BPAS - Middlesbrough

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last inspection we rated this key question Requires Improvement. At this assessment the rating has improved to Good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

There was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of women who used services and wider communities. Leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Women with protected characteristics felt supported. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.

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 evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of women and their communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff told us they received regular updates through the manager and from senior leaders. The organisation’s vision and strategy had recently been updated. Staff said details of the changes had been communicated through a virtual all staff conference. Posters outlining the new vision, the strategy for achieving the vision, and the underpinning values were visible in staff areas. Staff said the BPAS culture had changed for the better. It was not only focused on providing high quality care for patients but also for staff wellbeing and promoted caring for each other. Staff said they felt supported by leaders and colleagues, by new and embedded processes and procedures and by fair and caring leaders. They said there was a tremendous difference in confidence and competence in staff and a feeling that they were safe in making decisions to meet the needs of patients and of their teams.

Local teams, managers, and more senior leaders had a good and clear understanding of the local communities, demographics and vulnerabilities. They worked with local agencies, support groups, and hospitals to provide the service in the best way for patients in prison, at school, families in crisis, sex workers, and victims of abuse. Staff provided an outreach service to schools by visiting and talking about sexual health and awareness.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The service had a clear leadership structure. We saw this was shown on posters and the intranet, so staff knew who to approach for support.

Staff at all levels told us their leaders were visible and approachable. Staff spoke favourably about the online chat system they used. They told us this helped them to feel connected to their peers, managers, and to leaders within the wider organisation, especially when they might feel geographically remote. Regional leaders visited regularly.

Leaders had the skills, knowledge, experience to run the service. Staff told us they were provided with opportunities to develop their leadership skills.

Staff felt respected, supported and valued. They were encouraged to develop their skills and were given developmental opportunities. For example, leaders told us when staff identified they were interested in developing into a leadership role they were provided with opportunities to develop these skills. Staff also told us they could be seconded into a more specialist role if they wanted development opportunities. Staff were also supported to progress outside of BPAS. There was no pressure or stigma if they wanted to work elsewhere and managers were proud their service had enabled staff to do this.

The service fostered a positive culture where women felt they could speak up and their voice would be heard.

The staff we spoke with told us they worked in a culture where speaking up was encouraged and valued. They knew about the freedom to speak up guardian and how to contact them if needed.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs.

We saw positive and negative feedback from families and patients. Patients had written thank you cards to individuals and the team. The service displayed a ‘You said: We did’ board in reception that showed staff had listened to feedback about long waits in clinic and for some appointments and had recruited more staff. Staff told us they felt listened to and staffing had” never been better”. Students provided overwhelmingly positive feedback following placements.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for women and for staff who worked for them and with them.

Leaders worked to create an inclusive working environment. Staff felt encouraged to speak to managers about any reasonable adjustments they needed to improve their working lives. The service offered staff flexible working hours and job sharing to meet their needs.

The organisation had an annual people survey so staff could share their views about working for the organisation. The results from the 2024 survey were displayed in staff rooms and showed that most staff agreed they and their colleagues were treated fairly regardless of differences such as background, ethnicity, religion/beliefs, gender, age, disability, marital status, pregnancy/maternity, gender reassignment, or sexual orientation. The results also showed women felt that they could be themselves at work and they didn't need to hide or minimise aspects of their physical, cultural, spiritual, emotional self or background while at work.

BPAS had undertaken equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group. The most recent data showed the proportion of BME staff across all roles had decreased from 7% to 6%. However, the ethnicity of 60% of staff remained unknown. The most recent recruitment data showed applications were received from women of whom were 63% white, 34% BME, and 3% unknown. Interviews were carried out with 77% white, 20% BME, 3% unknown. Following the 2024 staff survey results, leaders had recognised the need to understand the ethnicity of their current workforce and said they were “committed to a policy of equal opportunity and welcomes applicants from all sections of the community as we recognise the value that a diverse workforce brings”. They had taken action to find out more with “Work following the previous year’s reporting has seen changes and additions to some questions in the annual women survey to help reporting, with the aim to help direct positive change”.

The organisation had a range of networks to promote visible representation and acceptance of difference within the workforce, and safe space where women could access advice and information. The networks included, a disability equality network, a race equality network, a neurodiversity network, a parent and carers network, and an LGBTQ+ network.

BPAS encouraged staff to provide positive feedback about each other and to celebrate excellence and kindness. Managers had distributed postcards and posters on how and why to do this. One example of a pre-printed said “I just wanted to say a big thank you – because you’re dedicated and courageous”.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver high-quality, sustainable care, treatment and support. Staff always act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Clinic staff held daily huddles to review any incidents or difficulties arising from the previous day, safety huddles involving the whole team prior to surgical lists to discuss the patients and their needs, and monthly meetings to manage incidents. Incidents were logged, discussed, and actions agreed, documented using a standard format, and closed on completion. Actions and learning were shared locally, regionally and nationally.

The service had a ‘floor to board’ approach to communication. All staff were invited to regular virtual all colleague conference calls led by board members. This enabled important information to be shared with staff at the same time. Clinic staff were not always available to attend calls but the manager attended and conveyed any questions, concerns, or messages to ensure staff felt involved and able to approach senior staff whether directly or indirectly. Staff trusted their manager to act on their behalf as appropriate.

