BPAS - Middlesbrough

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last inspection we rated this key question as Requires Improvement. At this assessment the rating has improved to Good. This meant women’s needs were met through good organisation and delivery.

We found women were involved in decisions about their care. Women and communities were always at the centre of how care was planned and delivered. The service provided information in ways women could understand. Women knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. Women received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. Women were involved in planning their care and understood options around choosing to not receive treatment.

This service scored 79 (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 were at the centre of their care and treatment choices and they decided, in partnership with women, how to respond to any relevant changes in women’s needs.

The service made sure patients were at the centre of their care and treatment choices and staff decided, in partnership with patients, how to respond to any relevant changes in women’s needs.

Staff told us they were responsive to their patients and would support them in way that met their changing needs. For example, staff supported and provided information for patients who had a longer gestation of pregnancy than expected which meant they could no longer have their preferred abortion treatment. This meant patients could access different services or options to have their treatment delivered in a different way or were supported to make the right decisions for themselves. Patients who were undecided about abortion treatment and needed additional time and support to make choices about their treatment could opt for a follow up telephone call or appointment after taking time to think through their options and staff could answer additional questions.

Staff told us many patients felt overwhelmed by the decisions they needed to make. Staff could explain the treatment options but always maintained the decision to go ahead with treatment, or not, could be made in the woman’s own time. Staff would explain the timeframes that abortion treatment could take place in and regularly provided reassurance the patient would usually have sufficient time to make the decision that was right for them. They could email them leaflets about treatment options and timeframes so patients did not have to remember all the information they were getting all at once and they could offer a referral to pre-abortion counselling. When patients could not take extra time such as if their gestation was close to the legal limits for abortion or their choice of treatment was reduced, staff offered urgent consultations, or longer appointments, and referrals to NHS hospitals to discuss and choose the most suitable option for their circumstances.

When dealing with a difficult case, the BPAS wider team supported the patient and family to access specialist treatment and services to meet the holistic needs of the patient.

Pregnancy remains were stored appropriately and disposed of sensitively and complied with the Human Tissue Authority (HTA) Code of Practice (April 2017). If patients wished to manage disposal of their own pregnancy remains according to their own beliefs, then staff supported them to do so and remains were stored until that time came. On one occasion pregnancy remains were stored beyond the standard BPAS storage date in order to support a patient to take sufficient time to make their decision according to their own needs. This meant the service missed the key performance indicator (KPI) for this standard, but staff documented the reason and contacted the patient with care and discretion to ask what next steps they wished to take.

The service understood the diverse health and care needs of women and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service understood the diverse health and care needs of women and their local communities, so care was joined-up, flexible and supported choice and continuity.

There were service level agreements in place with local NHS trusts where patients could be transferred in the event of an emergency such as an ectopic pregnancy. Staff described good relationships with NHS trust staff and were confident when handing over patients for specialist care.

The service worked in partnership with local prison services and mental health providers to ensure women in custody, women in immigration centres and women subject to the Mental Health Act (1983) could access the service and receive appropriate monitoring in a suitable environment (where possible and safe) for the duration of their abortion treatment.

Staff worked with local authority safeguarding teams, local police, local schools, and sexual health services to ensure safety of vulnerable clients, raise awareness of sexual safety, physical safety, domestic abuse, and abortion care to all parts of the community.

The service was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided online and written information about the services they offered including abortion treatment, screening for sexually transmitted disease and contraception. Patients were offered booklets to explain care and treatment with detailed step by step instruction of how and when to use their medicine, how long treatment would take and what would happen afterwards. The booklets were tailored for the abortion method the patient had chosen, or to help them choose. They also provided information about the risks involved in treatment and what to do if something did not feel right or in case of emergency.

There were videos on the organisation’s website that talked through what the service offered as well as step-by-step instructions for using abortion treatment at home as well as information about surgical treatment. The step-by-step instructions included what the pack of medication looked like, how to use the medication, the use of pain relief, and what to expect during and after treatment.

The service complied with the Accessible Information Standard. Written information was also available in easy read formats. All information was duplicated online for those who wished to use that format, or not carry a booklet. All the web-based videos had closed captions, and some had British Sign Language interpretation.

There was information on the providers website about requesting additional support for women who needed it. Staff could make adjustments to pathways of care to meet individual needs including religious or cultural needs, mental health, learning difficulties, or physical disabilities. Women with communication needs were asked to let the booking team, helpline teams, or clinic staff know. Staff offered women who used lip reading a longer appointment and clinic staff had arranged for a British Sign Language interpreter to attend a consultation. On another occasion, a member of the Newcastle team spent several hours writing out details to be discussed and anticipated questions during the consultation prior to a deaf patient attending. The nurse received a BPAS award for work they did to help the patient understand all the information provided, and questions required to be asked during their consultation.

