National Unplanned Pregnancy Advisory Service Stoke

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 that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

At our last assessment, we rated this key question good. At this assessment, the rating has remained good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report and how to report them and reported all incidents that they should report. The service used on online reporting system. Staff told us it was an easy system to use. When the details of an incident were uploaded onto the system, an email alert was automatically sent the clinic manager and appropriate head office leads, for example, safeguarding or the Infection Prevention and Control (IPC) for investigation. All incident investigation reports were reviewed by the NUPAS Risk Quality and Patient Safety Committee, who reported to the board.

The service used the Patient Safety and Incident Response Framework (PSIRF) to review incidents. This “sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to women and girls' safety incidents for the purpose of learning and improving women and girls' safety”.

Staff had access to updates and learning from incidents. Managers shared site specific updates verbally with individuals and teams during safety huddles and team meetings.

Staff shared examples of learning from incidents both internally and externally. For example, an incident when a woman experienced significant bleeding and staff needed to assess the blood loss, but not all staff were sure how this was undertaken. Staff demonstrated the correct procedure at the time, and a training session had been arranged to ensure all staff were confident and competent to accurately measure blood loss. There had been additional training arranged by the lead sonographer following an incident when an ectopic pregnancy was not identified. Shared learning from another area was ensuring women and girls’ haemoglobin (HB) was tested, an alert had been put on women and girls’ notes to ensure they were aware of the HB result before medicines were given.

Staff understood the duty of candour. They were open and transparent and gave and families a full explanation if things went wrong.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when women and girls and girls moved between different services.

Staff knew about national gestation guidelines for each type of termination. The service ensured appropriate assessments were conducted to minimise the risk of women and girls and girls receiving treatment that did not meet the eligibility for termination of pregnancy. All had a telephone assessment appointment which fully explored their medical history including allergies, pregnancy information and potential risks. This ensured all essential information was received to determine if the woman or and girl’s needs could safely be met. If there was any uncertainty or identified risk, women and girls and girls were invited to attend a face-to-face appointment, which included an ultrasound scan to accurately confirm the status of a potential pregnancy before any treatment was provided.

Staff gave women and girls information about contact with the NUPAS helpline, which was available 24 hours a day, 7 days a week, should they have concerns. Women and girls were also provided with a discharge letter that identified the treatment they had received, should they require further treatment in another service.

Staff told us about referral pathways, for example if staff identified a ‘pregnancy of unknown location’ (when a positive pregnancy test was not matched by an ultrasound that can see a pregnancy in or outside the uterus. This can mean the pregnancy was too early to see, an early miscarriage had occurred, or it is an ectopic pregnancy) with an advised referral to the early pregnancy clinic at a local acute hospital. The service had guidelines and policies in place for staff to follow in the event a woman or girl required transfer to an NHS Hospital.

Staff were aware of sepsis, and clinical staff all received training in sepsis identification and management.

Staff arranged psychosocial assessments and risk assessments for women and girls thought to be at risk of self-harm or suicide. Counselling was arranged for women and girls presenting with mental health difficulties. Support was arranged for women and girls who decided to continue with their pregnancy.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The service concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.

All staff received level three adult and children’s safeguarding training, which met national safeguarding training guidance. Staff kept up to date with their safeguarding training. There was a system to alert managers and staff when they needed to update or refresh their training.

Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff completed a safeguarding risk assessment to identify actual and potential safeguarding risks. Staff were supported to recognise cases of child sexual exploitation, domestic violence (including coercive behaviours) and female genital mutilation (FGM). Under 16 years were seen within the clinic and had a face-to-face consultation.

The NUPAS Stoke hub had 2 staff trained to safeguarding level 4 (adults and children) to provide staff with additional support and advice. In addition, the organisation had a safeguarding lead trained to safeguarding level 5 (adults and children). Staff said that when requested they received timely advice. Staff knew how to make a safeguarding alert and did so when appropriate. Staff said they appreciated the advice and support given by the safeguarding leads. In addition, clinical staff had regular safeguarding supervision.

The safeguarding adults and children’s policies were up to date and included all appropriate information, including various pathways for referral dependent on age, for example, under 13-year-olds and reporting this to the police as statutory rape.

Women and girls were seen alone to enable them to discuss potential safeguarding with staff if required and ensure they had not been under any coercion by another person to have the termination.

Staff understood the importance of maintaining the confidentiality of information about women and girls’ identity and their care and treatment. Staff ensured identity was protected, and when staff called them, they used their first or referred name only. Information was not shared with others including the women and girl’s doctor without their consent.

