The Care Quality Commission
  • Hospital
  • Independent hospital

MSI Reproductive Choices Regional Treatment Centre - Manchester

Overall: Outstanding read more about inspection ratings

5 Wynnstay Grove, Fallowfield, Manchester, Lancashire, M14 6XG (0161) 248 2220

Provided and run by:
MSI Reproductive Choices

All Inspections

29 July 2022, 10 August 2022, 11 August 2022

During a routine inspection

Our rating of this location improved. We rated it as outstanding because:

  • The service had enough staff to care for patients and keep them safe. Staff had extensive, specialist training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
  • Staff provided consistently good care and treatment that exceeded expectations. There was a strong safeguarding culture that was multidisciplinary in nature and staff demonstrated a rapid response to providing care for people at significant risk of harm and abuse.
  • Managers monitored the effectiveness of the service through a programme of continual, ambitious auditing and effective benchmarking. They made sure staff were competent by providing an extensive programme of continual professional development that was based on the latest understanding of patients’ health needs.
  • Staff worked well together for the benefit of patients and established a wide range of multidisciplinary relationships to explore opportunities for improved care. Staff advised patients on how to lead healthier lives based on deep knowledge of their personal circumstances, supported them to make decisions about their care, and had access to good information.
  • Key services were available seven days a week and staff sought an expansion of some services where this would improve patient outcomes, including in rapid response to significant increases in demand from specific patient groups.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients and worked collaboratively with specialist support services to meet cultural and other personal needs.
  • The service planned care to meet the needs of individuals and populations groups across the region and made it easy for people to give feedback. People could access the service when they needed it and the service maintained a highly responsive approach to maintaining short waiting times.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills through a programme of engagement that challenged each person with stretch goals. Staff understood the service’s vision and values, applied them in their work, and used provider standards to challenge the status quo and stigma that impacted people’s lives.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care and creating a working environment that promoted innovation and development. Staff were clear about their roles and accountabilities. The service engaged meaningfully with patients and the community to plan and manage services and all staff were committed to improving services through research and exploration of new evidence-based practice.

However:

  • There were gaps in facilities management safety processes in the satellite clinics we included in our clinical site inspections. This included a lack of emergency equipment and security arrangements in one clinic and poor understanding of the nature of the service by third party reception staff in another.
  • There was room for improvement in fire safety standards in the main treatment centre.

6 August and 17 August 2018

During a routine inspection

Marie Stopes International (MSI) Manchester Centre is operated by Marie Stopes International. Facilities include a treatment room, outpatient and ultrasound facilities. There are three consulting rooms and eight day care beds.

The service provides surgical termination of pregnancy procedures (SToP) up to 23 weeks and six days gestation along with early medical abortion (EMA) and medical termination of pregnancy (MToP) up to nine weeks and four days gestation. Treatment can be provided under no-anaesthesia, conscious sedation and general anaesthesia, according to patient choice and needs. The service also provides consultations, ultrasound scans, long acting reversible contraception and sexually transmitted infection screening services. In addition to these services, they also provide vasectomy (male sterilisation) under local anaesthetic.

In addition, MSI Manchester has eight satellite clinics, (early medical units EMU) across Greater Manchester and Lancashire, where they carry out consultations and early medical abortions.

We inspected this service using our comprehensive inspection methodology. We carried out unannounced inspections on 6 August 2018 and 17 August 2018.

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.

At our previous inspection on 19 June 2017 we found breaches in regulations and we served requirement notices in respect of:

  • Regulation 10 Health and Social Care Act (Regulated Activities) Regulations 2014 Dignity and respect.
  • Regulation 12 Health and Social Care Act (Regulated Activities) Regulations 2014 Safe care and treatment.
  • Regulation 17 Health and Social Care Act (Regulated Activities) Regulations 2014 Good governance.

At this inspection we checked that actions had been implemented to address these breaches. We found that some improvements had been made but not all concerns had been fully addressed in relation to Regulation 10 for privacy and dignity.

Services we rate

We rated it as good overall.

