BPAS - Middlesbrough

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last inspection we rated caring as good. At this assessment the rating has improved to outstanding. This meant women felt well-supported, cared for and treated with kindness, dignity, and respect, and women’s feedback confirmed this.

Staff always treated women with kindness, empathy and compassion. Women’s privacy and dignity was respected, they understood that they and their experience of how they were treated and supported mattered. We found every effort was made to take women’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

This service scored 90 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service always treated women with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Staff attitudes and behaviours when interacting with patients showed that they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it.

Staff supported patients to understand and manage their care, condition and treatment.

Staff directed patients to other services when appropriate and supported them to access those services.

Women were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. Women had choice in their care and were encouraged to maintain relationships with family and friends. Staff responded to women in a timely way. The service supported staff wellbeing.

Staff followed policy to keep women’s care and treatment confidential. Staff carried out consultations in private rooms and marked these as engaged when having discussions with women. They exited rooms discreetly when in use and locked doors and cabinets where information may have been accessible.

We observed staff being reassuring and kind to women and asking questions without judgement. Nurses and midwives used an electronic record to document each consultation and treatment before moving on to the next part of the record. Despite following written prompts, we observed staff maintained personal and compassionate interactions with patients. Patients said all staff treated them with kindness and understanding from arrival to departure and explained the full process in terms they could understand. We observed a consultation where a patient’s underlying condition meant they did not meet the criteria for the surgical abortion of their choice. Staff explained the reasons why this could not be carried out and discussed alternative treatments and options with the patient. They contacted the BPAS doctor on call and staff at the local NHS trust to help confirm and detail the reasons for the refusal due to their condition and how the patient could proceed with an alternative treatment or, if it was her decision, to go ahead with the pregnancy. Throughout these conversations the team kept the patient informed, showed kindness, compassion and respect, and helped them understand choices available using non-medical terms.

Records we reviewed showed staff had completed these showing an understanding and non-judgmental attitude when caring for or discussing women with mental health needs and signposting to appropriate services. We saw evidence of women being offered counselling services through BPAS to discuss their decision to terminate a pregnancy.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. Staff understood the demographics of the local community and adapted their communications to meet differing needs. We observed staff were kind and caring towards family members and partners. We read about an incident where a young person needed care and treatment. It was a very difficult situation which became urgent, and they worked with the family and external agencies as well as the regional NHS trust to support them to get the treatment the patient needed. Staff supported each other with the compassion, help and practical input from leaders.

Staff maintained the confidentiality of information about patients. One patient had commented in feedback that they had recognised someone they knew from outside the building and asked staff to help them avoid the individual. Staff worked together to help make the patient’s visit discreet and more comfortable. Unfortunately, the patient would not enter the clinic and staff offered a new appointment.

Staff were confident they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. Staff told us they occasionally had to work with partners who showed concern or anger when staff insisted on carrying out part of every consultation with the patient alone in order to check their feelings about safety with a partner or family. Staff supported each other to explain and calm these situations and the manager had stepped in on occasion to reduce confrontations. After such events the team would carry out a huddle to debrief and check the whole team’s wellbeing.

Staff provided positive feedback for each other using the BPAS reporting system. Staff were kind and encouraging to each other and showed their appreciation when they felt others had performed over and above expectations to support them. Examples included staff travelling to another centre when a nurse was ill. This meant the nurse could leave to recover and patients did not have treatments cancelled. On another occasion staff offered to accommodate additional patients at a nearby clinic to allow staff time to complete the handover and arrange safe transport for a patient to local NHS care. Staff recorded on the system when a relative of a young person had come to the unit to personally thank all those involved in their daughter’s care and to present them with a small gift of sweets. Not all staff were present at the time so they added it to the log for feedback.

The service treated women as individuals and made sure women’s care, support and treatment met women’s needs and preferences. They took account of women’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

There were no restrictions to patients requiring care. The service was a registered charity and if patients did not meet NHS funding requirements, the service could provide care and see to patients’ additional needs to ensure they were safe and received the right care.

Staff asked patients about their physical and mental health, their social situation and how they felt about safety and their sexual safety. Staff were calm and aimed to put patients at ease so they could talk openly about these aspects of their lives. Staff talked through difficulties and anxieties and offered referrals to professionals in response to patient’s needs and circumstances. Staff worked with great care with a family during a very difficult situation to support a young person and to quickly find the best course of action and appropriate location to meet their specific and individual needs.

The service made adjustments for patients – for example, by ensuring women’s access to premises and by meeting patients’ specific communication needs. Staff accessed telephone interpreters and on one occasion a member of the team translated in a language they spoke fluently.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on. We observed staff advising patients how to administer their medicines at home and what symptoms such as cramping they might expect. They also explained risks and complications that might occur with care and in a way the patient could understand. They used patient leaflets to signpost patients to use the complaints and feedback process and showed interest in how patients felt about their care. The information provided was available within the patient leaflet and online in different languages and accessible formats.

