National Unplanned Pregnancy Advisory Service Manchester

• There was a clear process in place for the recording and investigating of incidents and staff were aware of the process. Systems were in place to share learning from incidents should they occur.
• Staff were familiar with the Duty of Candour (DOC) regulations and recognised the importance of informing patients when things went wrong. A policy for Duty of Candour had been developed and staff training had commenced in March 2016.
• The service had clear systems in place to identify and report any safeguarding concerns. Staff were familiar with the service’s safeguarding policy and were aware of female genital mutilation and child sexual exploitation risks. All staff had completed training in safeguarding adults and children to level 2 (intermediate) and level 3 (advanced) standard.
• All the areas we visited were visibly clean and tidy. Cleaning schedules were in place and we observed evidence that these were being completed. Equipment was being suitably maintained and calibrated. Daily comprehensive checks were in place for resuscitation equipment which was readily available and easily located on the premises.
• The service had no medical or nursing staff vacancies and at the time of our inspection the full establishment of staff were on duty. The service had an induction checklist for new staff which included orientation to the environment and awareness of service policies.
• The service provided care and treatment that took account of best practice policies and evidence based guidelines. The service had clear standards agreed with commissioners and key performance indicators to monitor performance and service delivery in line with RSOP16.
• Staff had received an appraisal in the 12 months prior to our inspection. The service was supporting nurses to undertake the Faculty of Sexual and Reproductive Healthcare diploma. This would ensure that nurses were competent to deliver all methods of contraception including LARCs.
• Appropriate systems were in place to obtain consent from patients and consent was well documented in the patient record.
• The service provided a 24 hour telephone advice/help line that patients could use for information, support, or post-operative concerns.
• Feedback from people who used the service was positive about the way they were treated. People were treated with dignity and respect by staff and we observed staff being considerate and compassionate to patients. Patients felt involved in decisions about their care and treatment options were clearly communicated and explained.
• The service offered counselling to all patients who underwent a termination. The service was provided by diploma level trained counsellors and was offered to patients throughout the care pathway. The service also worked closely with support groups such Nestac (FGM group) and the local sexual assault referral centre to ensure patients received the appropriate support.
• People were able to access services in a timely manner and the service was performing within the recommended target timeframes.
• For patients requesting a coil to be fitted as their preferred long acting reversible contraceptive the service offered a monthly clinic in the evenings so that patients that worked during the day could access the service.
• People were given information how to complain and raise concerns and the service responded to complaints.
• The service philosophy was to “provide a high level of care to women seeking termination of pregnancy within a non-judgemental manner. Offering confidential, supportive advice and treatment to all women”. Staff we spoke with echoed the key principles of the philosophy in terms of providing a non-judgemental, supportive and confidential service. Staff we spoke with enjoyed their job and were compassionate and proud of the care they gave.
• The service produced a quarterly quality and risk assurance report that monitored performance against agreed standards, the number of complaints received, the number and nature of incidents reported, any safeguarding concerns and patient feedback.
• A management meeting was held each month to discuss governance matters such as incidents (and trends across the region), audits, operational issues and information governance issues.
• There were robust systems in place to ensure HSA1 forms were completed and in line with regulatory requirements.

However,

• We observed clinical staff not washing their hands prior to performing diagnostic testing and not all clinical staff were bare below the elbows in clinical areas.
• Audits were limited to corporate areas such as infection control, medicines management and records. There was limited evidence of the use of clinical audit to identify and understand issues and drive service improvement and patient outcomes.
• There was no registered manager in post at the time of our inspection. The previous manager had left in May 2016 and the recruitment process for a new manager was underway.