National Unplanned Pregnancy Advisory Service Manchester

Updated 13 September 2016

National Unplanned Pregnancy Advisory Service (NUPAS) Manchester opened in its current location in 2010. The service is part of the National Unplanned Pregnancy Advisory Service (NUPAS) group (Formally known as Fraterdrive Limited). NUPAS Manchester offers consultations and early medical abortions (EMA) up to nine weeks gestation, screening for sexually transmitted infections, and contraceptive services to NHS and private patients.

The service offers same day EMA treatments whereby two stage abortifacient medication (medicines used to bring about abortion) is administered within a period of 6 hours. However patients from overseas opting for this treatment are advised to stay in the country for at least 24 hours afterwards. Patients that exceed the nine week limit for EMA are consulted and advised about surgical treatment options. Surgical treatments up to 15 weeks and 6 days are available at the South Manchester Private Clinic, NUPAS Manchester’s sister clinic. Patients exceeding this limit are referred to other external agencies who will manage their care.

Prior to 2010, the service was located at different premises in the city centre for about 20 years offering consultations only for unplanned pregnancy.

The clinic is situated in the middle of Manchester City Centre and has treatment, screening and consultation rooms and a waiting area all of which are located on the ground floor of the premises.

Prior to the 1st April 2016, the service was known as Manchester Pregnancy Advisory Service. The name was changed as a result of a rebranding initiative. The change was to name only and none of the governance arrangements changed.

Services provided include:

• Prescribing abortifacient medication
• Administering abortifacient medication for early-medical abortion
• Contraception to patients who undertake a termination of pregnancy.
• Sexually transmitted infection screening for patients aged 25 and under and people seeking opportunistic screening (drop in service).

The service is registered with the care Quality Commission to provide the following regulated activities:

Diagnostic and screening procedures

Family planning

Termination of pregnancies

Transport services, triage and medical advice provided remotely

Treatment of disease, disorder or injury

The service also had four satellite clinics at Bolton, Salford, Blackpool and Trafford. All offer consultations for unplanned pregnancy and early medical abortions, typically one day per week

At the time of inspection there was no Registered Manager in place. The previous registered manager had de-registered in May 2016.

We carried out this inspection as part of our comprehensive inspection programme of termination of pregnancy services. As part of this inspection we reviewed services provided at NUPAS Manchester only.

Updated 13 September 2016

• There was a clear process in place for the recording and investigating of incidents and staff were aware of the process. Systems were in place to share learning from incidents should they occur.
• Staff were familiar with the Duty of Candour (DOC) regulations and recognised the importance of informing patients when things went wrong. A policy for Duty of Candour had been developed and staff training had commenced in March 2016.
• The service had clear systems in place to identify and report any safeguarding concerns. Staff were familiar with the service’s safeguarding policy and were aware of female genital mutilation and child sexual exploitation risks. All staff had completed training in safeguarding adults and children to level 2 (intermediate) and level 3 (advanced) standard.
• All the areas we visited were visibly clean and tidy. Cleaning schedules were in place and we observed evidence that these were being completed. Equipment was being suitably maintained and calibrated. Daily comprehensive checks were in place for resuscitation equipment which was readily available and easily located on the premises.
• The service had no medical or nursing staff vacancies and at the time of our inspection the full establishment of staff were on duty. The service had an induction checklist for new staff which included orientation to the environment and awareness of service policies.
• The service provided care and treatment that took account of best practice policies and evidence based guidelines. The service had clear standards agreed with commissioners and key performance indicators to monitor performance and service delivery in line with RSOP16.
• Staff had received an appraisal in the 12 months prior to our inspection. The service was supporting nurses to undertake the Faculty of Sexual and Reproductive Healthcare diploma. This would ensure that nurses were competent to deliver all methods of contraception including LARCs.
• Appropriate systems were in place to obtain consent from patients and consent was well documented in the patient record.
• The service provided a 24 hour telephone advice/help line that patients could use for information, support, or post-operative concerns.
• Feedback from people who used the service was positive about the way they were treated. People were treated with dignity and respect by staff and we observed staff being considerate and compassionate to patients. Patients felt involved in decisions about their care and treatment options were clearly communicated and explained.
• The service offered counselling to all patients who underwent a termination. The service was provided by diploma level trained counsellors and was offered to patients throughout the care pathway. The service also worked closely with support groups such Nestac (FGM group) and the local sexual assault referral centre to ensure patients received the appropriate support.
• People were able to access services in a timely manner and the service was performing within the recommended target timeframes.
• For patients requesting a coil to be fitted as their preferred long acting reversible contraceptive the service offered a monthly clinic in the evenings so that patients that worked during the day could access the service.
• People were given information how to complain and raise concerns and the service responded to complaints.
• The service philosophy was to “provide a high level of care to women seeking termination of pregnancy within a non-judgemental manner. Offering confidential, supportive advice and treatment to all women”. Staff we spoke with echoed the key principles of the philosophy in terms of providing a non-judgemental, supportive and confidential service. Staff we spoke with enjoyed their job and were compassionate and proud of the care they gave.
• The service produced a quarterly quality and risk assurance report that monitored performance against agreed standards, the number of complaints received, the number and nature of incidents reported, any safeguarding concerns and patient feedback.
• A management meeting was held each month to discuss governance matters such as incidents (and trends across the region), audits, operational issues and information governance issues.
• There were robust systems in place to ensure HSA1 forms were completed and in line with regulatory requirements.

However,

• We observed clinical staff not washing their hands prior to performing diagnostic testing and not all clinical staff were bare below the elbows in clinical areas.
• Audits were limited to corporate areas such as infection control, medicines management and records. There was limited evidence of the use of clinical audit to identify and understand issues and drive service improvement and patient outcomes.
• There was no registered manager in post at the time of our inspection. The previous manager had left in May 2016 and the recruitment process for a new manager was underway.