The Care Quality Commission
  • Hospital
  • Independent hospital

BPAS - Middlesbrough

Overall: Requires improvement read more about inspection ratings

One Life Building, Linthorpe Road, Middlesbrough, Cleveland, TS1 3QY 0345 730 4030

Provided and run by:
British Pregnancy Advisory Service

All Inspections

27 April 2022 and 29 April 2022

During a routine inspection

This was a comprehensive, unannounced inspection to follow up on enforcement action taken during an inspection in August 2021 where we identified specific areas of concern.

We rated the service requires improvement overall because:

  • The service did not have enough staff to offer cover arrangements in the event of staff absence potentially delaying treatment times for women.
  • The service did not label medicines appropriately in line with legal requirements.
  • Although leaders had begun to operate effective governance processes throughout the service and used systems to manage performance effectively, these were new processes and had not had time to become embedded in practice or show consistent improvements.
  • The service did not have a system for the observation of children under the age of 18 years using the modified early warning score (MEWS) to ensure early recognition and safe timely escalation of a deteriorating children.
  • The service did not have a process in place to measure wait times between contact to consultation or consultation to treatment, meaning that they were not able to monitor or improve waiting times for women

However:

  • The service had improved its processes and systems to safeguard people from abuse and manage patient safety incidents. Staff now comprehensively assessed and documented risk assessments.
  • Staff had training in key skills, they received training on how to recognise and report abuse. The service-controlled infection risk well. Staff kept clear and up to date records of patients care and treatment.
  • Staff provided good care and treatment, gave women refreshments, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff now recognised and assessed a patient’s possible lack of mental capacity to make decisions and documented this.
  • Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women.
  • The service planned care to meet the needs of local people, took account of women’s individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of women receiving care. Staff were clear about their roles and accountabilities.

04 August 2021

During an inspection looking at part of the service

This was a focused, unannounced inspection in response to specific areas of concern. We rated the service inadequate overall because:

  • The service did not always operate effective safeguarding processes and systems to protect people from abuse.
  • Staff did not always document risk assessments. They were not carried out comprehensively and did not remove or minimise every key risk.
  • The service did not operate effective systems and processes to store medicines at safe temperatures, label medicines appropriately or check stock levels.
  • The service did not always manage patient safety incidents well. Staff did not always recognise incidents or report them appropriately. Local managers investigated incidents and shared lessons learned with the whole team and the wider service. However, BPAS central team did not always investigate incidents appropriately.
  • The service did not always provide care and treatment based on national guidance and evidence-based practice. Managers did not consistently check to make sure staff followed guidance.
  • Staff did not always document support to patients to make informed decisions about their care and treatment. They did not consistently follow national guidance to gain patients’ consent. Although staff recognised and assessed a patient’s possible lack of mental capacity to make decisions, this was not always clearly documented.
  • The service did not always coordinate care with other services and providers.
  • Leaders and managers did not always understand and manage the priorities and issues the service faced.
  • Leaders did not operate effective governance processes throughout the service. They did not use systems to manage performance effectively. They did not always identify and escalate relevant risks and issues nor take action to reduce their impact.

However:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff received training on how to recognise and report abuse.
  • Staff kept clear and up to date records of patients care and treatment.
  • All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with each other.
  • The service was inclusive and took account of patient’s individual needs and preferences. Staff made reasonable adjustments to help patients access services.
  • Leaders were visible and approachable in the service for patients and staff.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.

Following this inspection, under Section 31 of the Health and Social Care Act 2008, we served an urgent notice of decision to impose additional conditions on the location’s registration as a service provider in respect of regulated activities. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so.

The provider responded giving assurance of their intention to review systems and processes to minimise risk. The corporate provider responded with an action plan. However, we were not assured of the timeliness of some of the actions to address immediate risk.

