2014/15

BPAS has almost 50 years of experience providing help to women with an unwanted pregnancy. 1 in 3 women will have an abortion by the time they are 45 years old. Every year at BPAS we help thousands of women in this position. As well as non-directive and impartial counselling for unplanned pregnancy and abortion treatment we also provide emergency contraception (such as the ‘morning after pill’), free pregnancy testing, STI testing, a full range of contraception options and vasectomy services.
We have nearly 60 centres across England, Wales and Scotland and during the year helped almost 70,000 patients of all ages. A small number of patients fund their own treatment, but 96% of the women that come to
BPAS don’t have to pay for their abortion treatment as it is funded through over 160 contracts that BPAS holds nationally with the NHS for the provision of services.
Procedures by provider
BPAS
NHS other independent providers
(Abortion numbers 2014, UK residents: 184,571)
Feedback received from patients overwhelmlingly states how caring, non-judgemental
and experienced our staff are, especially in this very specialised aspect of healthcare.
Coventry client
2014
I just wanted to thank you for all the little things you did to support me. You were
2 professional and I felt you didn’t judge me.
London client
2014

Patient satisfaction is already very high (average 9.5/10), but BPAS constantly strives for improvement in the delivery of its reproductive healthcare services and has a number of innovations planned that will benefit patients, particularly where access to services is difficult.
Some comments from BPAS patients can be found here: www.bpas.org/about-our-charity/performance/client-feedback-women
Planned improvements during 2015/16 will result in easier access to local appointments, even less waiting time in units, fewer visits to units for treatment and offer additional treatment options.
Patients expressed high levels of satisfaction with respect for their privacy, the information and advice they received and the standard of nursing care. In addition, over 97% of patients were satisfied or very satisfied with the cleanliness of the clinic and managers are encouraged to make this important aspect of service provision a priority.
Patients very satisfied with:
Satisfaction with how well we respected patients’ privacy
Satisfaction with the advice received
Satisfaction with the standard of nursing care
0% 20% 40% 60% 80% 100%
2014
2013
2012
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During the year, there was a small increase in the number of patients that expressed some concern over waiting times (10% in 2014). Nevertheless, 87% of those that expressed a view felt the waiting time to consultation was acceptable and 89% felt the waiting time to treatment was acceptable. Despite this, BPAS believes that this figure can be improved and has conducted a review of patient pathways to introduce innovative steps that will ensure waiting times are improved in 2015.
On average in 2014, patients waited 6.6 calendar days for a consultation and 6.5 calendar days for treatment.
At the time of booking, treatment appointments were available within 3.4 calendar days on average and patients chose to wait longer in order to have treatment at a more convenient time or location.
Escort or partner involvement is something that has been raised as an area for potential improvement and BPAS is examining options for improving this in 2015.
Wait from Consultation to
Treatment
Wait to Consultation
Patient concerns:
Escort/partner involvement
0% 20% 40%
2014
2013
2012
60% 80% 100%
We know that clinic location is a challenge for some patients even though 90% of our respondents are satisfied with this aspect of our service. Consequently, we will be opening a further 10 new local centres during 2015.
A new question was introduced into the client feedback form in 2015 to establish the number of surveyed clients that would recommend BPAS to someone they know who needed similar care. Between January and
April 2015, 99% of 10,162 respondents would recommend us. This compares favourably with the NHS average of 65%.
4

