Archived: Unplanned Pregnancy Advisory Service Finchley

Termination of pregnancy (TOP) refers to the treatment of termination of pregnancy (abortion) by surgical or medical methods. Unplanned Pregnancy Advisory Service Finchley is part of the provider group National Unplanned Pregnancy Advisory Service (NUPAS): an organisation that provides termination of pregnancy services in 14 locations in England. Prior to 1 April 2016 the Unplanned Pregnancy Advisory Service Finchley was known as Finchley Pregnancy Advisory Service. The change was made to the name only, as a result of a rebranding initiative, with no changes in governance or function. The service is offered under contract with local commissioning groups for NHS patients, and is also provided for private patients.

The service is provided in two locations, which are leased on a sessional basis: at the ground floor of Finchley Memorial Community Hospital, and at a satellite treatment unit which is part of Marks Gate Health Centre, Romford, Essex.

The service was registered in 2013 as a single specialty termination of pregnancy service providing a range of services including early medical abortion (EMA) up to a gestation of 9 weeks. The service opened at Finchley Memorial Hospital in 2013, and at Marks Gate in September 2015. Services at both locations include: pregnancy testing, unplanned pregnancy counselling/consultation, early medical abortion, abortion aftercare, sexually transmitted infection testing, and contraceptive advice and contraception supply. The service is provided for patients aged 13 and above.

We carried out an announced comprehensive inspection at Finchley Memorial Hospital on 28 June 2016, and at Marks Gate 29 June 2016, as part of the first wave of inspection of services providing a termination of pregnancy service. The inspection was conducted using the Care Quality Commission’s new methodology.

We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities which it provides. The inspection team included two inspectors and a specialist advisor in midwifery and nursing.

Our key findings were as follows:

Is the service safe?

• Staff were familiar with the processes in place to report and investigate safety incidents. However, incidents, including those with a potential to cause harm to patients or staff, were not always reported.
• There were systems, processes and practices in place to keep people safeguarded from abuse.
• National specifications for infection prevention and control were adhered to.
• There were assessment processes in place to ensure suitability for treatment.
• Medicines were safely ordered, supplied, and stored in accordance with manufacturers’ instructions, and administered only when they had been prescribed for a named patient.
• Records were securely stored, well maintained and generally completed with clear dates, times and designation of the person documenting.
• Safety and maintenance checks were carried out on equipment in accordance with local and national requirements. All equipment was clean and ready for use.

• There were sufficient numbers of suitably trained staff available to care for patients.

• Arrangements were in place to manage emergencies and transfer patients to another health care provider where needed and were known to staff. There were no emergency transfers between January 2015 and May 2016.

• All patients underwent a risk assessment to determine their individual risk of developing blood clots.

Is the service effective?

• Care and treatment was generally provided in line with Department of Health Required Standard Operating Procedures (RSOPs) and national best practice guidelines.
• A range of clinical audits were presented at monthly performance and quality meetings.

• Policies were reviewed and signed off by the Medical Advisory Committee prior to implementation.

• Staff had received an appraisal in the 12 months prior to our inspection, and were supported to learn and develop in their role.

• Appropriate systems were in place to obtain consent from patients.

• Patients were offered pain relief, preventive antibiotic treatments and post-abortion contraceptives.

• The NUPAS after care telephone service was accessible to patients over 24 hours a day, seven days a week.

Is the service caring?

• Staff were caring and compassionate and treated patients with dignity and respect.
• Patients’ wishes were respected and their beliefs and needs were taken into account.

• Patients felt safe and well cared for and consistently commented on the non-judgmental approach of staff.

• During the initial assessment, nurses explained to patients all the available treatment options for termination of pregnancy.

• Patients considering termination of pregnancy had access to counselling, with no time limits attached, but were not obliged to use the counselling service.

Is the service responsive?

• The service was planned to meet the needs of patients. Patients either referred themselves or were referred by their GP. They were able to book appointments through the NUPAS telephone booking service which was open 24 hours a day throughout the year. There was access to telephone or face to face consultations.
• Patients were referred to other services for termination of pregnancy, where appropriate, for example due to a medical condition or late gestational date, and were provided with information to help them to make decisions.

• A professional interpreter service was available for patients whose first language was not English, to enable them to communicate with staff.

• Complaints were managed locally and, where unresolved, were escalated to the central office. Feedback was given to staff and the complainant.

Is the service well led?

• There was a vision, philosophy, and objectives for the service. Staff were familiar with the NUPAS strategy and spoke positively of a culture that recognised there was a need for continuing service development.
• The certificate of approval (licence for termination of pregnancy) issued by the Department of Health was available at each location.

• The direction of the service was discussed with staff, who were allocated specific roles to support service improvements.

• There were corporate governance arrangements to manage risk and quality and to ensure the service adhered to the requirements of the abortion act. However, the governance arrangements mainly took place at a national level.

• Incidents and risks were not always identified, reported or acted upon by people with the authority to do so.

• The audit programme was not fully implemented, in particular: incomplete monitoring and review of record keeping and medicines management.
• The culture within the service was caring, non-judgmental and supportive to patients.
• Staff felt supported by the treatment unit manager and senior managers, and felt encouraged to learn and develop in their roles.

There were areas of poor practice where the provider needs to make improvements.

The provider should ensure :

• Greater local ownership among staff of practices and procedures carrying out risk assessments and audits that are proportionate to the size of the treatment unit. The risk register should include any local risks that have been identified.
• An up to date policy on counselling services, training and supervision is available to staff and standards are monitored and reviewed against it.
• Delivery and stock control of medicines are managed in accordance with legislation, provider policy, and professional standards and national guidance.
• Staff are supported to independently report incidents of all kinds, including those with a potential to cause harm to patients or staff, even when no harm occurred. All staff should receive prompt feedback to reduce the risk of recurrence of incidents.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Professor Sir Mike Richards

Chief Inspector of Hospitals