Posters stating were women and girls were entitled to a chaperone were located throughout the clinics.

We scored the service as 3. 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.

Staff were aware of the national gestation guidelines for each type of termination. Individual risk assessments were carried out as part of the telephone assessment which were then followed up within the clinic. Depending on answers to the risk assessment, for example the if they had a medical condition, were unsure of last menstrual period, bleeding or pain, a women and girls may require a scan to accurately determine gestation to ensure they were on the right treatment pathway or may require referral to NHS care. The service ensured that appropriate assessments were conducted to minimise the risk of women and girls receiving treatment that did not meet the eligibility for termination of pregnancy.

The service had a specialist placement policy for urgent referrals for women and girls nearing 24 weeks of pregnancy. The policy stated staff would ensure women and girls could receive treatment before the 24-week deadline, even if the treatment was with another provider.

Staff completed a risk assessment to assess the risk of deep vein thrombosis (DVT). Women and girls’ records we looked at included the risk of potential deep vein thrombosis.

Staff used standardised national assessments for monitoring deterioration and were trained in recognising the signs and symptoms of deterioration, including sepsis. Staff knew how to escalate and follow the transfer agreement to the local acute hospital trust. Patient records we looked at who had surgery included early warning scores and were correctly completed. When a woman or girl required transfer to an NHS Hospital all observations were copied for use by the receiving NHS hospital. The transfer notes also accompanied the women and girls to hospital. A copy of the transfer notes was kept in women and girl’s records.

Staff completed a World Health Organization (WHO) Surgical Safety Checklist for all women and girls and girls on the surgical lists. The WHO Surgical Safety Checklist is recognised tool designed to improve communication and reduce surgical errors by ensuring critical steps were followed.

A box for managing a haemorrhage in an emergency was available. This contained all emergency equipment and treatment required if a patient started bleeding heavily.

Staff had access to a defibrillator in the event of an emergency. Staff tested equipment daily when the clinic was open.

Post termination, women and girls given details of the NUPAS 24-hour aftercare telephone line. We observed women and girls were advised they could use the line for any query or concern, no matter how big or small.

We scored the service as 3. The evidence showed a good standard. The service mostly detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The design of the environment of clinics within the Stoke hub followed national guidance. The Stoke and Wolverhampton clinics were buildings owned by the provider. The Cannock and Burton clinics were situated at the back of a large health centre and had a separate entrance with a waiting room and reception area.

There were fire exit signs and fire extinguishers throughout the clinics we visited. All fire exits, and doors were kept clear and free from obstructions. Fire alarms and emergency lighting were tested on a weekly basis.

Staff carried out daily safety checks of specialist equipment. The resuscitation trolley was checked daily when the service was open and was tamper proof.

There were appropriate maintenance arrangements in place for all clinics. Equipment was regularly serviced and maintained. Faulty equipment was reported to facilities and was quickly repaired. Storage rooms were well stocked and kept tidy. However, we found that freezer temperatures where products of conception were stored until collected were not monitored. However, the service immediately rectified this following our inspection and we saw records to show that checks were undertaken on the days the clinic was open.

The buildings including access to them were monitored by CCTV.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The manager used the NUPAS safe staffing tool to determine appropriate staffing numbers. If there was a vacancy, the manager sent a request to NUPAS human resources and finance teams for sign off to enable the vacancy to be advertised. Information about applicants including qualifications, employments history and references were shared with the managers who decided on suitable applicants. Interviews were managed centrally, including ensuring all employee safety checks were completed, for example Disclosure and Barring Service (DBS). DBS is a UK government body that checks a person's criminal record for employers. The clinic manager was notified of start dates when all required checks had been completed.

New staff received an induction during which they were required to complete all mandatory training before commencing clinical work. The clinic manager arranged one to one meetings with new starters weekly for their first month, then monthly until the end of their 6-month probation period. These meetings were used to discuss progress of competencies, training and any concerns or questions.

Staff received and kept up to date with their mandatory training which was comprehensive and met the needs of women and girls and staff. Staff had access to mandatory training by a mixture of e-learning modules and face-to-face sessions. Managers monitored mandatory training and alerted staff when they needed to update their training. Mandatory training requirements were specific for each job role. Staff received allocated learning time to complete their training, staff and managers also had a weekly catch up where issues or concerns regarding training requirements could be discussed.

Mandatory training topics included fire training, health and safety, moving and handling, a recognised learning disability training course, mental health awareness and infection prevention and control. The clinic manager had oversight of mandatory training completion rates and 97% of staff had completed required mandatory training.