BPAS undertakes research and draws on international best practice to ensure it is able to provide clinically robust, evidence-based services. In addition to their usual induction, specialised training programmes are provided for all doctors and nurses at BPAS and this education is maintained through Continuing Professional
Development.
BPAS monitors clinical incidents, near misses, complications, never events and ‘not at BPAS’ events through the incident and complication reporting system. BPAS has a Client Safety Incidents Policy and Procedure in place describing the monitoring and reporting process. Rates of incidents and complications are presented at the
Regional Quality and Improvement Forum (RQUAIF) and to our Clinical Governance Committee.
Serious incidents requiring investigation have a root cause analysis investigation undertaken, with the findings and recommendations shared and embedded throughout the organisation at all levels.
During 2014 there were 308 incidents (5.1 per thousand), compared to 295 (5.0 per thousand) in 2013 and
327 (5.9 per thousand) in 2012. 38% of the incidents in 2014 were classed as ‘minor.’ Of the remainder,
53% were classed as clinical incidents and 36% related to point of care tests or laboratory testing.
Of these, 21 were classified as Serious Incidents Requiring Investigation (1 per 3,000 treatments), compared to
22 in 2013. Although this rate of incidents is low, the following actions have been identified:
• The Client Safety Incident Forms were revised in 2014. The provision of feedback and management actions
arising from any Serious Incident Requiring Investigation (SIRI) learning points is being provided in a more
timely manner and within the specified time frame.
• The procedure for reporting and recording lab sampling errors was revised in 2014 to improve on reporting
rates and ensure management action is undertaken. Lab sampling errors will remain a priority issue for clinical
governance.
• The new Policy and Procedure for Perioperative Procedures was issued in 2014. Two surgical safety checklists
are available at BPAS; one to be used for surgical Termination of Pregnancy (TOP) and one for
all other procedures.
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BPAS maintains comprehensive policies and procedures that are available to all staff through our intranet.
These are subject to regular scrutiny to ensure compliance with best practice and they are regularly reviewed by the relevant sub committees of the Board. During the year 68 policies and procedures were updated, representing 45% of all policies and procedures.
All treatment pathways are audited annually; infection control audits and record keeping audits are undertaken monthly. Audit findings are monitored by (RQUAIF) which is a sub-committee of the clinical governance committee. BPAS employees a Clinical Audit and Effectiveness Manager who coordinates clinical audits at BPAS and undertakes treatment and infection control audits for internal assurance purposes.
During 2014 there were no incidents of C.difficile infection at BPAS.
BPAS operates robust Governance arrangements for safeguarding, supported by a full range of policies and procedures that have been communicated to all relevant staff. This is supported by appropriate training.
BPAS undertakes an annual audit of arrangements for safeguarding and promoting the welfare of children and vulnerable adults. During 2014, the 47 criteria tested were all assessed as meeting the standards fully with all processes in place and up to date. Within the year 539 safeguarding cases were identified and reviewed with 51% requiring further external advice.
51% of our centres achieved ‘You’re Welcome’ status and BPAS as an organisation is compliant with the new
‘Young People Friendly’ standard. The average satisfaction score for BPAS services provided to under 18s was 9.4.
Of this group 98% were satisfied or very satisfied with BPAS for the welcome they received, the advice provided, the standard of nursing care and how well we respected their privacy.
6

BPAS is a company limited by guarantee (No.01803160) and a Registered Charity (No. 289145). As such, we are subject to audit by BDO LLP. In an independent analysis of the UK’s 154 largest Care Quality - Health & Social
Care companies, BPAS was rated as the highest rating ‘Strong’. It submits audited annual financial statements to
Companies House and an annual return and accounts to the Charity Commission. BPAS is also regulated by the
Care Quality Commission (CQC), which regularly visits registered treatment units in England and the Healthcare
Inspectorate in Wales. BPAS operates under licenses for healthcare provision from Monitor and for abortion services from the Department of Health. No serious concerns have been raised by any auditors or regulators.
Observations from CQC Inspections in the last 3 years:
• An issue about cleaning at the Bournemouth unit was raised in November 2013, which has been addressed.
• Issues around the local risk register and rapid dissemination of incident investigations were raised at the
Richmond unit in August 2014. These have been addressed.
Remuneration
Committee
Finance &
General Purposes
Committee
Board of
Trustees
Clinical
Governance
Committee
Infection Control
Committee
Regional Quality
Assessment and
Improvement
Forum
Research &
Ethics Committee
BPAS governance chart
BPAS governance is overseen by 12 Trustees that have been selected for their particular skills and receive induction on appointment. This Board of Trustees forms four sub Committees; ‘Clinical Governance,’ ‘Finance and General Purposes,’ ‘Research and Ethics’ and ‘Remuneration’. There is also an Information Governance
Committee. Day-to-day management of the organisation is undertaken by the Executive Leadership Team (ELT), headed by our Chief Executive Ann Furedi and supported by Directors of Strategy, Finance, Operations,
Organisation Development, External Affairs and a Medical Director. This is an experienced and stable team that is well versed with improving quality and managing change within the organisation.
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We have 621 staff (387 FTE). All staff receive induction training on arrival at BPAS and in addition, receive appropriate, specialist training relevant to their role; such as pregnancy options advice, abortion treatment options, scanning, contraception and sexual health. BPAS also runs a programme of training for NHS doctors and medical students in this specialised area of healthcare.
Staff turnover and sickness absence are generally below industry averages and the workforce is well motivated and has good morale. Staff turnover is 13.9% (2013; 15.2%). The average number of days of sickness absence per employee is 7.4 (2013; 6.7), which compares to 9.8 in not for profit care services and 9.7 in the health sector.
The latest staff survey showed that 92% of staff members are proud to work for BPAS and 86% recommend it as a good place to work. BPAS monitors Personal Development Reviews to ensure that they are regularly undertaken for all staff.
Chief Executive
Director of
Organisational
Development
Director of
Finance &
Corporate
Services
Director of Strategy
HR, Training
& Internal Comms
Department
Accounts
& Payroll
Departments
Director of
Business
Development
& Department
Director of
External Affairs
Press &
Public Policy
Department
Marketing
Department
IT Support
Client
Information
Department
Property
Services
Department
Information
Governance &
Special Governance
Medical
Director
Research
Director of Nursing
Operations
3 x Directors of Operations
Regional Clinical
Leads
Clinical
Department
& Client
Engagement
Manager
65 BPAS
Clinics Nationwide
Contact Centre
BPAS organisational chart
8