We found good practice in relation to:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. This included resuscitation and safeguarding for nursing and medical staff at appropriate levels.
  • Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. We observed appropriate infection prevention and control measures in place including hand washing and use of personal protective equipment.
  • The service had suitable premises and equipment and looked after them well. Equipment was well maintained and serviced. Daily checks were recorded and completed appropriately.
  • Risk assessments were in place and monitoring carried out before, during and following procedures such as venous thromboembolism checks (VTE) use of the World Health Organisation (WHO) and five steps to safer surgery checklist and the termination of pregnancy early warning score (TEWS).
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and abuse and to provide the right care and treatment. Experienced staff were supporting newly appointed staff at the main clinic. . All staff had received an appraisal in the 12 months before inspection.
  • The service prescribed, administered and recorded medicines in line with trust policies and procedures. Medicines, including controlled drugs and abortifacients (medicines that induce a termination of pregnancy) were managed well. Daily checks of stock were carried out. Take home medicines included pharmacy dispensing labels as well as manufacturers’ instructions.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the provider.
  • The service provided care and treatment based on national guidance such as the Royal College of Obstetricians and Gynaecologists (RCOG), the Department of Health Required Standing Operating Procedure (RSOP) and the National Institute for Health and Care Excellence (NICE).
  • Staff monitored patients’ comfort needs and provided pain relief as required. Light refreshments were provided following surgery.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them and benchmarked internally. An integrated dashboard was maintained and audits were carried out routinely.
  • Staff worked together as a team to benefit patients. There was effective multidisciplinary working both internally amongst staff and externally with other health professionals.
  • Staff understood their roles and responsibilities under the Mental Capacity Act 2005. Consent was obtained both verbally and in writing before care and treatment. Staff understood principles of Fraser guidelines and Gillick competence in assessing mental capacity. (Fraser guidelines and Gillick competence are used specifically for patients under the age of 16 requesting contraceptive or sexual health advice and treatment.)
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. We observed respectful, sensitive and non-judgemental care for patients by all staff.
  • Staff provided emotional support to patients to minimise their distress. There was telephone counselling available via the 24-hour helpline service.
  • Staff involved patients and those close to them in decisions about their care and treatment. Patients were encouraged to be supported by someone close to them through the care pathway.
  • The service planned and provided services in a way that met the needs of local patients. Bookings were made centrally through MSI UK One Call. This meant patients were offered a choice of appointments at MSI Manchester or alternative MSI locations to ensure treatment occurred in a timely manner.
  • The service took account of patients’ individual needs at the main clinic. There was an accessible entrance for patients with reduced mobility, a hearing loop and an interpreter service for patients whose first language was not English. The website could be translated into a wide-range of languages.
  • The service treated complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
  • The service had managers at all levels with the right skills and abilities. The leadership structure had changed to include local leadership as well as regional.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action which had been developed with involvement from staff. The service followed the provider’s vision and had regional focus.
  • Managers at the service promoted a positive culture that supported and valued staff. Managers encouraged an open and transparent culture and actively engaged with staff.
  • The HSA4 forms were discussed with patients during the booking process and written information was provided at the main centre. (Providers have a statutory requirement to complete HSA4 form to notify a termination of a pregnancy to the Department of Health)

We found areas of practice that require improvement:

  • Whilst a governance framework was in place we found this was not fully embedded due to the introduction of a new management structure, therefore local oversight of risk was not fully effective at the time of inspection.
  • The probes used for trans vaginal scans (TVS) were cleaned only to minimally accepted standards, although senior managers told us that infection control processes were being reviewed.
  • The door to the cleaning cupboard was not locked and included accessible cleaning fluids.
  • There were plans to reorganise the surgical treatment and recovery areas that included privacy curtains for each chair space. However; this was not in place at time of inspection.
  • There was no face-to-face counsellor available at the time of inspection, although the position had been appointed into and the staff member was completing the induction process.
  • The level of screening provision was dependent on a patients address and commissioning arrangements. Patients were not signposted to other health professionals if unable to access the full range of screening provision.Managers locally could access demographic details for staff, including emergency contact details and proof of professional registration, however; details provided of full records were not consistent. Complete personnel records were held centrally by the human resource department for the provider; the registered managers were not able to access all records.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and it should make other improvements to help the service improve. We also issued the provider with one requirement notice in respect of Regulation 17 Health and Social Care Act (Regulated Activities) Regulations 2014 Good governance. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals

19 June 2017

During a routine inspection

Marie Stopes International Manchester Centre (MSI Manchester) is part of the Marie Stopes International group. The service provides surgical termination of pregnancy procedures (SToP) up to 23 weeks and six days gestation along with medical termination of pregnancy and early medical termination of pregnancy (MToP) up to nine weeks and four days gestation.