The service used a translation service for women whose first language was not English, including British Sign Language. The website had a facility which meant it could be translated into 60 of the most commonly spoken languages in the United Kingdom. The website had some functions to enable users with vision impairment to use assistive technology, including a text only version of the website.

Information governance systems included confidentiality of patient records. All records were completed via an electronic application, and computers were password protected. Staff logged out of programs when they were not using computers.

Staff ensured carers and partners were supported by answering questions and updating them about the patient’s progress following a surgical abortion.

The service made it easy for women to share feedback and ideas, or raise complaints about their care, treatment and support. They involved women in decisions about their care and told them what had changed as a result.

Staff told us, and we saw, there was a clear process for learning from complaints. Staff identified key themes and trends in complaints and concerns at staff meetings. They also discussed and learned from complaints at regional and national level. Managers also discussed the actions taken to address complaints, so staff had an enhanced understanding of the impact of women’s experience went things had not gone as planned. Staff described the process and how they shared learning with the multidisciplinary team as well as with specialists such as the BPAS regional safeguarding lead.

Patients were asked to complete a friends and family survey. In February 2025 BPAS Middlesbrough and its satellite sites had recorded 28 responses, most of which were very positive. However, there were 5 negative comments about staff attitude and condescending staff on telephone consultations. The service received responses through a patient satisfaction report that again showed mostly very positive responses. Responses amounted to about 10% of patients who received treatment. The negative responses mainly related to pain following surgical abortions. Staff explained they had recently stopped offering codeine routinely for patients to take home and had included advice for patients to take their own pain medicine. Staff believed this was the reason for the negative feedback and planned to provide clear information on pain relieving medicines in future.

The April 2025 satisfaction survey showed 100% of patients who responded would recommend BPAS. Again, the response rate was between 9.4% and 9.8%. Staff and managers discussed ways to improve this in local and regional meetings.

The service provided information on how to raise a complaint or concern in patient leaflets and all on-line materials. They logged all patient complaints, both written and verbal.

There were no formal complaints, although staff knew how to handle complaints appropriately. When patients complained or raised concerns, they were provided with respectful feedback. Patients were asked to complete a satisfaction survey following their treatment. They were sent a text with a free text response to share their comments and concerns about the service. The service received few negative informal comments. However, all were recorded and discussed by the team. We saw comments from patients about long waiting times in clinic waiting for prescriptions. Although staff explained the reasons doctors required time to make legal decisions or request further information before doing so, some patients were unable to wait. When patients could not wait for a prescription, staff organised for them to return the following day or by utilising the centralised “pills by post” service. Some clients had difficulty finding the new location for the Newcastle clinic because online maps had not been updated. This was outside the control of BPAS or clinic staff.

Managers met monthly to look at the feedback and consider how changes to service delivery could improve women’s experience of treatment. Trends and themes in feedback were also shared with staff so they could be taken forward for learning.

The service made sure that women could access the care, support and treatment they needed when they needed it.

The service offered appointments routinely up to 6 days a week, including a weekend clinic to ensure that women were able to access urgent scanning when required.

BPAS had a telephone consultation service which carried out an initial consultation and the service offered patients a choice of appointments suitable to their gestation.

According to the National Institute for Health and Care Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists, assessment for abortion should be accessed within 7 calendar days of making contact with an abortion service. Completion of abortion treatment should take place within 14 days of the initial contact for most women. This timeframe included women being seen for an ultrasound scan to confirm gestation of pregnancy when indicated. The length of time women had to wait for an appointment was a key performance indicator monitored by the integrated care boards that commissioned the service.

Patients could access the service promptly when needed and were given flexible appointment times appropriate to their gestation. They could opt for an appointment at the clinic of their choice or, if urgent, whichever clinic had the earliest appointment available. There was a supernumerary lead nurse or midwife at each of the Newcastle and Middlesbrough clinics so if a patient had urgent or complex needs, or presented with a later gestation, they could be seen within 48 hours. On average there was a 4 day wait for the next available clinic consultation and, if separate, a 1 day wait for a clinic treatment. The service provided data from 12 months to June 2025 to show 97% of patients received early medical abortion (EMA) treatment within 7 calendar days of a consultation. Of those patients who had a face to face consultation, only 57% of patients were seen within 7 calendar days of their first contact with BPAS. The additional time that patients waited to commence treatment was mostly impacted by complex or safeguarding needs, for medical information to be reviewed, or patient choice. Only 36% of patients who opted for a surgical termination of pregnancy (SToP) received their treatment within 7 days. This was because a SToP list was only provided once every 2 weeks. However, because these involved a small number of patients (310 out of 2798), the service still met the overall KPIs for consultation to treatment. At the time of this assessment, a new surgeon was being appointed. This would enable the service to decrease waiting times by offering weekly SToP lists within the following few months.

