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Marie Stopes International Manchester Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 28 November 2018

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

Inspection areas

Safe

Good

Updated 28 November 2018

We rated safe as good because:

  • Staff received mandatory training including resuscitation and safeguarding. Managers monitored compliance rates to ensure staff had the correct skills and knowledge.
  • We observed appropriate infection prevention and control measures in place including hand washing and use of personal protective equipment.
  • Equipment was well maintained and serviced. Daily checks were recorded as completed appropriately.
  • Risk assessments were in place and monitoring carried out pre, 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).
  • There were sufficient numbers of staff with experienced staff mentoring junior staff.
  • Medicines, including controlled drugs and abortifacients were managed well. Daily checks of stock were carried out. Take home medicines included pharmacy dispensing labels as well as manufacturer’s instructions.
  • Staff reported incidents and lessons were shared and learned following serious incidents.

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

  • 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.

Effective

Good

Updated 28 November 2018

We rated effective as good because:

  • 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).
  • Refreshments were offered as appropriate and pain relief was available when needed.
  • The service monitored outcomes for patients and benchmarked internally. An integrated dashboard was maintained and audits were carried out routinely.
  • Staff had received training for their roles with competencies monitored and assessed. All staff had received an appraisal in the 12 months prior to inspection.
  • There was effective multi-disciplinary working both internally amongst staff and externally with other health professionals.
  • Consent was obtained both verbally and written prior to care and treatment. Staff understand principles of Gillick and Fraser guidelines and assessing mental capacity.

Caring

Good

Updated 28 November 2018

We rated caring as good because:

  • We observed compassionate, respectful, sensitive and non-judgemental care for patients by all staff.
  • There was overwhelmingly positive feedback from patients either through feedback questionnaires or directly contacting the service.
  • There was telephone counselling available via the 24-hour helpline service.
  • Patients were encouraged to be supported by someone close to them throughout the pathway.

Responsive

Good

Updated 28 November 2018

We rated responsive as good because:

  • Bookings were made centrally. Patients were offered a choice of appointments at MSI Manchester or alternative MSI locations to ensure treatment occurred in a timely manner.
  • The service met individual needs in that, at the main centre there was an accessible entrance for patients with reduced mobility, a hearing loop was available and there was an interpreter service was available for patients whose first language was not English. The website could be translated into a wide-range of languages.
  • There was a 24-hour helpline available both pre- and post-termination for advice and support.
  • Discussions took place, for surgical terminations about disposal of pregnancy remains.
  • There was a complaints process and complaints were managed in a timely manner.

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

  • Patients were not signposted to other health professionals if screening provision was not comprehensive.

Well-led

Requires improvement

Updated 28 November 2018

We rated well-led as requires improvement because:

  • The leadership structure had changed to include local leadership in the Manchester centre as well as regional. The two local managers were new in post and oversight of governance, risk & quality improvement were not fully embedded, at the time of inspection.

  • At the time of inspection there was a lack of managerial oversight at the satellite clinics.
  • A well led framework was in development as well as a quality improvement plan but this was not fully embedded at the time of inspection.
  • Managers locally could access demographic details for staff, including emergency contact details and proof of professional registration, however; they could not access the employees full employment records and would have to request information to be sent to them from the human resources department if required; the registered managers were not able to access all records
  • The service followed the providers vision and had regional focusses.
  • Risk registers were maintained for the main centre and the clinics.
  • Managers encouraged an open and transparent culture and actively engaged with staff.
Checks on specific services

Termination of pregnancy

Good

Updated 28 November 2018

The Manchester Centre is part of the provider Marie Stopes International UK (MSI UK). The centre provides surgical termination of pregnancy up to 23 weeks and six days gestation and medical termination of pregnancy up to nine weeks and four days gestation. There are also eight clinics for medical terminations up to nine weeks and four days gestation throughout the northwest. The service also provides family planning services, including advice on contraceptive options including oral contraception and long acting reversible contraception (LARC) as well as male sterilisation (vasectomy). We rated this service as good overall. Safe, effective, caring and responsive were rated as good and well led was rated as requires improvement.