Archived: Marie Stopes International Telford Centre

Updated 7 November 2017

MSI Telford Centre was registered with the Care Quality Commission (CQC) in January 2016. The Telford and Shrewsbury sites each hold a licence from the Department of Health (DH) to undertake termination of pregnancy services in accordance with The Abortion Act 1967. Both sites are situated within GP practices and are not MSI owned premises.

Services are provided predominantly to NHS-funded patient referred by local clinical commissioning groups (mostly Telford and Wrekin and Shropshire) and receives referrals from other areas as well as private patients for health.

Termination of Pregnancy (TOP) refers to the abortion of pregnancy by surgical or medical methods. Marie Stopes International (MSI) Telford is part of the provider group MSI and MSI International, a not for profit organisation that was founded in 1976 to provide a safe, legal abortion service following the Abortion Act 1967. The organisation has expanded from one centre in London to a global network of more than 600 centres across 37 countries.

There was no registered manager available at the time of our inspection for MSI Telford Centre with interim management arrangements supported by a regional director. All staff working at the Telford and Shrewsbury sites were based at the MSI Birmingham site.

There were no special reviews or ongoing investigations of the service by the CQC at any time during the 12 months before this inspection. The service had not been previously inspected by the CQC.

Updated 7 November 2017

Marie Stopes International Telford Centre is operated by Marie Stopes International (MSI). MSI Telford Centre was registered with the Care Quality Commission (CQC) in January 2016.

Regulated services are provided at Trinity Health Centre, Malinsee Surgery, Church Road, Telford, and at the early medical unit (EMU), Radbrook Green Surgery, Bank Farm Road, Shrewsbury. At the time of the inspection, surgical termination of pregnancy was not being undertaken.

The Telford and Shrewsbury sites each hold a licence from the Department of Health (DH) to undertake termination of pregnancy services in accordance with The Abortion Act 1967. Services are provided predominantly to NHS-funded patients referred by local clinical commissioning groups, as well as to private patients. The main site is MSI Telford with the Shrewsbury site as a satellite service.

We inspected this service using our comprehensive inspection methodology. We gave the provider three working days’ notice that we would be inspecting the service. We carried out the announced part of the inspection at MSI Telford on 8 August 2017 and its satellite the Early Medical Unit at Shrewsbury on 9 August 2017, along with an unannounced inspection to MSI Telford on 22 August 2017.

We observed activity levels, staff interaction with patients, and made checks on the environment and equipment. Before and after our inspection we reviewed performance information submitted by the service. We spoke with seven members of staff including; MSI regional managers (there was no registered manager available), medical staff (by telephone as they were not onsite during our inspection), registered nurses, and health care support workers. We also spoke with eight patients. We reviewed 26 patient records, including those of 13 patients who used the surgical termination of pregnancy services undertaken before the provider suspended this activity.

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?

Services we do not rate

We regulate termination of pregnancy services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• Safeguarding of children and young people and safeguarding adults at risk policies and training were available at appropriate levels for all staff.

• There were locally agreed policies and standards that referred to evidence-based practice and against which performance was audited and reported upon.

• Policies were kept up to date. We saw that relevant staff were involved in their development and review.

• Learning and development was provided at an appropriate level to enable staff to develop and maintain their skills and competencies in areas such as consent, scanning, and counselling.

• Pain was assessed and treated in accordance with national guidelines.

• Staff were compassionate in their approach and were seen by patients to be non-judgmental.

• All consultations were carried out in private rooms with no interruptions from other patients or staff.

• All patients received their treatment from decision to proceed to termination of pregnancy. within the recommended Department of Health time frames.

• There was flexibility to re-arrange appointments at very short notice to meet the needs of patients.

• Consultations were undertaken either face to face or by telephone to meet people’s needs.

• There was a clearly defined referral process for patients who required specialist services.

• Complaints were managed in accordance with MSI policies and in the required time frames. Patients and staff understood the processes they should follow.

• Both sites (Telford and Shrewsbury) were accessible to wheelchair users or people with limited mobility.

• The leadership team were knowledgeable about quality issues and priorities, understood the challenges, and were taking some action to address them. However these were not generally known or understood by staff.

• Staff spoke positively about the changes introduced by the new management team and the pace at which the changes had taken place.

• There were systems in place to monitor and act upon compliance with standard operating procedures and clinical and professional guidance and professional opinion such as that provided by relevant Royal Colleges including the use of audit tools and checklists.

• Required checks on emergency equipment were not consistently undertaken.

• There was no record that fire evacuation exercises had been undertaken at Telford.

• Records for the disposal of pregnancy remains were missing for the last date of surgical activity

However, we also found the following issues that the service provider needs to improve:

• The incident reporting system and trend analysis were not yet embedded or effective at a MSI Telford Centre and its satellite site in Shrewsbury. There was limited evidence of any action taken following incidents or lessons learnt being shared with the team.

• Failures in information technology meant staff could not access all required information.

• Medicines were not always securely stored and improvement was needed to monitor medicines.

• There was limited segregation of clean and dirty equipment to minimise infection risk.

• There was limited evidence that staff had training in the duty of candour. However the provider told us after our inspection that duty of candour was included within safeguarding training.

• Not all staff had completed all required mandatory training.

• There were gaps in management and support arrangements for staff such as appraisal and supervision.

• There was poor patient flow due to unsuitable premises. This included a cramped recovery lounge, a lack of available recliners and privacy for recovery and limited toilet facilities.

• There was no registered manager at the time of our inspection and no regular monitoring or oversight of the early medical abortion unit (EMU).

• Chaperoning requirements were set out in the MSI chaperone policy 2017; however, they were not followed as nurses normally worked as lone workers at the Shrewsbury site and frequently at Telford site. The provider told us after our inspection that if patients requested a chaperone, they would be booked in to a larger clinic.

• There had been a high turnover of staff at senior and executive management level, which had led to some instability at the centre.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices that affected MSI Telford. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Updated 7 November 2017

We regulate this service but we do not currently have a legal duty to rate when it is provided as an independent healthcare single speciality service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary . We have a duty to rate this service when it is provided as a core service in an independent hospital.