All of these results had improved greatly since our last inspection in 2022 when managers had no formal system to fully monitor waiting times, and staff were confident they would continue to improve. At the time of this assessment, following the successful recruitment of additional staff, the clinic diary showed there were appointments available for the same day or the next day. However, the service received informal complaints from patients who had not been able to access an appointment as quickly, or at a time they wanted.

Most consultation appointment slots were for 60 minutes. There were longer appointments available for young women and women with any additional needs. Young women were given a longer assessment appointment to ensure a thorough assessment of their understanding of abortion treatment could be made and any safeguarding needs could be addressed promptly. Appointment slots of 90 minutes were also reserved for women who required an interpreter as more time was needed for the interpretation process.

Young women were prioritised for appointment slots outside of school hours. Staff contacted patients who did not attend for treatment unless they expressly wished not to be contacted. This was to ensure patients were aware of all options dependant on their gestation and could make informed decisions. Staff respected the choice of women if they wished not to continue with a termination of pregnancy.

Medical cover was provided by a team of BPAS doctors. They were available by telephone and through the BPAS online system. They would review a patient’s medical history and ask further questions if there was any uncertainty regarding suitability for treatment. Doctors provided prescriptions for early medical abortion. The prescription required signatures from 2 doctors. This part of the process was performed remotely once patient assessments were complete and patients had been found suitable for abortion treatment. Doctors also prescribed long-acting reversible contraceptives (LARC) including injections and implants which trained nurses and midwives administered.

A surgeon visited BPAS Middlesbrough one day every 2 weeks to carry out planned surgical abortions. They worked with unit staff as a team and discussed each case in advance of the procedure. The surgeon would fit a contraceptive coil following the termination if the patient wanted it. At the time of the assessment BPAS were recruiting for an additional surgeon and interviews were being carried out. Following our visit staff told us recruitment had been successful. This meant that in the following months the staff at BPAS Middlesbrough hoped to offer weekly surgical lists.

Staff and leaders actively listened to information about women who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The provider had developed an Equity, diversity, inclusion and belonging plan for 2025/2026 to ensure the culture of the organisation enabled all staff to provide a safe and fair service for all patients of any background. Staff and leaders actively listened to information about women who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. Staff were trained in equality, diversity, inclusion and human rights.

Patients could choose where they wanted to have their treatment, at a time suitable to them, and a method to meet their needs and preferences. Women from a range of ages, religious and spiritual backgrounds and the diverse range of vulnerabilities and local ethnicities accessed the service. BPAS’ own data showed the service was accessed by patients with physical disabilities and mental illnesses, learning disabilities, different sexualities and gender.

Staff within the service and the wider organisation promoted a culture in which the women using the service felt empowered to give their views. Patients we spoke with were confident they could raise concerns, use the feedback methods provided if they wished to, or ask questions. However, staff and patients told us most women wanted to forget the experience quickly and return to normal living.

The regional team and registered manager monitored capacity and demand for the service and made adjustments to add appointment slots or add in a weekend clinic if required. This ability had recently improved with additional staff recruited and available.

Women were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff allowed patients time to make informed decisions at all stages of treatment. No patient was pressured into accepting treatment. Staff checked consent and understanding at every stage.

Women were given advice and information about terminating their pregnancy, including on the timescales for medical and surgical abortions. However, they were not under any pressure to decide within a timescale. The options of having a termination of pregnancy, giving the baby up for adoption or going ahead with the pregnancy were discussed.

Nurses and midwives discussed options available according to patient’s medical history, existing conditions, or complex needs. We observed staff taking time to help a patient who would not be suitable for a procedure at BPAS due to an existing condition. Staff gave information, answered questions, and provided alternative pathways, including services offered by other providers such as local NHS hospitals, with patience and compassion.

All patients were offered counselling if they wanted help to make a decision, and they could be given additional information to help them to make a choice in their own time. Patients were told they could also access post abortion treatment counselling at any point in the future.