29 January 2019
Marie Stopes International (UK) is operated by Marie Stopes International. Marie Stopes International is a charity providing a range of reproductive healthcare services. Marie Stopes UK (MSUK) is a country programme within Marie Stopes International. MSUK has 12 registered locations in total; five centre locations in the South region, five in the North region, a vasectomy centre and a contact centre, MSI One Call. In addition, there are a number of early medical units (EMU) managed through the location centres.
The providers mission is to ensure the individual’s right to have children by choice not chance.
MSI provides the following services across nine clinical locations; consultations, ultrasound scans, medical and surgical termination of pregnancy, and counselling for people who use the service. In addition, vasectomy, long acting reversible contraception and sexually transmitted infection (STI) testing and screening are offered.
The EMUs provide pregnancy testing, unplanned pregnancy consultations, medical termination of pregnancy, advice and provision on contraceptive options and STI screening and treatment.
MSI One Call is the main contact centre for all MSI services in the UK. It provides the following: centralised patient booking, telephone consultation pre-assessment, post procedure support and advice line and telephone counselling for patients attending any MSI clinics nationwide. MSI One Call is available 24 hours a day, seven days a week and is the first point of call for patients wishing to access any of the clinic services provided at any MSI location.
The provider is registered for the following regulated activities:
During our inspection, we visited the provider’s office at Conway Mews, London. We spoke with nine members of staff including administration and support staff, training team administrations and senior managers. We reviewed the providers improvement action plan and multiple documents and supporting evidence provided in relation to aspects outlined within the Section 29 warning notice.
29 January 2019
Marie Stopes International (UK) is operated by Marie Stopes International (MSI). MSI is a not for profit organisation that was founded in 1976 to provide a safe, legal abortion service following the Abortion Act1967. It performs in the region of 70,000 abortions (both medical and surgical) a year which is representative of around a third of abortions performed in England. MSI also provides a vasectomy service, family planning, sexually transmitted infection (STI) testing and screening.
The last unannounced inspection at provider level took place on 28 and 29 February 2017. Whilst improvements had been made since the initial provider inspection in July and August 2016, many processes were yet to start or were so new they needed to be embedded. Therefore, the impact of these measures on ensuring patients were protected from harm could not be determined. We remained concerned around the fragility of the leadership team, governance processes and oversight of risk and quality assurance.
Following this inspection, we undertook enforcement action and served a warning notice on 6 July 2017, at provider level, under Section 29 of the Health and Social Care Act 2008 in respect of Regulation 17: Good Governance.
We carried out a focussed announced inspection at provider level, on 21 November 2018 to follow up specifically on compliance with the 14 points of concern within the Section 29 warning notice. We found that the service had improved and adequate actions had been taken to meet the requirements of the Section 29 warning notice.
To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.
CQC regulate termination of pregnancy service providers and from August 2018 have the legal duty to rate these services. Ratings are provided at location level. As this was a focussed follow up inspection at provider level there are no ratings attached to this inspection.
We found the following areas of improvement:
Processes to monitor patient safety and risk had been strengthened and reporting systems had been embedded into practice across locations.
Work had been undertaken to strengthen leadership across the organisation both at provider and location level.
There had been improvements in compliance of mandatory training, safeguarding, infection prevention and control and equipment monitoring and reporting.
The human resources (HR) structure had been revised and strengthened with several new appointments within the team. There had been a focus on staff recruitment, with positive results.
Several initiatives were underway to improve staff engagement, leadership and accountability, recognition and motivation and training and development.
The arrangements for governance and management of risks, issues and performance had been strengthened. Regional governance meetings were now embedded with standardised format and reporting procedures to improve consistency.
Implementation of several digital systems had improved the data collection and analysis capability of the service with the aim to strengthen quality assurance and improve services.
We had seen a positive impact on patient safety at location level. Safe had been rated as good in the three most recent MSUK location inspections undertaken between August and September 2018 (MSI Maidstone, MSI Manchester and MSI Essex). Processes had been established and inconsistencies between locations had reduced.
However, we also found the following issues that the service provider needs to improve:
Continued changes of leadership, structure and processes had impacted on the pace of change. A sustained period of stability, at provider and location level, was not yet achieved.
Revised governance process had not progressed significantly. There was no effective process in place to ensure recent changes had been reflected appropriately in policies, procedures and the organisation’s Statement of Purpose.
Assurance systems were weak, processes were not robust, data analysis was not fully quantifiable and there was limited check and challenge undertaken by the executive leadership team.
Risk, issues and poor performance were not always dealt with appropriately or in a timely manner. Meeting minutes were of poor quality and recording of outcomes was not always accurate or specific.
Whilst there had been improvements, the pace of progress in some areas remained slow. Many of the actions stated in the improvement action plan were not yet fully operational, and some were not due to begin until mid-2019.
In two of the three most recent location inspections, MSI Manchester and MSI Essex in August and September 2018 respectively, well led was rated as requires improvement. The findings were reflective of those at provider level. Whilst governance frameworks were in place, they were not yet fully embedded and local oversight of risk was not fully effective. In both centres there had been changes in local leaders and registered managers.
Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.
Deputy Chief Inspector of Hospitals