Treatment can be provided under no-anaesthesia, conscious sedation and general anaesthesia, according to patient choice and needs but the service does not carry out manual vacuum aspiration procedures. Women are provided with advice on contraceptive options, oral contraception and long acting reversible contraception (LARC). The service also provides male sterilisation (vasectomy).

In terms of medical abortions, the provider offers four treatment options. Medication can be administered at the clinic in two stages with six hours, 24 hours, 48 hours or 72 hours in between each stage. At the time of inspection the service did not currently offer simultaneous medical abortions, but plans were in place to pilot the reintroduction of simultaneous administration in August 2017 (whereby both stages of medication are administered at the same appointment with a 30 minute gap between each stage). This would prevent women from having to attend twice for treatment.

In addition, MSI Manchester has 10 satellite clinics, (early medical units EMU) across Greater Manchester and Lancashire, where they carry out consultations and early medical abortions up to nine weeks and four days. Staff work on a rotational basis between the satellite clinics and MSI Manchester.

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 services, 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 we take regulatory action as necessary.

Since our last inspection in 2016, we have noted the following improvements at MSI Manchester Centre:

  • There had been changes to the way syringes containing an induction agent were stored. Each syringe was covered with a cap to reduce the risk of cross infection.

  • Daily cleaning schedules had been fully completed.

  • The service had implemented a system to ensure chair covers in the recovery area were checked and cleaned between each patient

We found the following areas of good practice:

  • Staff demonstrated they understood the principles of safeguarding adults and children and knew what actions they needed to take in cases of suspected abuse.

  • World Health Organisation (WHO) and five steps to safer surgery checklists were completed for all patients undergoing surgical procedures.

  • There were locally agreed and up to date policies and standards that referred to evidence based practice and against which performance was audited.

  • Records indicated that pain was assessed and treated in accordance with national guidelines.

  • Staff treated patients attending for consultation and procedures with compassion and respect; staff were non-directive and non-judgemental.

  • The service worked towards key performance indicators to assess and monitor performance. These were reported each month via the governance and quality dashboard.

  • All new staff, were inducted and followed a training programme; this included a competencies framework and continuous assessments by their mentor and senior manager.

  • Ultrasound scanning was undertaken by staff who received a bespoke ultrasound training course to date pregnancy provided by a qualified external sonographer delivered in line with the requirements of MSI policy.

  • Staff across the service were aware of appropriate procedures in obtaining consent. They were familiar with guidance, such as Fraser guidelines.

  • People could access the service when they needed it. Waiting times from treatment and arrangements to admit, treat and discharge patients were in line with good practice.

  • A governance framework supported staff to deliver good quality care through the identification and monitoring of risks. As part of the wider corporate organisation, the clinic had a clear governance and committee structure in place, including clinical governance, medical advisory and health and safety committees.

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

  • The registered manager had not reported a notifiable serious incident to the CQC.

  • Two nursing staff were not up to date with either basic life support training or immediate life support training.

  • Although the April 2016 hand hygiene audit showed 100% of staff complied with infection prevention control protocols, observations whilst on inspection indicated that staff did not always follow protocols when performing patient care.

  • The clinic’s counsellor was not trained to safeguarding level three. We raised this as a concern and all face to face counselling sessions for patients were immediately changed to telephone sessions.

  • There was a lack of local oversight for training and revalidation for surgeons and anaesthetists attending the clinic. The senior manager was unable to show us hard copies or electronic personnel files that belonged to doctors who worked at the clinic. At the time of inspection the Registered Manager was unware how to access these documents.

  • Records showed not all nursing and medical staff had received an appraisal in 2016.

  • Contraception arrangements included long acting reversible contraceptive (LARC); the clinic did not achieve their target of 50% between the reporting period of April – June 2017.

  • Evidence of discussion in relation to disposal of pregnancy remains was not always documented in records.

