The Care Quality Commission (CQC) has published the reports of its inspections of Marie Stopes International from earlier this year.
The concerns identified by the quality regulator from these inspections led to Marie Stopes International suspending specific types of termination between 19 August and 7 October 2016, while it worked with CQC to address these concerns.
These restrictions were:
- Suspensions of all termination of pregnancies for under-18s and vulnerable groups of women
- Suspensions of all surgical terminations under general anaesthetic or conscious sedation
- Suspensions of all surgical terminations at its Norwich centre.
CQC issued four warning notices to Marie Stopes International, in response to regulatory breaches around 'consent', 'safeguarding', 'care and treatment' and 'governance', as well as a number of 'requirement notices', to support improvement.
While these restrictions were in place, NHS England set up a helpline and identified alternative providers, including NHS trusts and the British Pregnancy Advisory Service, to ensure there were no gaps in care during this period.
Marie Stopes International recommenced its restricted services during October 2016, once it had reassured CQC that it had addressed the most serious concerns. This included Marie Stopes International carrying out staff training in key areas such as resuscitation and consent and strengthening its governance arrangements.
The twelve reports published today (Tuesday 20 December) summarise CQC's findings from its inspections of ten of Marie Stopes International's registered locations in England, its call centre and its UK administrative offices between April and August 2016.
CQC continues to monitor the progress of Marie Stopes International and it plans to inspect its centres and UK administrative offices again in the near future to ensure that ongoing improvements are made and maintained.
Professor Edward Baker, deputy chief inspector of hospitals at the Care Quality Commission, said:
"Our inspections of Marie Stopes International from earlier this year identified a number of serious concerns, which were recognised in its temporary suspension of specific types of termination in August.
"On the ground, we found that feedback from patients was positive across Marie Stopes International's centres and its staff provided a non-judgmental service and treated patients with dignity and respect.
"However, our concerns at a corporate level – particularly around governance arrangements, staff training, and around patient safety and safeguarding protocols – did not give us the necessary assurance that patients would be protected from avoidable harm at all times, that possible safeguarding concerns could be identified and that incidents could be reported and learned from.
"At all times, our priority has been – and continues to be – to ensure that patients undergoing or seeking advice about terminations from Marie Stopes International get safe, high-quality and compassionate care.
"While we recognise that Marie Stopes International has made progress since our inspections, we will continue to monitor its services very closely and our planned re-inspections will determine exactly how embedded these improvements have been.
"We will not hesitate to take further action, if necessary in order to guarantee this provider meets the standard of care we expect and that its patients deserve."
During CQC's inspection of Marie Stopes International's UK administrative offices, CQC identified concerns, including:
- Limited clinical oversight: This included a vacancy for the head of nursing and a consultant in gynaecology and obstetrics (who would review policies and oversee medical staff) who was only contracted for eight hours a week. Also, while the professional registration of its clinical staff was checked at employment, Marie Stopes International could not demonstrate that this was checked on an ongoing basis.
- Poor risk management and monitoring arrangements: This included around patient consent and safeguarding, around the completion and submission of HSA1 and HSA4 forms (in which professionals state the grounds for the abortion and the formal notification that one has been performed), and around the reporting of incidents.
- Gaps in training: This included in staff being appropriately trained to explore issues such as female genital mutilation and child sexual exploitation, around making sure vulnerable patients had a good understanding of procedures, a lack of assurance around staff training and competence in conscious sedation and general anaesthesia.
During CQC's inspection of Marie Stopes International's Norwich site, where all surgical terminations were then suspended for those three months, CQC found that patients were positive about the care they received and felt it was individually-centred. Also, staff were observed to be helpful, caring and treated patients with dignity and respect. However, CQC found that:
- There were no effective systems to monitor and manage risk to patients, staff did not have 'level three' safeguarding training (which covers child protection and signs of abuse), infection control audit results were poor, and systems to maintain equipment were ineffective.
- Staff were found to be completing the World Health Organisation's 'Five Steps to Safer Surgery' checklist in writing but not verbally too, as expected. This could have put patients at risk of avoidable mistakes being made.
- Patient flow through the centre was compromised at times. There were periods of extended waiting times due to the lack of recovery space causing theatre backlogs.
- Clinicians were reportedly bulk-signing HSA1 forms, which meant that they did not necessarily have access to all relevant information or sufficient time to review it before authorising a termination. Also, there was no process in place for ensuring HSA4 forms were submitted to the Department of Health within the legal timeframe of 14 days.
CQC found elements of good practice across the registered centres it inspected. For example, in Marie Stopes International's call centre, CQC found that:
- Staff were aware of how to report incidents and staffing was appropriate to the needs of patients calling the centre.
- Records were clear and concise and care was based on national guidance.
- Staff put the patient at the centre of their care, providing a compassionate and non-judgemental service.
- Calls were answered in a timely manner and redirected, as necessary.
The full details of CQC's findings are in the twelve inspection reports.
Marie Stopes International performs around 70,000 abortions (both medical and surgical) a year, which represents around a third of the procedures performed across England.
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