National Unplanned Pregnancy Advisory Service Stoke

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

NUPAS had a shared vision, values and strategic objectives. The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

Central to the vision, values and strategic objectives was supporting women and girls’ choice by providing termination and contraception services in a safe, caring and person-centred environment whilst adapting to improvement. Throughout our assessment we saw staff understood and applied the values and met the organisations values. Appraisal discussions were linked to the organisation values so staff could evidence they were ‘living the values. The values were also a core focus of corporate induction days, and the services chief executive officer attended a values session with each new cohort.

The Leaders modelled and encouraged compassionate, inclusive and supportive relationships among staff so that they felt respected, valued and supported.

We scored the service as 3. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The service had a Care Quality Commission registered manager who had managed the service for more than 13 years and was highly respected by staff. Managers also ensured they were compliant with CQC registration standards.

The service had an up-to-date certificate from the Secretary of State and the Department of Health.

Managers understood their responsibility in reporting notifiable incidents. The clinic manager was able to access peer support with other NUPAS managers. At the time of inspection, they met informally, however, the service was developing a set of objectives, and formal agenda for these meetings.

The head of operations directly line managed the clinic managers. The head of operations manager ensured managers had oversight of operational performance dashboards. There were weekly manager calls which included discussions around competencies and monthly floor to board safety briefings.

Staff said they felt valued by managers. Staff said all managers were approachable and supportive and this included the senior leadership team who regularly visited the clinics. Staff particularly acknowledged the supportive role of the registered manager. Several staff said senior leaders attended clinics and worked clinical shifts to both provide additional support to staff and maintain their clinical skills which staff valued.

There were systems to review the performance of managers to continually develop their skills and improve the service.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Information provided by staff and leaders identified the organisation had a positive culture where people felt they could speak up and their voice would be heard. Staff told us managers were supportive and approachable. Staff said they would be confident to raise concerns about practice, and any concerns would be listened to and acted upon.

The service had systems and processes to support people to raise concerns and for their concerns to be acted upon.

NUPAS had 2 “freedom to speak up” guardians who provided a point of contact for staff to raise concerns or seek support when needed. However, staff said they were confident they would raise any concerns with the registered manager.

Women and girls and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

NUPAS demonstrated a commitment to equality, diversity, inclusion, and human rights. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

NUPAS promoted equality, diversity, and inclusion (EDI) through initiatives such as flexible working arrangements with staff able to apply for flexible working arrangements to account for personal circumstances such as childcare or other caring responsibilities or health issues and fair, transparent recruitment practices. These measures created an environment where staff were treated equitably and supported to perform at their best.

The provider undertook equality monitoring of its workforce to ensure staff reflected the local community. Information provided identified they were considering how to improve the organisation considered how to improve the diversity of the workforce to reflect the city’s population and encourage people from protected groups to participate where their level of participation was disproportionately low.

A senior manager was the EDI lead and was responsible for EDI initiatives, implement and monitoring staff engagement to ensure NUPAS maintained a positive, inclusive, and supportive workplace culture.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The clinical director and head of operations had oversight of operational governance. The head of operations oversaw the regional managers. The regional manager was the registered manager of all clinics within the NUPAS Stoke hub. NUPAS Stoke hub included clinics in the Midland region in Stoke on Trent, Wolverhampton, Cannock and Burton.

Clinical team meetings were co-chaired and managed by the medical director and clinical director and included, the pharmacy team, head of nursing, safeguarding lead and quality assurance lead.

The clinic manager met with the senior leadership team monthly to review incidents, complaints, performance data and risks. Performance data included benchmarking against other sites. This information was presented to the clinical leadership team, who also met monthly to ensure policies and processes were ratified and up to date. Reports from these meetings were presented at board.

Clinic managers reviewed local risk registers with their teams during the three-monthly team meetings. Clinics closed whilst these meeting took place to ensure all staff could attend. Managers and staff were aware of the biggest risk at the locations where they worked, and we observed action plans that included review dates and had an accountable person logged to review and mitigate each risk.

Staff told us how recommendations from incidents and complaints had been implemented within the service.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The manager worked closely with commissioners throughout the Midlands to ensure they provided a timely and accessible service for all women and girls, which resulted in additional clinic venues.

Managers also liaised closely with early pregnancy units to ensure all required information was available to support the transfer and delivery of care.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service demonstrated a commitment to learning and continuous improvement. We saw the provider had a strong investment in staffing and developing its staff with specialist training. Staff described a culture where they were supported to receive training including specialist training and then ongoing supervised practice in contraception advice, sonography and several staff were also undertaking specialist training in long-acting contraception and encouraged to reflect on practice and share learning across teams. Leaders supported innovation and gave teams the time and tools needed to improve women and girls experience and safety.

NUPAS had advanced its services through key innovations, including being the first termination provider to fully implement the NHS Women and girls Safety Incident Response Framework (PSIRF), significantly strengthening organisational learning and quality‑improvement processes.

The introduction of a Professional Development Lead had provided valuable expertise to provide support to staff and develop practice for the organisation. The launch of a Clinical Support Services team had improved post‑termination aftercare and specialist pathways. These developments were supported by an updated safeguarding audit programme, expanded translation and accessible women and girls‑information resources, and continued investment in leadership development and workforce wellbeing.

NUPAS and its staff also supported termination focused research in collaboration with third party organisations, enabling people’s involvement in studies that improve access and raise standards of care.