  • Women were not routinely informed and did not receive a discussion to explain to them that their details were sent to the Department of Health.

Following this inspection, we told the provider that it MUST take action to improve:

  • The provider must ensure that the layout of the day room, where patients recover following surgical treatment, does not compromise patients’ privacy and dignity.

  • Ensure effective medicines management processes are in place and improve recording of controlled drugs to ensure stock levels and doses administered are recorded accurately

  • The provider must ensure an effective process for complaints handling, sharing information and taking actions to identify areas for development to improve services.

  • Ensure an effective appraisal process is embedded, involving full participation and discussion to enable staff development.

  • Ensure improvements in corporate and location level communication and engagement to ensure an effective process for governance, quality and risk oversight of services at local level

The provider must ensure records for the disposal of pregnancy remains are completed and available

In addition, we told the provider it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals

19 May 2016 and 16 June 2016

During a routine inspection

Marie Stopes International Manchester Centre (MSI Manchester) is part of the Marie Stopes International group and was acquired in November 2004. The service provides surgical termination of pregnancy procedures (SToP) up to 23 weeks and six days gestation and early medical termination of pregnancy (MToP) up to nine weeks and four days gestation. Treatments can be provided under no-anaesthesia, sedation anaesthesia and general anaesthesia. The service does not carry out manual vacuum aspiration procedures. The service also provides advice on contraceptive options, provides oral contraception, long acting reversible contraception (LARC) and male sterilisation (vasectomy).

In terms of medical abortions, the provider offers three treatment options. Medication can be administered at the clinic in two stages with six hours, 24 hours,48 hours or 72 hours in between each stage. The service had previously offered simultaneous medical abortions (whereby both stages of medication are administered without a gap between each stage) but had suspended this treatment at the time of our inspection until more outcome data has been collected.

The clinic is open Tuesday to Saturday and alternate Thursdays for vasectomy patients. In addition MSI Manchester has 10 satellite clinics across Greater Manchester and Lancashire where they carry out consultations and early medical abortions up to nine weeks and four days. Staff work on a rotational basis between the satellite clinics and MSI Manchester.

We carried out this inspection as part of our comprehensive inspection programme of termination of pregnancy services. As part of our inspection we reviewed medical and surgical termination of pregnancy services carried out at the MSI Manchester clinic only. At the time of inspection there were no vasectomy lists.

The announced inspection of MSI Manchester took place on 19 May 2016 and we visited all areas within the service including the theatre, recovery areas, consultation rooms and waiting areas. We also carried out an unannounced inspection on 16 June 2016 to see how patients were cared for during a busy surgery day.

We have not provided ratings for this service. We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities which it provides.

Although we do not currently have the powers to rate these services, we report on whether they are safe, effective, caring, responsive to people's needs and well-led. We highlight areas of good practice and areas for improvement.

Our key findings across all the areas we inspected were as follows:

Are services safe at this service

  • There was an electronic system in place to report incidents, with triggers to alert senior management. Staff we spoke with were aware of the process and understood their responsibilities. Serious incidents had been investigated at local level, with identified actions to prevent reoccurrence. It was clear from the reports and resulting action plans that the identified actions had been completed in a timely manner.
  • Staff we spoke with understood the requirements of duty of candour. A duty of candour policy had been introduced in April 2016.
  • The service had clear systems in place to identify and report any safeguarding concerns. However, records showed only 57% of staff had completed level two training in safeguarding children and adults. Staff were not routinely trained to level three in children’s safeguarding. The regional manager informed us that a new head of safeguarding had been appointed in the last six months and was reviewing training requirements in line with intercollegiate guidelines.
  • There was a clear transfer policy agreement in place with the local NHS trust. If a patient required an emergency transfer to the local NHS provider, patients would be transferred by a member of clinical personnel and the theatre list would be stopped until staff were available.
  • There was little reliance on agency staff to cover nursing shifts and two shifts had required agency cover in the last three months. Registration with the Nursing and Midwifery Council and General Medical Council was monitored by the central human resources team and quarterly reports were sent to the registered manager flagging any issues.
  • Medical staffing was provided by doctors working both remotely and within the centre. The service employed one surgeon to work at the centre on a full time basis. There were no vacancies for medical staff and surgeons; staff working at other MSI centres provided cover if necessary.
  • However, we were not assured that staffing in theatres met the recommended staffing standard identified by the Association for Perioperative Practice (AFPP).
  • The provider’s schedule of services for anaesthetists and surgeons states that they should “assess all remaining clients and liaise with the senior nurse before leaving the centre”. This meant that they were able to leave the centre before all patients have been discharged and potentially leave the clinic with no staff trained in advanced life support should a patient deteriorate post-operatively.
  • At the time of our inspection we observed syringes containing an induction agent (drug used to help patients relax before and during general anaesthesia) in a kidney dish on the anaesthetic machine in theatre. The tips of the syringes were not covered to protect them from the risk of cross infection. We asked the anaesthetist if this presented a risk of infection and they told us they usually placed the tip of the syringe back into the sterile wrapping. At the time of our inspection we observed additional syringes being prepared and the tips were covered in the sterile packaging until used.
  • Cleaning schedule checklists for the theatre had not been completed consistently and there was no record of how often and when the fabric covers for chairs in the ward area had been cleaned or changed.
  • Resuscitation equipment was not checked daily, which is identified as best practice by the Royal College of Anaesthetists (2012).