This service has been placed into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

9-10 June 2016 and 17 June 2016

During an inspection looking at part of the service

BPAS Middlesbrough is part of the British Pregnancy Advisory Service. The BPAS Middlesbrough service opened in 2012 and provided termination of pregnancy services, pre and post termination counselling as well as contraception advice and screening for sexually transmitted diseases. At the time of the inspection, the service was providing medical abortions up to 10 weeks gestation to both private and NHS patients. The service provided termination of pregnancy services to children under sixteen and could provide counselling and treatment for patients of any age. The service planned to offer non-scalpel vasectomies in the near future.

We made an announced inspected of the service on 9-10 June 2016 and an unannounced inspection on 17 June 2016 as part of our independent healthcare inspection programme.

We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities it provides.

Are services safe at this service?

There was a culture of reporting and learning from incidents across the organisation and within the local services. Staff we spoke with demonstrated an excellent understanding of safeguarding adults and children and knew what actions they needed to take in cases of suspected abuse. All patients received a private initial consultation without anyone else present to safeguard against possible coercion or abuse and to give them the opportunity to disclose such information in a safe environment. All staff had completed training to level 3 in safeguarding for children and adults.

Staffing was sufficient and appropriate to meet the needs of patients in their care. Staff ensured medicines were stored and administered safely. Pathway documents and clinical risk assessments we observed were completed fully and legibly. Staff completed and submitted all Department of Health documentation as required.

Are services effective at this service?

Care was provided in line with national best practice guidelines with the exception of the use of simultaneous administration of abortifacient drugs for early medical abortion (EMA), which is outside of current Royal College of Obstetrician and Gynaecologist (RCOG) guidance. However, patients were given up to date information about the risks and benefits of this treatment before giving consent and the organisation was monitoring outcomes from this treatment.

The complication rate for simultaneous administration at BPAS Middlesbrough was higher than the complication rate across the whole of BPAS. Although higher than that of other centres, the complication rate had not breached the BPAS threshold of 5% and, therefore, had not been viewed as a concern.

We observed that patient assessments were thorough and staff followed pathway guidance. Pain relieving medications were routinely prescribed for patients to take at home following the initiation of treatment.

Observation and assessment of staff competence was an integral part of pathway audit. Staff told us they always made sure patients gave their consent in writing and adhered to Fraser guidelines in respect of children and young people. We observed this in records we saw for patients aged under 18. There were good links with local safeguarding teams and the local NHS hospital.

Are services caring at this service?

Senior managers and staff involved and treated patients with compassion, kindness, dignity, and respect. The results of the BPAS ‘Client Satisfaction’ reports showed 99% of patients at BPAS Middlesbrough would recommend the service to others. Client satisfaction reports showed high levels of patient satisfaction. Client Care Coordinators (CCCs) and nursing staff gave appropriate emotional support to patients. Staff provided all patients with a counselling service before and after termination of pregnancy. There was access to specialist advice and support when needed. We saw examples where staff had gone out of their way to support patients in difficult situations.

Are services responsive at this service?

Service planning monitored activity and staff scheduled sufficient clinics to meet demand. Staff made sure they had enough information and could get further advice when necessary. The service met waiting time guidelines and patients could choose a date or alternative venue for their procedure. The service shared learning from complaints across the organisation, nationally, regionally and locally and staff gave examples of this during the inspection.

Are services well led at this service?

The organisation had a clear mission to provide safe and effective care for termination of pregnancy. Senior managers had a clear vision and strategy for this service and there was good local and regional leadership for the service. Quality of care and patient experience were seen as the responsibility of all staff. There were effective governance systems in place and staff received feedback from governance and quality committees. Staff felt supported by their managers and were confident they could raise concerns and have them dealt with appropriately. There was a corporate risk register in place however a local risk register had not been developed. This was planned to be developed with help from the corporate risk manager. There were some local risks identified and standard operating procedures were in place to ensure business continuity in various situations.

The service was aware of and we observed records and staff working towards Department of Health requirements regarding compliance with the Abortion Act 1967 and the ‘Required Standard Operating Procedures 2014’.

The organisation had a proactive approach to staff and public engagement. Innovation, learning, and development were encouraged.

