BPAS - Middlesbrough

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated effective as good. At this assessment the rating has remained good. This meant women’s outcomes were consistently good, and women’s feedback confirmed this.

We looked for evidence that women and communities had the best possible outcomes because their needs were assessed. We checked that women’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring women were at the centre of their care. We found leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This service scored 75 (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 made sure women’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 8 patient records at BPAS Middlesbrough and 2 patient records at the Newcastle clinic.

Staff completed personalised, holistic, and comprehensive health assessments of every patient in a timely manner during their initial telephone conversation and updated these with patients’ needs and requirements at every contact and when they attended the clinic for further consultation, scan, and treatment.

Staff used a range of tools to assess and review women’s treatment needs. The tools were standardised and staff understood how to use them. BPAS processes ensured staff understood their patients’ holistic needs. Staff could provide information about or make an onwards referral support services. These included services that supported victims of domestic violence or sexual abuse, and they could make internal referrals to the organisation’s counselling services for support with women’s abortion choices. Staff gave examples of referrals to local and regional NHS services for specialist or urgent care and support.

Staff asked patients about their communication needs when they first made contact with the service and about further personal needs throughout their care and treatment.

Staff encouraged young women to consider if they needed a supportive adult and who they could approach for support. They asked all women if they felt safe with the person they had an intimate relationship with and if they were being asked to do things they were unhappy with as part of the safeguarding assessment. Consultations were adapted for under 18-year-olds to ensure these patients felt safe and gave them as much time as they needed to reflect and answer this.

The service planned and delivered women’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff assessed and met patients’ needs for food and drink before and after surgical abortions. The service provided hot and cold drinks along with biscuits and snacks. They checked patients felt well before leaving the clinic.

Staff participated in clinical audit, benchmarking and quality improvement initiatives.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. A BPAS national team had oversight of policies and procedures, and these were regularly reviewed to reflect up to date clinical guidance and practice. These were stored on the BPAS intranet and accessed by all staff. Staff were informed when policies were updated and allowed time to read and understand them.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. For example, if nurses or midwives were uncertain as to a patient’s suitability they could contact BPAS clinicians for help and support. As well as doctors and nurses’ skills and knowledge, the service had developed software that would identify omissions in records and potential risks as they completed each part of the assessment. Staff used a suitability tool to show medical conditions and medicines that would not be suitable for medical terminations.

We observed a consultation with a patient who was suffering from anaemia. The patient explained they had not been taking medication to treat this condition because of side effects. When staff tested their haemoglobin level, they found it was too low to proceed with the surgical termination the patient had chosen. Staff contacted the lead midwife, the patient’s GP and the local NHS hospital to help the patient explore other options.

The service worked well across teams and services to support women. They made sure women only needed to tell their story once by sharing their assessment of needs throughout their care and between services.

Staff held regular and effective multidisciplinary meetings. Staff discussed patient information prior to surgical abortions and completed safer surgical checklists before, during and after each procedure.

Staff shared information about patients via electronic records. They completed all patient details to enable colleagues such as doctors to make clinical decisions, follow legal requirements, and provide prescriptions.

The teams had effective working relationships, including good handovers, with other relevant teams within and outside the organisation (for example, local authority safeguarding teams, specialist and emergency services at local and regional hospital trusts, general practitioners, police, and multi-agency risk assessment conference meetings (MARAC)). Staff had developed good relationships with local schools and sexual health services.

There were formal service level agreements and handover procedures to enable safe and swift transfer of cases to local and regional hospitals such as for emergency treatment for ectopic pregnancy or for NHS care and support with late terminations.

The service supported women to manage their health and wellbeing to maximise their independence, choice and control. The service supported women to live healthier lives and where possible, reduce their future needs for care and support.

Patient assessments included discussions about sexual health. They sent out testing packs if patients consented.

Staff asked patients if they would like to use contraception following a termination. They provided information and advice and offered long-acting reversible contraception (LARC) in the form of injections, implants or coils. These were funded by the integrated care board (ICB) along with abortion care. If women wished to use other methods of contraception, staff could signpost them to other services who provided these.

The service routinely monitored women’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of women themselves.

Staff had monthly team meetings where they discussed their key performance indicators (KPIs) and if these were being met. KPIs were monitored and submitted to the local Integrated Care Board (ICB) who commissioned the service, to try and improve women’s access to treatment. The main KPIs included how quickly women could access an assessment of their needs (5 working days or 7 calendar days for a standard referral, 2 days for urgent appointments), access ultrasound scans (6 days) and how quickly their treatment pathway was completed (10 working days or 14 calendar days).