Are services effective at this service

  • The provider had policies and guidelines in place in relation to: offering patients a choice of procedure, discussion and options for future contraception and screening for sexually transmitted disease.
  • Policies were not always updated to reflect practice changes in a timely manner. Both the ultrasound policy and the medicines management policy we reviewed were out of date at the time of inspection. The ultrasound policy had been due for review in July 2015 and the medicines policy had been due for review in March 2016.
  • The service had key performance indicators in place and these were reported each month via the governance and quality dashboard. The dashboard showed there had been no returns to theatre or transfers from January to March 2016.
  • The service had locally agreed standards in place with commissioners. The service also reported any instances of ectopic pregnancy to the commissioners.
  • Medical records audits included monitoring of pathways of care, information provision and pre-abortion assessment in line with Royal College of Obstetricians and Gynaecologists’ (RCOG) guidelines. The pre-abortion assessment was performed in conjunction with the corporate pre-existing conditions guidelines. Details about the type of abortion procedures that were carried out were captured and monitored via centrally produced capacity reports.
  • For new staff, an induction and training programme was in place where competencies were assessed with mentor support and supervision. Senior staff we spoke with stated that staff were assessed against these before being allowed to practice unsupervised. Records showed all of the medical and nursing staff had received an appraisal in 2015.
  • Staff across the service were aware of appropriate procedures in obtaining consent. Healthcare assistants and nurses had been trained in line with the provider’s own policy and would go through the consent process with patients during the consultation. However, none of the staff had received safeguarding training at level three, which meant we were not assured that staff taking consent had the appropriate knowledge, skills and competence to support patients who may be vulnerable or lack capacity to make a decision.

Are services caring at this service

  • Staff took time to interact with patients; they were attentive to their needs and spoke in a compassionate manner most of the time. Staff in theatre were supportive and tried to put the patient at ease.
  • All patients were provided with a feedback questionnaire prior to discharge, to be completed in the clinic or later at home. They were anonymous, sealed, and sent to an external organisation for collation and reporting. For the period January 2015 to March 2016, service users had rated the service at 96% for the overall quality of care.
  • Counselling services were available to help and support patients if required, either by telephone or face to face.
  • The layout of the recovery room meant there was limited privacy for patients. Staff at the time of our inspection did not seem to be aware of this or sensitive to the need to adapt practice when required to ensure patients’ privacy and dignity was not compromised.

