MSI Reproductive Choices Regional Treatment Centre - Bristol

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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked women were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked women’s liberty was protected where this was in their best interests and in line with legislation.

The service had a proactive, systematic approach to learning. When women 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 across the service.

Managers investigated incidents thoroughly and the provider was open and transparent when things went wrong. Women were protected by a comprehensive 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 women in planning any changes.

At our last assessment this key question was not rated. At this assessment the rating was outstanding. This meant women were safe and protected from avoidable harm.

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 had a strong proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

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 because of learning.

Staff fostered a proactive and transparent approach to safety. They raised concerns and reported incidents, which managers investigated thoroughly. The organisation shared learning through weekly CLIPS (Complaints, Litigation, Incidents, Patient Feedback, and Safeguarding) meetings and six-monthly thematic reviews. Meetings were held to ensure incidents had been correctly graded, actions completed to reduce the likelihood of similar incidents occurring again and to spread organisational learning. Incidents requiring action were assigned to a named person to ensure they were carried out within agreed timescales. When urgent action was required, the meeting would include the organisation’s subject experts and safeguarding leads.

Staff received regular feedback and learning updates via bulletin boards, emails, and daily safety huddles. They reported feeling supported and confident concerns would be met with understanding, not blame.

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 and incidents which had occurred in other parts of the organisation. Learning from incidents was shared on staff bulletin boards, emails and the morning safety huddle. Staff gave the example of 2 incidents where the shipping address was incorrect on the system. This was quickly addressed on the electronic system to prevent recurrence. Staff told us of another incident involving an incomplete HSA1 form, which should be completed before a procedure. However, this was missed. The provider immediately updated the electronic system to prevent progression without proper documentation, ensuring compliance with the Abortion Act 1967.

There had been no serious incidents from June 2024 to June 2025.

Following an activity, event or incident where care did not go as planned, the staff involved would gather in a “swarm huddle”. This was a method of evaluation led by a learning response lead following an incident and acted as a de-brief. It was designed to be a safe space for staff to discuss the event. This enabled insights and reflections to be sought quickly and generated prompt learning. We saw evidence of this when a patient had a haemorrhage following a surgical termination and was transferred to an NHS emergency facility for further management. This meant women were safely managed when they developed complications.

Staff told us they were encouraged and supported to raise concerns. They felt confident 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 happened.

The evidence showed an exceptional standard. The service always worked with women and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when women moved between different services.

Safety and continuity of care was a priority throughout women’s care journey. This happened through a collaborative, joined-up approach to safety involving staff working with partner organisations to ensure women remained safe. There were clear referral pathways with agencies including local NHS early pregnancy assessment units, mental health services, domestic abuse support services, and sexual assault referral centres. Staff also worked collaboratively with agencies which supported women from different cultures. This included a community service/non-profit organisation who support learning disabled and autistic adults across Bristol and South Gloucestershire to become more independent. The provider’s quality improvement group chose a project to improve accessibility for patients with disabilities. The service had a young man with Down’s Syndrome (with a support person from non-profit organisation), a tour around the Bristol centre. They pointed out good support measures and 12 measures for improvement. These included displaying waiting times, a quiet waiting area, to increase the size of posters as they were quite small, a review of wording used on posters not easily understood such as anaesthetic and chaperone, and information and discharge summaries available in easy read. The provider implemented the changes including buying noise cancelling headphones for patients. The non-profit organisation also provided bespoke training for staff. The impact was a noticeable increase in patients asking for a quiet place to sit and wait, staff were better equipped to recognise and manage the needs of someone with a learning disability and tailor the appointment to meet their needs, and staff reported feeling better prepared to look after patients with a learning disability and/or autism.

Women who were not found suitable for abortion treatment or who had gestations longer than 23 weeks and 6 days were referred to the NHS for treatment.

There were escalation process and a policy for staff to follow if patients became unwell in the clinic. This included the management of sepsis and post operative haemorrhage.

When discharged, women were asked whether a copy of the discharge letter could be 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.

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

The evidence showed an exceptional standard. The service worked well with women and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving women’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 consultation the nurse/midwife practitioners (N/MPs) spoke to women about safeguarding. Staff explained if they had safeguarding concerns, they would make a referral to the relevant safeguarding team.