Our key findings were as follows:

  • Staffing levels, medicines’ management and record keeping were good.
  • Staff followed policies and procedures.
  • Care was provided in line with national best practice guidelines with the exception of the use of simultaneous administration of abortifacient drugs for early medical abortion (EMA), which is outside of current Royal College of Obstetrician and Gynaecologist (RCOG) guidance. However, patients were given up to date information about the risks and benefits of this treatment before giving consent and the organisation was monitoring outcomes from this treatment. The complication rate for simultaneous administration at BPAS Middlesbrough was higher than the amalgamated complication rate for the whole of BPAS. Although higher than that of other centres, the complication rate had not breached the BPAS threshold of 5% and, therefore, had not been viewed as a concern.
  • There was enough equipment to allow staff to carry out their duties. The service had processes for checking and maintaining equipment.
  • Staff we spoke with understood their responsibilities to raise concerns and report incidents and near misses.
  • There was evidence of a culture of learning and service improvement.
  • There were systems for the effective management of staff which included an annual appraisal and support for revalidation
  • The service had a rolling programme of local clinical audits. Managers monitored and benchmarked performance of all units across the organisation using a performance dashboard.
  • Leaders were aware of their responsibilities to promote patient and staff safety and wellbeing.
  • Leaders were supportive and the culture encouraged candour, openness, and honesty.

We saw several areas of good practice including:

  • Staff went out of their way to provide a caring and holistic service to their patients. They did this by working well with local agencies and charities to provide additional support and services for vulnerable patients.
  • Regular, direct observation of staff practice was an integral part of the BPAS approach to ensuring staff maintained an expert level of competence in their individual roles.
  • All members of the team worked together to ensure they gave patients the best possible experience of the treatments given and the service offered.
  • The provider ensured that all patients received a private initial consultation without anyone else present to protect patients against possible coercion or abuse and to give them the opportunity to disclose such information in a safe environment.
  • Staff had access to a specialist placement team who would arrange referral to appropriate providers for patients with complex or additional medical needs, who did not meet usual acceptance criteria.
  • Staff knew their own role and remit for safeguarding children and vulnerable adults, and had a heightened awareness of the needs and vulnerabilities of children and young people using their service.
  • Completion of records complied with prescribed practice and was consistently of a high standard.

Professor Sir Mike Richards

​Chief Inspector of Hospitals

31 January 2014

During a routine inspection

We observed patients waiting for their appointments and saw they were reassured beforehand by staff in a friendly manner, in appropriate surroundings and a comfortable environment. We saw patients were supported by staff to think through all of the potential options and reach their own decisions about next steps.

We saw that the provider sought people's view and that patients had said they were satisfied with the standard of care offered at the clinic. They said that clinic had provided good advice and made them feel at ease.

Surgical options are not provided at the clinic but the provider aimed to develop this service. We found that action was taken to assess patients and offer them the appropriate treatment. We saw that staff supported patients to find locations they could easily attend for surgical procedures, as they used medication options at the clinic.

We found that the clinic had policies and procedures in place to ensure patients were treated in a safe environment. We saw that the building was well-maintained.

We found that staff were recruited appropriately and regular checks were completed to make sure their nursing registration remained current. We also found that there were sufficient staff on duty to meet patient's needs.

We saw there were information leaflets at the reception area and throughout the premises that encouraged patients to make complaints, suggestions or concerns known.

28 February 2013

During a routine inspection

The staff told us when people asked for treatment; they were presented with the options available to them. This was also confirmed by the results of client satisfaction survey where everyone reported being very satisfied or satisfied with the choices of treatment offered. This meant people who used the service understood the care and treatment choices available to them.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Comments from the client satisfaction survey included 'Amazing service could not be happier 'thank you 'and 'Staff were lovely.'

Staff were encouraged to develop their knowledge and skills and some had undertaken training to gain additional skills such as counselling. This meant staff received appropriate professional development.

The provider regularly monitored the service to make sure that risks to patient safety were minimised and an appropriate standard of care and treatment was provided.