At the time of this assessment the service met KPI targets for all of these criteria, unless patients chose to wait longer for any reason. However, in the reporting period from June 2024 to May 2025 compliance ranged between 80% and 91% for completion of the treatment pathway, therefore missing the KPI.

An incident had occurred where a patient had not been able to access an emergency post-treatment appointment and had an emergency admission to hospital following a ruptured ectopic pregnancy.

Since that incident the service had employed more nurses and midwives. Records showed there was improved availability for appointments and most were same day or next day appointments.

Other KPIs included the number of women offered contraception, the number of women who took up testing for sexually transmitted diseases, and the number of incomplete abortion treatments. An incomplete abortion treatment is when the pregnancy continues despite medicines to end terminate the pregnancy being used. An additional procedure would be needed to complete the termination. Patients carried out post-treatment pregnancy tests at home and could access the 24-hour helpline at any time for advice.

Not all patients completed their treatment as they were able to change their mind, repeat a step such as book a further consultation or access counselling before moving to the next stage. Patients were supported whether they chose to complete their treatment or not. In the 12 months prior to the assessment 141 patients had a consultation but did not proceed to treatment and 14 patients had booked a surgical termination but did not attend. Staff made a follow up call to patients who did not attend as a welfare check. They would not call any patient who expressed a wish for no contact. This was noted in the patient’s electronic record

Staff used an adapted escalation tool for the detection and response to clinical deterioration in patients. This was completed and recorded as a key element of patient safety and improving patient outcomes.

Staff used technology to support patients effectively (for example, for prompt access to blood test results).

The service undertook regular monthly audits of records. A dashboard recorded compliance rates, and in the 12 months prior to this assessment all audit compliance was above 90%. The BPAS target of 95% was met for most documentation and where there were improvements to be made managers had documented action plans for improvement.

Other audits included completion of HSA1 forms with 100% compliance. Actions following audits for medicines management addressed confusion over what temperature should be reported as out of range. This was discussed at staff meetings, and the most recent result was 96%.

Managers used the electronic patient record (EPR) to perform a monthly audit of staff completion of the assessment forms. This was to check all parts of the form had been fully completed to demonstrate all questions had been asked to ensure a holistic view of the woman had been formed. Some excess stock had been identified in previous months and managers investigated changing procurement processes to address this. There was no excess stock identified during out assessment.

Women were given a pregnancy test to use 3 weeks after they had a medical termination. A gap of 3 weeks allowed time for pregnancy hormones to decrease significantly. If women had a positive pregnancy test, they were advised to call the organisation’s helpline so a follow up appointment could be arranged. The success rate of medical terminations was monitored by the organisation to improve outcomes for women.

The service told women about their rights around consent and respected these when delivering person-centred care and treatment.

All records we reviewed showed staff had completed the consent process and full documentation of the assessment of mental capacity. A monthly audit of compliance for consent, was consistently recorded as 91% or above. Actions were set for individuals and teams to improve practice. Some audit findings showed the incorrect box was chosen on the electronic record and staff were reminded to take care to choose the correct box.

If staff felt there was any concern about a patient’s capacity to consent, staff could involve senior leaders and the BPAS safeguarding team to decide next steps.

Patient records for women who had undergone a surgical termination of pregnancy (SToP) all evidenced staff had documented two-stage consent.

Staff took all practical steps to enable patients to make their own decisions. Although there are legal limits regarding timing of abortions, staff allowed patients as much time as possible to make decisions on the treatment they wanted, if any. Staff ensured there was no pressure put on a patient by offering alternatives and referrals to other services. Staff used Gillick competence and Fraser guidelines to assess the ability of young women to consent to abortion treatment. This ensured a young person could understand and fully appreciate what was involved in their treatment. Occasionally, but rarely, the service provided care for children under 16 following strict safeguarding oversight and support of other external agencies as appropriate.

A monthly audit was conducted to ensure staff were seeking women’s consent to treatment. The audits for all sites for June 2024 to May 2025 demonstrated a range between 91% and 100% compliance, showing seeking and recording consent was in line with the organisation’s policy and above the target of 95% on all but 3 occasions. Where actions to improve compliance were required, these were all logged, reviewed and completed.