Staff received ‘Skills and Drills’ scenario training, including emergency transfers. Skills and drills are simulation-based training where healthcare staff practice clinical and teamwork scenarios in a safe environment, using realistic situations to improve skills for better women and girls safety and women and girls outcomes.

Staff received life support training and clinical staff working during surgical procedures were trained to Immediate Life Support level. Clinical staff received training in sepsis identification and management.

All staff who were at work and had been in post for 12 months had received an annual appraisal. Staff valued their appraisals stated and felt they were able to discuss training and development needs and areas for improvement. Appraisals were used as an opportunity to review staff objectives, including expanding staff competencies, for example, contraceptive and scanning training.

Staff completed clinical passports, which recorded competencies for consultation, pre-operative care, contraception training and scanning courses. Staff said they received a lot of training from the provider and had lots of opportunities to develop skills. The lead sonographer ran a monthly lunch-and-learn session to improve scanning skills which staff said had been helpful.

Surgical days included a doctor, a nurse or midwife and health care assistant in the procedure room with an additional nurse in recovery as a minimum. This ensured that women and girls and girls received one to one care during treatment in accordance with best practice.

The NUPAS head office managed the rotas for doctors. Doctors were rotated to either work remotely to sign off HSA forms or lead onsite surgical lists.

We scored the service as 3. 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.

The clinics we visited (Stoke and Cannock) were clean and had suitable furnishings which were visibly clean and well-maintained. There was a service level agreement in place for cleaning.

Cleaning records were completed appropriately. The service did regular audits on cleanliness which showed satisfactory levels of cleanliness. If cleanliness failed to meet the required standard an action plan would be developed and monthly audits would be undertaken until improvement was demonstrated. We observed effective cleaning and use of covers on scanning probes, staff used stickers to indicate when equipment had been cleaned.

Staff followed infection control principles including the use of personal protective equipment (PPE). Staff received training on infection prevention and control. Staff were seen to wash and sanitise their hands appropriately and wore personal protective equipment. Staff hand hygiene audits and use of personal protective equipment were undertaken monthly as part of the ‘essential’ steps audits and identified full compliance. Clinical staff had arms bare below the elbows to aid effective handwashing. Posters demonstrating effective hand hygiene practices were located above every sink.

The service completed monthly infection prevention and control audits. The last audit in March 2026 identified 100% compliance. The audit in December 2025 identified 96% compliance with required improvements subsequently undertaken.

The service had a contract with a third party for disposal of sharps bins. Sharps bins were labelled, dated and signed. Lids were securely fixed, and boxes were not filled beyond the recommended fill line.

Staff disposed of clinical waste safely in appropriate waste bins. The service had a contract with a third party to dispose of clinical waste. There was also a contract with a third party to dispose of pregnancy remains. Whilst onsite, remains were stored in a freezer which was cleaned following the collection of its contents.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Staff followed good practice in medicines management (storage, dispensing, administration, medicines reconciliation, recording, disposal) and did it in line with national guidance.

All medicines were ordered centrally from the NUPAS head office. Staff managed and stored medicines safely within the clinics in locked cupboards in lockable rooms with access by identified clinical staff only. The temperature of the room where medicines were stored was recorded and met manufacturers guidance.

Emergency medicines on the medicine trollies were secured with tamper proof tags attached. Medicines management was audited and monitored. When action was required a record of actions undertaken was recorded.

Staff followed systems and processes to prescribe and administer medicines safely. The service used abortifacient medicines to induce medical termination. These were prescribed by one of the doctors who completed the HSA1 form (a legal form which must be signed by two doctors for termination to take place) and then was reviewed and signed by a second doctor. If women and girls had identified their wish for oral contraception or required medicine for nauseas oral or and other medicines would also be prescribed remotely by the doctor. Nurses and midwives administered these medicines as directed.

The service had no controlled drugs (CDs) as at the time surgical termination of pregnancy was undertaken under local anaesthesia only. CDs are medicines usually strong pain relief which require additional security.

Medicine allergies were clearly identified on women and girl’s records. The service had an in-date antibiotic policy which provided advice and effective use of antibiotics.

Staff reviewed medicines regularly and provided information about their medicines. Staff ensured medicines were identified and was recorded on their electronic women and girls record. There were weekly checks to ensure clinics had enough abortifacient medicines available for women and girls who were booked for the following week. Women and girls received specific instructions as to how and when to take the medicines they had been prescribed. This was both verbal and in written format.

Staff completed medicines records accurately and kept them up to date, recording the time and date medicines were administered.

Staff learned from safety alerts and incidents to improve practice. The service had systems to ensure staff knew about safety alerts and incidents, so women and girls received their medicines safely.