National Unplanned Pregnancy Advisory Service Stoke

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 people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people 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.

At our last assessment, we rated this key question as good. At this assessment, the rating has remained as good.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

During our inspection, we reviewed 9 patient records. All women and girls' records included a comprehensive health assessment, a record of their observations, risk assessments and included all necessary information to ensure the treatment provided was safe and met their needs.

Records were clear, up to date, stored securely and easily available to all staff providing care.

Staff assessed women and girl's pain using a recognised tool and gave pain relief in line with individual needs and best practice. Staff prescribed, administered and recorded pain relief accurately.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’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.

Staff followed policies to plan and deliver care according to best practice and national guidance. Policies were developed and reviewed centrally facilitated by the NUPAS medical consultative committee. Policies were in line with Department of Health Required Standard Operating Procedures (RSOP) guidelines and professional guidance from the Royal College of Obstetricians and Gynaecology (RCOG) and Royal College of Anaesthetists for the treatment of termination of pregnancy. Staff had access to electronic versions of policies without difficulty.

Staff received a “news flash’ update which identified a need to review the updated policy and/or process. There were both red and green news flashes depending on the urgency for review and action. Staff had to confirm on the system that they had read and understood the policy or update. Any policy changes were followed up in team meetings to ensure understanding.

Weekly manager meetings were used to brief managers on policy changes before a news flash was circulated to staff.

The central quality team had oversight of audit scheduling, and an online audit list used traffic light colour coding to indicate when an audit was due. The regional clinical lead completed audits, which were then reviewed by the quality team and head of nursing. They contacted clinics directly with results and any required actions.

Staff protected the rights of women and girls subject to the Mental Health Act 1983 and followed the Code of Practice. Staff had received training in the Mental Health Act and described the process to follow if they had concerns which we observed during the inspection.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

All staff completed a safety huddle each morning before the clinic opened. On surgical days staff ensured pre surgical observations were completed for all women and girls and girls on the list and followed up any questions regarding results. Additional information and additional requirements were discussed for example safeguarding concerns, confirmation an interpreter had been booked when required or extended appointment times for women and girls with learning disabilities.

Staff worked across health care disciplines and with other agencies when required to care for women and girls. Staff worked well as a team within the clinic and with outside agencies for example early pregnancy units, accident and emergency, mental health services and the local authority safeguarding. There were clear lines of accountability and staff we spoke with knew what and who they were responsible for.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service displayed information promoting healthy lifestyles. Information available included contraception, sexually transmitted diseases and awareness of domestic violence and help available.

Staff supported women and girls to live healthier lives by supporting women and girls to make decisions about their fertility and the safe use of appropriate contraception for them. The service signposted women and girls to local sexual health services for screening and high-risk women and girls were encouraged to have screening if they were proceeding to surgical interventions.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service completed and returned analysis data for each termination of pregnancy to the Department of Health (HSA4 report).

Managers and staff monitored the effectiveness of treatment and used the results to improve women and girls’ outcomes. Outcomes included both national, regional and location complication and failure rates. Complications varied and included continuing pregnancy, bleeding, excessive pain and an ectopic pregnancy which had not been identified by the clinic. An electronic incident record was completed, and the women and girls’ records updated to reflect information and actions taken. The data was measured against the provider national average to provide evidence of any trends, themes or increases in complications in specific areas. Complication rates between October and December 2025 ranged between 2.1% and 1.1% across the NUPAS Stoke and its satellite clinics which was better than other similar services.

Managers monitored the number of women and girls offered contraception including long-acting reversible contraception (LARC). The manager told us that they were supporting more staff to complete training in contraceptive implants to enable increased opportunity for women and girls and girls to have long-acting contraception.

Managers and staff carried out a programme of repeated audits to check to improve care and treatment. The audits for the service were compared against all the services within NUPAS and learning taken to make improvements across the organisation. These benchmark reviews prompted managers to look at issues and address any shortfalls when required. Managers shared and made sure staff understood information from the audits. When required improvement was checked and monitored. Audits identified satisfactory women and girls outcomes (such as complication and failure rates) against other services.

Staff used recognised tools to improve the detection and response to clinical deterioration in women and girls and girls as a key element of women and girls safety and improving women and girls outcomes and audited records to ensure appropriate use of these tools.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff gained consent from women and girls for their care and treatment in line with legislation and guidance. Staff discussed treatment options available with women and girls to ensure they consented to treatment based on the information available. Possible side effects and complications were recorded. Records showed complications had been discussed with women and girls to demonstrate their informed consent. Staff recorded consent in women and girls’ records. Staff ensured were seen alone to minimise the risk of coercion by a third party. The service had a policy outlining the principles of consenting women and girls and of capacity to consent. The service audited their consent forms and found consent was gained in line with required best practice and NUPAS policies and procedures.

Staff received training on understanding the Mental Capacity Act 2005. The service did not provide treatment to women and girls who did not have the capacity to make a decision regarding their care and treatment.

Staff understood Gillick Competence and Fraser Guidelines and supported girls under 16 years who wished to make treatment decisions and ensured they understood the decision. Staff had access to advice and support if they had any concerns regarding consent. Gillick competence is the principle used to judge capacity in children to consent to medical treatment. Fraser guidelines are used specifically for children requesting contraceptive or sexual health advice and treatment. Where a person under the age of 16 is not Gillick competent and therefore is deemed to lack the capacity to consent, it can be given on their behalf by someone with parental responsibility or by the court. However, there is still a duty to keep the child’s best interests at the heart of any decision, and the child or young person should be involved in the decision-making process as far as possible. For children under the age of 16 Gillick Competency must be assessed and Fraser Guidelines assessment completed. Children under 16 can consent to treatment if they are considered Gillick Competent, i.e. have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options. If a child passes the Gillick test, they are considered ‘Gillick competent’ to consent to that medical treatment or intervention. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else.