There were also local and regional meetings, which included task and finish groups and champions groups, that met regularly. Meetings had standard agendas and were minuted. Issues and concerns from these meetings were taken up via managers such as the quality matron or safeguarding lead to sub committees to escalate risk to senior and executive leaders. The sub committees also fed into the monthly quality risk group meetings which was then raised with the quarterly governance committee. Information discussed at these meetings fed directly into the board meetings. Information and recommendations were shared back to staff in the same way.

The service had a risk register. Risks were regularly reviewed in governance meeting to monitor actions identified to reduce risk. The biggest risk was the late cancellation of a surgical list if a consultant was ill or unable to travel to Middlesbrough. This had happened in the past, causing staff and patients severe difficulties. Staff told us the entire protocol and procedure for a cancelled list had been vastly improved with clear guidelines and standard procedures. Senior leaders would take responsibility for decision making, thus allowing clinic staff to contact patients and make arrangements for alternative treatments or locations. Staff told us this process had given them support and confidence in BPAS leaders they had not experienced in the past. All staff spoke very positively about the changes in leadership, and the clinical and personal support mechanisms that had been implemented.

In order to meet the requirements of the Abortion Act 1967 and 1990, a HSA1 form was completed by 2 doctors before medication or surgery to terminate a pregnancy was dispensed to women. Completed HSA1 forms demonstrate the legality of an abortion as set out in the Act. Following a surgical abortion a HSA4 form was completed. BPAS doctors completed these following prescription of medication to terminate a pregnancy. The surgeon carrying out a surgical abortion completed the HSA4 form immediately following the procedure. This was also an improvement from previous inspections when BPAS staff had not had a robust process to follow. Staff said all HSA4 forms were completed on time and within the 14-day legal requirement.

The electronic chat facility used by the provider allowed all members of staff to contact each other either to send direct messages or have video calls. The staff we spoke with said they felt confident in providing the most appropriate care and advice to patients after communicating with a colleague if they felt they needed a second opinion. They also felt confident to contact managers and leaders if needed.

Managers had quarterly meetings to look at patient feedback and discuss themes and trends to explore how they could improve patient experience. They shared this information with staff and encouraged them to use innovation to design and develop service improvements through the quality improvement board.

Leaders had oversight of the audits completed for each clinic and ensured actions required to improve compliance were completed.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for women. They always share information and learning with partners and collaborate for improvement.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for women. Staff shared information and learning with partners and collaborated for improvement. Staff worked in partnership with local authorities, police, schools, domestic abuse services, local prisons and probation services to ensure women and their children were safeguarded from harm. Staff met quarterly with the director of public health to discuss local issues, and monthly with the local Teenage Pregnancy Partnership where they were able to offer answers to young women’s questions and an opportunity to enable them to make their own decisions in future. They also met with local sexual health networks, signposting to other services, and to discuss best practice.

Managers and representatives from the wider organisation had regular meetings with commissioners to discuss contract management and look at performance against key performance indicators.

Occasionally incidents involved transfers of care to other services for example of a patient was found to have fetal abnormalities, an ectopic pregnancy, or an infection due to retained products of conception (RPOC). The service communicated with the accepting hospital staff, made clear arrangements for admission and liaised with the teams to ensure information and outcomes were shared and the patient received the best care for their needs. The service had good relationships with local and regional NHS hospital trusts and their staff.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for women. They actively contribute to safe, effective practice and research.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff were encouraged to explore creative ways of delivering equality of experience, outcome and quality of life for women. Staff actively contribute to safe, effective practice and research.

The organisation had an academic research and ethics committee. Staff were actively encouraged to become involved with the research studies and learning from the outcome of research was shared across the organisation to improve patient outcomes.

The organisation had a quality improvement board that met regularly. Staff were encouraged to make suggestions about improvements. Staff told us “Things have never been better” because they felt free to raise suggestions and felt they were listened to. One example for improvement staff had suggested was to ask patients to carry out a post-treatment pregnancy test at 3 weeks instead of 2 weeks. This was because some patients, although experiencing no symptoms, were getting positive results at 2 weeks and worrying about retained products or a failed abortion. This involved anxiety, a return to clinic, or undergoing a further scan or a repeated test. Staff found that a pregnancy test carried out by the patient 3 weeks post-treatment gave more reliable results. Staff still encouraged patients to contact BPAS immediately should they have symptoms of a failed or incomplete abortion. This change had reduced the need for some post-treatment clinic appointments and thus freed more appointment times and better access for all.

The topics covered by the quality improvement board also reflected the outcomes of audits and key performance indicators (KPIs) that required improvement to increase compliance.

Staff told us the availability of the telemedical hubs had been developed during the COVID-19 pandemic to reduce the need for multiple or complex clinic visits. The telephone consultations had reduced demand for appointments, but staff could still book face to face consultations for younger or vulnerable patients and those with special needs such as disabilities or patients without safe access to a telephone. This in turn allowed for nurse led care to reach higher standards because of increased capacity.

The service was continually promoting development opportunities for staff, allowing women to follow their own path and to support them in doing so. We spoke with staff who had developed and progressed and were proud of their achievements and their ability to provide a better, safer service to patients.