Archived: BPAS - Brierley Hill

BPAS Brierley Hill is part of the national charitable organisation British Pregnancy Advisory Service (BPAS). BPAS provides medical and surgical termination of pregnancy services.

BPAS Brierley Hill provided a medical termination of pregnancy service in Brierley Hill West Midlands. BPAS Brierley Hill has contracts with clinical commissioning groups (CCGs) in the Black Country area to provide a termination of pregnancy service. Most patients are funded via the NHS, some patients choose to self-pay for services and the clinic offered services to paying overseas patients.

BPAS Brierley Hill provided support, information, treatment and aftercare for people seeking help with regulating their fertility and associated sexual health needs. Its main activity was termination of pregnancy.

We inspected but did not provide ratings for this service.

Are services safe at this service?

• Incidents and risks were reported and managed appropriately. Lessons learned and actions to be taken were cascaded to front line staff.
• Nursing and medical staffing numbers were sufficient and appropriate to meet the needs of patients in their care.
• Staff complied with best practice with regard to cleanliness and infection control. The clinic environment and equipment were clean and suitable for use; standards were monitored through audits and risk assessments such as health and safety risk assessments.
• Staff were aware of their safeguarding responsibilities, including to patients that were under the age of sixteen years old.
• Medicines were stored, prescribed and administered safely and in keeping with the Abortion Act 1967. Some aspects of audit arrangements for medication particularly those medicines used to bring about a termination of pregnancy were not consistently robust.

Are services effective at this service?

• Treatment was based on up to date good practice and staff followed policies and procedures.
• Patients were prescribed appropriate pain relief, preventative antibiotics and post termination of pregnancy contraceptives.
• There were processes in place for implementing and monitoring evidence based guidance.
• The clinic undertook audits recommended by Royal College of Obstetricians and Gynaecology (RCOG).
• Consent was gained in line with Department of Health guidelines for most patients. The provider had policies, procedures and guidelines for staff to support these. However protocols to assess capacity and support for patients who lack capacity to consent including those with a learning disability were not robust in practice. The risks involved in simultaneous administration of termination of pregnancy medication were not made sufficiently clear to patients. The provider informed us this was put right immediately after our inspection visit.
• Each patient had an ultrasound performed to confirm the pregnancy and gestation stage so that the correct treatment could be recommended.
• Pre and post termination of pregnancy counselling was offered and a telephone advice line for patients was available 24 hours a day.
• Nursing staff were trained and assessed as competent for general nursing practice and specific competencies pertaining to their roles.

Are services caring at this service?

• Staff treated patients attending for consultation and termination of pregnancy with compassion, dignity and respect. There was a focus on the needs of patients.
• A ‘client care coordinator’ met with all patients on their own to establish that the patient was not being pressurised to make a decision. Patients’ preferences for sharing information was established, respected and reviewed throughout their care.
• If patients needed time to make a decision, the staff supported this.
• All patients considering termination of pregnancy had access to counselling before and after procedures.

Are services responsive at this service?

• Pre and post-procedure checks and tests were carried out at the clinic to ensure continuity of care.
• Waiting times were within the guidelines set by the Department of Health and agreed by the local Clinical Commissioning Groups.
• Interpreting and counselling services were available to all patients and the clinic was accessible for those with disabilities.
• The service had good links with the sexual health service within which it was situated.
• Patients could be offered a provisional same day service, where they were booked on the same day for an appointment, assessment, ultrasound scan and received treatment.
• Complaints were responded to appropriately and within service agreed timescales.

Are services well led at this service?

• Senior managers had a clear vision and strategy for this service and staff were able to demonstrate the service’s common aims to us.
• There was strong local leadership of the service and quality of care and patient experience was seen as the responsibility of all staff.
• Staff were proud of the service they provided and were aware of the requirements RCOG’s clinical guidelines.
• Staff felt supported to carry out their roles and were confident to raise concerns with their managers.
• Patients were encouraged to provide feedback through a satisfaction survey, and the results were positive.
• There was a clear system of governance in place at national and regional levels and clinical governance was well managed to ensure service quality and performance was monitored and actions taken when needed. Governance forums were used to discuss quality and risk issues and monitor the service was adhering to legal requirements such as completion and submission of legal documentation (HSA1 and HSA4 forms).
• Comments, concerns and complaints were shared with staff.
• The provider had reviewed treatment programmes. When possible it had introduced new regimes to provide women with greater choice and flexibility.

.We saw several areas of good practice including:

• A sample of young people had been consulted in designing the safeguarding risk assessment. This improved the effectiveness of questions to identify young women who were isolated, at risk of abuse or exploitation.

However, there were also areas of where the provider needs to make improvements.

Importantly, the provider must:

• Put into practice protocols for all patients who may lack capacity to consent.
• Improve the audit arrangements in place for medication particularly abortifacient medicines.
• Improve practice in respect of the administration of an intramuscular medication
• Improve practice in respect of use of ‘anti-d’ (a blood product derivative drug used to prevent formation of antibodies).

In addition the provider should:

• Consider developing a formal, local contingency plan for business continuity in the case of prolonged loss of premises due to major incident.
• Consider participating in relevant local or national audit programmes or peer review to bench mark outcomes against other similar services.
• Make clear on the consent form when simultaneous termination of pregnancy medication was administered the risks involved.

Professor Sir Mike Richards

Chief Inspector of Hospitals