Are services responsive at this service

  • Services were responsive to patients’ needs. Appointments were offered in a timely manner and patients were given options to choose the procedure that was the best option for them. Waiting times for consultation from initial contact and treatment from initial contact were consistently within the Royal College of Obstetricians and Gynaecologists’ (RCOG) recommended timeframes.
  • Records we reviewed showed pre-existing medical conditions were considered and risk assessed in the medical review. If a patient was deemed at risk and could not be managed in the clinic they were referred to the local NHS provider.
  • A 24 hour telephone line was available to provide advice and support outside service hours. In the event a patient deteriorated, the patient could be brought back to a clinic for consultation or if it was an emergency could be directed to their local accident and emergency department.
  • There was disabled access on the basement level, where a patient with reduced mobility could be treated, whether receiving a medical or surgical termination of pregnancy.
  • A telephone interpreter service was available for non-English speaking patients, as well as written information, in the form of leaflets and on the website.. A hearing loop had been introduced on 12 May 2016.
  • Where possible any concerns raised whilst the patient was on site would be dealt with by staff. Formal complaints were reviewed and responded to by the head of quality and customer service with involvement from the registered manager.
  • We were not assured that patients were given information to make an informed choice with regards to disposal of pregnancy remains. We did not see any evidence of discussions in the patient record and did not see information about options given to patients. However information was available on the provider website.
  • The post-operative area was cramped, there was little room for privacy and patients’ dignity was at risk. The area was staffed with two staff, who were also responsible for collecting patients from theatre, watching a monitor and responding to patients’ needs in a separate room.

Are services well led at this service

  • The service had a clearly defined vision supported by the corporate mission statement “Children by choice, not chance”. Staff we spoke with were able to articulate this and were ‘pro-choice’ in their approach to providing patients with care and treatment.
  • There was a regional management structure in place that identified lines of accountability. Staff we spoke with told us they felt supported to learn and develop and liked working at the clinic.
  • There was a corporate governance framework in place supported by both a corporate central governance committee and local integrated governance committees. Local compliance with governance standards and key performance indicators was monitored via a governance and quality dashboard that was submitted to head office on a monthly basis.
  • Review of best practice guidance and any changes to clinical policy were discussed and ratified during the corporate clinical leads meetings. Any decisions would then be signed off by the central governance committee. However, there was no evidence of local management involvement in decision making, with a top down approach being adopted by the provider. This was evident in the initial decision to implement simultaneous administration of medication for early medical abortions.
  • There was no effective process in place to ensure policies were reviewed and updated in a timely manner.
  • Staff stated that practising privileges were handled corporately and were reviewed by the medical director and lead doctor. However, there was limited oversight of this process at local level. For example, the registered manager was not involved in the decision to renew practising privileges and did not have sight of the doctor’s most recent appraisal or revalidation. Similarly, pre-employment checks were carried out and stored at head office. The provider was in the process of transferring this information onto an online system so it could be accessed from any clinic but it was not in place at the time of our inspection.
  • The process for signing HSA1 forms meant that abortifacient medication could be prescribed before two signatures had been obtained on the HSA1 form, we found this in two out of eight records reviewed.
  • Patients were not informed about the statutory requirement of HSA4 forms. Staff did not explain to patients that these details were sent to the Department of Health and that it was a legal requirement.
  • Clinical governance reports included data on failure rate by surgery and medical treatments, infections, and the reasons for any transfers. However, the reports included data at either national or regional level and were not broken down by clinic so it was not clear how the data was used to drive local improvement.

We saw some areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure all staff have received the appropriate level of safeguarding training in line with intercollegiate guidelines.
  • Ensure that staffing levels in theatre have been risk assessed and adhere to recommended guidance at all times.
  • Ensure staffing levels in the recovery area are sufficient to meet patients’ needs at all times.
  • Consider how best to ensure patients’ privacy and dignity is maintained in the recovery area.
  • Ensure patients are informed of the requirement to submit abortion data to the Department of Health and how this information is anonymised.
  • Ensure syringes that are used to administer intra-venous medication are stored appropriately prior to use to prevent risk of cross infection,
  • Ensure cleaning records in theatre are fully completed and that there is a clearly documented process for changing seat covers in the recovery area.
  • Review how often resuscitation equipment is checked in line with best practice guidance.
  • Ensure the registered manager has clear local oversight of the practising privileges review and renewal process.
  • Ensure the registered manager has clear local oversight and assurance with regards to the completion of pre-employment checks prior to new members of staff commencing employment.
  • Consider how data included in quarterly governance reports can be broken down to clinic level so they can be used meaningfully to identify local issues and improve local performance and patient outcomes.
  • Ensure both the ultrasound policy and the medicine management policy are reviewed to ensure they contain current information in line with best practice. This should include being clear whether scanning post treatment is a routine requirement or not.
  • Ensure that there are effective processes in place to ensure that the certificate(s) of opinion HSA1 forms are signed by two medical practitioners in line with the requirements of the Abortion Act 1967 and Abortion Regulations 1991.
  • Ensure that staff are appropriately trained to assess and respond to a deteriorating patient and staff with advanced life support training remain on site whilst patients are recovering from surgical termination of pregnancy.