Referrals made for safeguarding included for homelessness, late disclosure of pregnancy, coercive partners, and female genital mutilation (FGM). Referrals to the Multi-Agency Risk Assessment Conference were made if staff identified high risk domestic abuse cases. There was a process and policy for monitoring safeguarding concerns raised by the clinic and telemedical teams. The provider introduced Advanced Safeguarding Practitioners (ASP) (trained to Level 4 safeguarding) in 2022 to address the growing number and complexity of safeguarding demands within the organisation. Complex safeguarding cases were assigned and managed by ASPs for specialised support for women with overlapping vulnerabilities.

There was a strong understanding of safeguarding by staff 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.

Information about safeguarding services was readily available for staff. There was a process to ensure staff in the clinic and telephone hub could make immediate contact with a safeguarding lead or an ASP through a computer-based chat function. There was an ASP based in the Bristol centre.

Staff received training in safeguarding adults and safeguarding children in line with national intercollegiate guidance. The executive lead for Safeguarding was trained to level 6 (advanced qualification for professionals), the named midwife and doctor for safeguarding were trained to level 4, with all other qualified staff trained to level 3.

An automatic safeguarding referral was made for all women under the age of 16. Women under the age of 13 were not seen by the service but would have a safeguarding raised, the police informed and referred to an NHS clinical pathway. 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 N/MPs 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 abortion treatment. This was to ensure the reported gestation of the 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 such as safeguarding.

The providers data from 2022 to 2024 shows a consistent increase in both the total number of women seen and the number of safeguarding disclosures. The disclosure rate, which measures the proportion of MSIUK women making safeguarding disclosures, has also risen steadily each year. Women told us they felt safe using the service.

Staff told us failure to respond adequately to a safeguarding concern was a zero-tolerance event within the organisation which requires internal investigation and escalation. Any incidents of this type were internally investigated and escalated as required.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that 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 or surgical termination of pregnancy and assessed to ensure the proposed 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 termination of pregnancy, they were assessed to establish the gestation of pregnancy. Understanding the gestation of pregnancy was also a legal requirement for having a 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 gestation of the pregnancy. N/MPs 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. Confirming gestation was also important for women seeking surgical termination of pregnancy because surgical terminations over 23 weeks and 6 days were not performed by the provider. There were ultrasound referral criteria for women seeking termination of pregnancy. These included uncertainty about gestation, history of ectopic pregnancy, women under 16 years and recent termination of pregnancy (within the last 3 months).

Staff had access to an online suitability tool showing medical conditions and medicines contra-indicated for a medical or surgical termination. The provider’s doctors reviewed 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. The provider had Pre-existing Condition Guidelines to use for women. For example, women with Diabetes who were having a general anaesthetic were always listed first for surgery and had their blood sugar monitored pre and post operatively. They were encouraged to eat and drink following surgery to prevent any episodes of hypoglycaemia (low blood sugar). The guidance also included directions to follow for women with diabetes/weight management on semaglutide medication as it delays digestion impacting on the time food is digested and the possibility of vomiting post operatively.

Important information was highlighted on the electronic system 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 women seeking treatment.

In response to a warning notice at the last inspection, the provider took steps to address the lack of a paediatric early warning system. The provider used a TEWS (Termination Early Warning Score) scoring system, adapted from the national Maternity Early Obstetric Warning Score (MEOWS) and developed, in partnership with communities, to implement improvements resulting from the notice. They incorporated blood loss into the scoring and acknowledged physiologically, individuals under 18 were not significantly different from adults provided a full set of observations were completed. This included height, weight, BMI (body mass index) and blood loss. The provider found TEWS was suitable for identifying deterioration in patients under 18 and had clear rationale for its use. This was an improvement since our inspection in 2017. Incident notifications confirm the system has successfully supported early identification and appropriate treatment of deteriorating patients. However, the use of tools to predict deterioration does not replace professional clinical judgement.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They 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 and labelled clean.

The clinic was purpose built with consulting rooms being bright, well stocked and visibly clean. They were suitably furnished and contained the correct equipment to keep women safe. Women we spoke with were happy and 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. Any reusable instruments were sent off site for decontamination and sterilisation. We observed stocks of equipment and sterile packs were well organised and stored in cupboards accessible only by staff.