Patients gave very positive feedback. One example from a member of staff who took a telephone call stated “Patient asked me to pass on her gratitude and appreciation to you. Patient said that you put her at ease and made a horrible experience more bearable. She said she has just started a new job and feels like she has got her life back.”

The service promoted women’s independence, so women knew their rights and had choice and control over their own care, treatment and wellbeing.

We observed staff talking to women about the range of different treatment options they were able to offer, including medical and surgical abortions, timeframes and other options including adoption, and choosing to go ahead with the pregnancy. Staff offered a referral to a counselling service to help a woman talk through their options.

Patients were able to choose their own appointment date and time, and staff provided information on any limitations and alternatives for example when a patient wanted to attend a clinic outside their home area and when another patient needed an appointment within their children’s school time.

The service was exceptional in how they listened to and understood women’s needs, views and wishes. Staff responded to women’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were aware of and dealt with any specific risk issues, such as venous thromboembolism (VTE). They risk assessed every patient against a list of conditions and took the necessary precautions before during and after surgical abortion treatment.

Staff identified and responded to changing risks to patients. Staff provided information on what symptoms to look out for to signal post-treatment complications such as retained products of conception and how to contact BPAS urgently if such problems arose. Records showed staff identified and reacted quickly to signs and symptoms of ectopic pregnancy. This could be recognised through a patient’s symptoms and usually confirmed by ultrasound scan in the unit. Staff documented their findings and actions including contacting the local trust and ambulance service to arrange an urgent transfer to hospital. They called hospital contacts in advance to ensure the patient could receive treatment immediately on arrival rather than be left to wait in an emergency department.

Staff from the telemedicine call centre logged an example of how staff responded to a patient’s specific needs and opened the unit on a weekend. They wrote “The Middlesbrough clinic saw a (young person) for a scan and early medical abortion (EMA) pills by collection, in between patients on Saturday, as she was potentially nearing the EMA limit and could not attend during school time. They went above and beyond for this client, this is typical of all the clinics in the North East they are so accommodating and client focused. Thank you so much Middlesbrough”.

Staff told us how they sometimes helped patients with transport costs or accommodation to help in accessing treatment at another BPAS unit out of area or to meet legal time limits. They could access charitable funds to provide this additional care and would go out of their way to support any patient in particular need.

Staff had supported a patient who had experienced severe distress when they said they had passed a recognisable fetus at home at 8 weeks’ gestation. They spent time listening to the patient’s worry and shock and their wishes for this information to be added to the booklet for early medical abortion. Staff said they would pass on the information to the senior clinical team and offered the patient a follow up appointment in a further 2 days. The patient had been very grateful to the team to allow them to discuss their concerns openly and compassionately.

The evidence showed an exceptional standard in care and support for staff. The service always cared about and promoted the wellbeing of their staff and was exceptional at supporting and enabling staff to always deliver person-centred care.

Staff told us they worked in a supportive environment. They felt positive and proud about working for the provider and their team. Staff felt respected, supported and valued by their team members, managers and senior leaders.

We observed staff working together as a team and as individuals with confidence. They said they could ask any member of the BPAS wider team for help, advice or support Staff described how policies and processes supported and enabled them to provide the best possible care for their patients.

Staff had access to support for their own physical and emotional health needs through an occupational health service. Staff could access BPAS mental health first aiders. These staff had received additional training to help identify colleagues who might benefit from extra support and as well as being able to signposting them to support services. Their role also included promoting a healthy work environment by improving mental health literacy and removing stigma about mental ill health through conversations and learning events.

BPAS provided a range of reasonable adjustments for staff with disabilities or additional needs and responsibilities so they could perform their duties effectively. For example, staff with dyslexia could have a coloured overlay for their computer to improve readability, staff could request more breaks or split shifts to help with wellbeing and or caring responsibilities. Speech recognition software was available, or staff could be allocated longer appointment times so they would have the support they needed to complete patient records.

Staff could access support during and or after dealing with a difficult situation. They could access support from senior members of the team, including the safeguarding lead, through a computerised direct messaging platform throughout consultations. Following an appointment they could access senior staff, including managers, for support when needed.

As well as an internal occupational health department, staff could seek support for work related, and non-work related, issues through the employee assistance service. The employee assistance service was an independent service that could offer one to one counselling support for staff.

The service’s staff sickness and absence were similar to the average for the provider.

The provider recognised staff success within the service they used a BPAS Recognise poster where staff could write positive comments about colleagues. There were messages about successful scanning competencies and welcoming a new lead midwife. Staff could also write postcards to colleagues preprinted with messages such as “I just wanted to say a big thank you – because you’re dedicated and courageous”. Thank you cards and survey results were displayed on staff noticeboards. One patient wrote “I am writing to give my heartfelt appreciation for your professionalism, your expertise, and your care during a really difficult time… I will always remember your kindness and gentleness that you showed during my consultation and scan… I’m glad to have found the service and you”.

Staff appraisals included conversations about career development and how they could be supported. Staff were able to develop and further their careers.