passport if the woman did not already have one. Women were advised to let the telephone advisor know of their disability so reasonable adjustments could be made as early on the process as possible.

Staff encouraged young women to consider who might be a supportive adult they could approach for support. They asked all women 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. However, staff were aware this might be the first time women, especially young women, had considered their sexual safety so they gave them as much time as they needed to reflect and answer this.

We observed a woman, who was deaf, through treatment at the clinic. Her partner was allowed to stay with her. This meant he could use sign language to keep her informed about what was happening. We also noticed staff took extra care to speak directly to her so she could lip read.

All patients undergoing surgical termination had a pre-operative assessment up to one week before surgery. The N/MP gained initial consent from the women, confirmed by the surgeon pre-operatively.

The evidence showed a good standard. The service planned and delivered women’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.

Managers had regular meetings across the organisation where best practice was shared to ensure the clinics and telemedical hubs were using the same standards of care.

The organisation had a Policy and Document Approval group which met monthly. They reviewed policies to ensure they were updated and incorporated the latest best clinical practice. The policy group members included the organisation’s subject experts and matrons. Policies and procedures were stored on the organisation’s intranet and were available to all staff. When policies were updated, staff received an email to let them know.

Staff used technology to support their clinical assessments of women. This supported the staff to make sound decisions based on professional judgment and best practice.

The evidence showed a good standard. The service worked well across teams and services to support women. They made sure women only needed to tell their story once by sharing their assessment of needs when women moved between different services.

Electronic patient records could be accessed by relevant staff within the organisation. For example, information collected by the booking team, was also visible to the telemedical hub staff and clinic staff. This reduced the times staff needed to ask women the same questions.

N/MPs worked closely with external teams including community midwives, safeguarding teams and other sexual health services. They described strong working relationships based on trust which had been established for many years. The provider had a specific proforma to be used to inform the community midwives the woman no longer wished to proceed with a termination.

Staff undertook competency-based training so they could work in all aspects of the clinic. This meant staff could rotate between the telephone consultations, face to face consultations including scanning, pre and post operative care and the treatment room.

Staff said safeguarding teams were always very responsive to their referrals, and in turn they aimed to respond promptly if they were asked for additional information about a woman and her situation. The provider worked closely with Independent Domestic Violence/Sexual Violence Advisor services, Sexual Assault Referral Centres, Local Authorities, Social Services and the police.

The evidence showed a good standard. The service supported women to manage their health and wellbeing to maximize their independence, choice and control. The service supported women to live healthier lives and where possible, reduce their future needs for care and support.

The assessment included a discussion around women’s sexual health. The provider offered sexual health service for all women as part of their treatment. This meant they could be tested and treated for some sexually transmitted diseases. Women could receive their treatment by post if they wished. All clients were counselled for sexual health testing. Point of care testing was offered for Syphilis, HIV, Chlamydia and Gonorrhoea. Point of care testing for HIV and Syphilis has limitations; if a positive result was produced, this indicated full testing was required. A direct referral would be arranged to the local sexual health service

Women were offered a full range of contraception and did not have to go back to their GP. This was offered at the same time as their treatment. Women were given a choice about contraception; they could have it immediately or come back later.

The evidence showed an exceptional standard. The service monitored all women’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of women themselves.

Clinical outcomes and complication rates for all patients treated at Bristol were all within parameters set by the provider for all the services offered by the provider. This meant patients received safe and effective care.

The success rate of medical terminations was monitored by the organisation to improve outcomes for women. Staff monitored outcomes using a set of indicators. The main indicators included how quickly women could access an assessment of their needs (5 working days for a standard referral, 2 days for urgent appointments), accessing ultrasound scans (6 days) and how quickly their treatment pathway was completed (10 days). Other indicators included the percentage of women offered contraception, the number of women who took up testing for sexually transmitted diseases, and the number of incomplete abortion treatments (an incomplete abortion treatment is when the pregnancy continues despite medicines to terminate the pregnancy being used). In these cases, an additional procedure would be needed to complete the termination.

According to the National Institute for Health and Care Excellence and the Royal College of Obstetricians and Gynaecologists the expected failure rate for early medical abortions was approximately 2 to 3%, or 2 to 3 out of every 100 cases. From January 2025 to July 2025 there were 4 (0.09%) recorded cases of a failed early medical termination of pregnancy. This was lower (better) than the expected failure rate at 0.3%, or less than 3 in 1000 treatments.

A helpline was available for women to call for advice, available 24 hours a day, seven days a week.

The evidence showed an exceptional standard. The service always carefully explained to women what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

Women were advised, under the Abortion Act 1967, it was a legal requirement for the provider to share anonymised information for women using their service for abortion treatment with the UK government’s Chief Medical Officer. The information shared included a unique reference number, date of birth, postcode, ethnicity, marital status, treatment details, gestation of pregnancy, and the legal grounds for the abortion. The legal grounds for abortion could only be granted if 2 doctors agree it would cause less harm to the woman's physical or mental health or the health of existing children than continuing with the pregnancy.

Gillick competence and Fraser guidelines were used to assess the ability of young women to consent to abortion treatment and sexual health advice and treatment. Gillick competence is concerned with determining a child’s (person aged under 16 years) capacity to consent through assessment of their intelligence, competence and understanding to fully appreciate what is involved in their treatment. Fraser guidelines were used specifically to decide if a child could consent to contraceptive or sexual health advice and treatment. The provider had access to a specialist young person’s outreach team for women seeking a termination under the age of 18. This provided an extra level of support for women. Additional questions were included in the assessment process for young women to assess their sexual safety.

Staff gained initial verbal consent from women during the consultation and recorded this in their electronic patient records. Interpreters were used to gain consent from women whose first language was not English, including for women who used British Sign Language. Women were asked to consent to treatment and acknowledge they understood the risks. Women were given information about risks and complications involved in having a medical or surgical termination of pregnancy and were assessed to ensure the proposed abortion treatment was legal, suitable, and safe for them. Consent forms were tailored to specific procedures, for example, medical termination, surgical termination, and disposal of products of conception.

Women were given an information booklet explaining consent and what it meant. Also, there was extensive information on the provider’s website. Staff checked to ensure women had the information they needed to understand consent.

Staff understood how to assess women’s capacity to consent to treatment. Staff knew how to work with women detained under the Mental Health Act (1983); women held in an immigration detention centre or women serving a prison sentence. The case would be managed by the advanced safeguarding practitioner if a women lacked capacity to make decisions about her treatment.

The provider audited informed consent compliance bi-monthly. The past 3 audits showed 100% compliance. Audits scoring 100% were spot checked for accuracy in a separate monthly audit by the Registered Manager to ensure audits were an accurate representation of findings. All audit exceptions were reported at the providers quarterly local integrated governance meetings.