The treatment procedure room was equipped for surgical procedures; it was not required to be as sterile as an operating theatre. We observed staff wore scrubs and specialist footwear during treatments to minimise the risks of and spread of infections. Staff were bare below the elbow and washed their hands and used antiseptic hand gel in between providing patient care. We saw staff wearing protective equipment before providing patient treatments to minimise the risks of spreading infections.

The evidence showed an exceptional standard. The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met women’s individual needs.

To ensure all staff working in the service were familiar with policies and procedures, the organisation employed substantive staff. Some staff did not have a permanent base but travelled within the southwest to where they were needed. This meant the service did not employ agency nurses. However, the service occasionally used agency sonographers. Doctors were employed by the organisation and could always be contacted through an online messaging platform. On surgical days there were doctors on the premises. 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 staff were expected to participate in regular safeguarding supervision. Compliance with mandatory training including safeguarding training, appraisals, and supervision was 96% which was above the organisational compliance target. All new staff received a six-week induction and were supernumerary for up to 12 weeks so they could shadow other N/MPs to understand and feel confident in their new role. This gave new staff time to complete mandatory training and have competencies signed off.

To ensure women had the best care and treatment, the provider made training available to staff and prioritised staff development. Appraisals were meaningful with a clear focus on continuous development, with all staff receiving an appraisal this year. Staff were given development opportunities. For example, nurses and midwifes working in the clinic received additional competency-based training in ultrasound scanning, contraception counselling, insertion of contraceptive devices including implants, surgical treatment room techniques, and anaesthetics and recovery. Staff were rotated throughout the clinic as most were/training to be, competent in each area. This meant staff remained motivated and kept their skills current. Management courses were also available. New to the Advanced Practice Development Lead role was specialist training in teaching and assessing. This provided career progression into a senior role.

Safeguarding level three training numbers were 78% in July 2025. This was because the organisation changed the training requirements to include all front of house staff to be trained to level three. More training availability was being provided to cater for this need. Completed training for safeguarding levels 1 and 2 were 98% and 83% respectively.

Statutory mandatory training overall for the provider was 96.2% compliant.

There was a process for managers to follow to check 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 provider had trained pregnancy counsellors all patients were entitled to access. Appointments were usually given within a week of contact and women could have as many sessions as they felt they needed.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Housekeeping staff cleaned the clinic daily. Cleaning was outsourced to a private company. A bi-weekly environmental audit tool was used to monitor cleaning and scored an average 93.5% from April to July 2025.

We reviewed records which showed 95.5% of clinical staff at MSI Bristol had in-date mandatory infection prevention and control training.

We observed staff cleaning equipment in between each patient.

Clinical and domestic waste bins were clearly labelled and emptied regularly. Waste was kept in a locked enclosure outside the building and collected weekly by an external contractor. Sharps bins were closed and stored safely.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met women’s needs, capacities and preferences. They involved women in planning, including when changes happened.

The service had safe systems for appropriate and safe handling of medicines.

Medicines including controlled drugs were usually stored securely and safely. Staff followed established systems to manage medicines safely. Medicine administration records were complete. There were effective processes to ensure patients received appropriate information on how to take their medicines.

Appropriate medicines related risk assessments were completed, and local and national guidance was followed when prescribing.

Staff completed medicines management training. Medicines audits were completed regularly, actions identified were communicated with staff and followed up.

The service had systems to ensure staff knew about safety alerts and incidents. We saw reported incidents were monitored, reviewed and where required changes to practice were implemented. This meant increased opportunities for learning and improvement across the organisation.

Medicines were stored securely. Including oxygen and controlled drugs. However, we found approximately 5 syringes of unlabelled medicine drawn up and stored in the controlled drugs cupboard in the treatment room. This was not in line with the providers Medicine’s policy. However, there was no evidence of any patient impact. There were no alternative anaesthetics used in the service and the medicine was unique in its presentation, therefore, it was more difficult to confuse with other medicines. They were kept in the controlled drug cupboard which prevented anyone tampering with it during the break. The service should ensure national guidance and the MSI Medicines Management policy were followed in relation to the handling of injectable medicines in anaesthesia.