In addition the provider should:

  • Ensure there is an effective system in place to provide patients with information to make an informed choice with regards to disposal of pregnancy remains, including documentation of discussion and decision.

Due to the number of concerns arising from the inspection of this and other MSI locations, we inspected the governance systems at the MSI corporate (provider) level in late July and August 2016. We identified serious concerns and MSI undertook the immediate voluntary suspension of the following services as of 19 August 2016 across its locations, where applicable:

  • Suspension of the termination of pregnancy for children and young people aged under 18 and those aged 18 and over who are vulnerable, to include those with a learning disability
  • Suspension of all terminations using general anaesthesia or conscious sedation
  • Suspension of all surgical terminations at the Norwich Centre.

MSI responded to the most serious patient safety concerns we raised and was able to lift the restrictions on the provision of its termination of pregnancy services at this location on 12 October 2016.

CQC also issued warning notices for breaches of the following regulations, which are relevant to this location:

Regulation 11 Consent

Regulation 12 Care and treatment must be provided in a safe way for service users.

Regulation 13 Service users must be protected from abuse and improper treatment in accordance with this regulation.

Regulation 17 Systems or processes must be established and operated effectively to ensure compliance with the requirements in this Part. (Good governance)

Regulation 20 of the Care Quality Commission (Registration) Regulations 2009

CQC is actively monitoring compliance with the above warning notices in order to ensure that services are operated in a manner which protects patients from abuse and avoidable harm.

Professor Sir Mike Richards

Chief Inspector of Hospitals

30 September 2013

During a routine inspection

We spoke with two women who used the service. They told us they were very satisfied with the care and treatment they had received at Marie Stopes Manchester. One person told us, 'I couldn't ask for more care and support'.

We found people were consulted about their treatment and their rights to privacy and dignity were respected.

People's needs were assessed and care and treatment delivered in a safe and appropriate manner.

Staff had access to policies and procedures which were in place to safeguard children and vulnerable adults. They were able to tell us what action they would take should they have any concerns about anyone who attended the service.

Staff told us they felt well supported. We found staff had the necessary skills and training to undertake their role in a safe and appropriate manner.

We found suitable arrangements were in place to manage an effective process for identifying, receiving and handling complaints for people who used the service.

6 December 2012

During a routine inspection

Marie Stopes International Clinic Manchester is based in a residential street off a main road into Manchester city centre. There was limited parking both on site and on surrounding streets.

We found a secure entry system on the front door managed by the reception staff. there were two waiting areas on the first floor for people and their partners to use. The people accessing the service were taken to the first floor for their consultation and pre procedure scan. This area was limited to the person accessing the service only.

We spoke to two people who told us: "I feel that the staff have been compassionate towards me, they have been understanding and informative". "This was not what I expected, I was very nervous but the staff have taken me through every aspect in a calm and caring way. They have been great with me". "I was considered at every point in my treatment, they asked me if I understood everything and did not mind repeating if asked". "There is a very professional manner here but they manage to remain personal and don't talk down to you at any time. They involve you all the time and keep asking if you are all right and happy to continue".

20 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 no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

During an inspection looking at part of the service

This review was carried out to check that the provider had made improvements in relation to one minor concern we identified in relation to complaints at our last review of compliance at this location. We did not obtain feedback from people using the service during this review.

25 May and 1 June 2011

During a routine inspection

We did not speak directly to people who use the service during this review. People attend the centre for day case procedures only. During our visit we asked the nursing staff to notify people using the service that we were visiting and would be happy to speak to them, but no one wished to speak to us.

We reviewed the report from the provider's 2010 patient survey. This showed high levels of satisfaction with the services provided at Marie Stopes International Manchester Centre. A range of very positive comments from people using the service were included within the survey report. The only negative comment related to the size of the waiting room.