We produce comprehensive patient information that is available through the website and provided to patients. This information covers all aspects of the services provided. In addition, social marketing campaigns are undertaken through a variety of media, including email and radio, to make patients aware of how to access abortion treatment and other related healthcare issues, such as how to access emergency contraception, more effective forms of contraception and how to access STI tests. During 2014, all existing patient publications were updated and three new publications produced, covering; Fetal Anomaly, Miscarriage Management and a Guide to STIs.
In 2015 the new website was launched, which built on the lessons learned from the previous site. This drew on an analysis of search pathways through the site and feedback from patients. There are significant improvements in its design and access to key information.
9

BPAS has completed the NHS IGSOC Toolkit to level 12 with a score of 80%. There is an Information
Governance Committee (IGC) that meets regularly and is chaired by the Senior Information Risk Officer (SIRO).
A risk register is maintained and a reporting system is in place for IG incidents. These are reviewed by the IGC and ELT to ensure appropriate action has been taken. During 2014/15 there were no incidents classed as level 2 or higher using the NHS reporting levels. Sensitive electronic data is stored in a Category 4 facility and regular penetration of BPAS systems is undertaken to ensure protection of this information.
Patients are encouraged to complain if they are not satisfied with any aspect of the service. All complaints are thoroughly investigated and acted upon. During the year 64 complaints were received (1 per 1,000 treatments).
The main areas of complaint resulted from ‘retained products of conception,’ a known complication of abortion,
‘other clinical complications’ and ‘dissatisfaction with the way in which they were treated by staff’. There were
60 complaints in 2012 and 53 in 2013.
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The NHS has outlined some mandatory reporting requirements for the services that BPAS provides. The following NHS indicators are relevant to the provision of services at BPAS:
Responsiveness to the personal needs of patients during the reporting period – Client Satisfaction
Score 8, 9 or 10 out of 10.
100%
Satisfaction – 8, 9 or 10 out of 10
50%
0%
2012/13
90.8%
2012 2013
2013/14
95.2%
2014
2014/15
95.9% Overall Client Satisfaction
Responsiveness to the personal needs of patients during the reporting period – Client Dissatisfaction
Score less than 6 out of 10.
10%
Dissatisfaction – less than 6 out of 10
5%
0%
2012/13
2.4%
60
2012 2013
2013/14
1.2%
53
2014
2014/15
0.9%
64
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Overall Client Dissatisfaction
Complaints

All patients are encouraged to complete a Feedback Form and over 50% take the opportunity to let us know how we have done across a range of areas relating to their care. This information is reviewed by the Executive
Leadership Team, Clinical Governance Committee and the Board to identify whether the process is robust and to consider potential areas for improvement in the service.
BPAS is committed to a programme of continuous improvement and the following steps are being taken to improve the service in 2015/16:
• Waiting times are to be reduced
• More local units to be opened
• Pathways reviewed to minimise waiting times in units.
• New systems introduced to support these patient pathways.
• New clinical regimen to reduce the number of visits needed to units
• A new website to improve the experience of clients accessing information by mobile devices
• Use of the telephone to gather information, where possible, rather than requiring women to travel.
2012/13
N/A
2013/14
N/A
2014/15
99% % that would recommend BPAS
This figure is taken from a survey of patients and based on 10,162 responses from January to April 2015. This is the first year in which this question has been included in the survey.
The percentage of patients who were admitted to hospital and who were risk assessed for venous thromboembolism during the reporting period:
2012/13
100%
2013/14
100%
2014/15
100% % risk assessed
It is mandatory that all clients undergoing treatment at BPAS have a VTE risk assessment completed. This is audited in the annual programme of treatment audits.
12

2012/13
NIL
2013/14
NIL
2014/15
NIL Per 100,000
C.difficile reports are monitored monthly by the BPAS Director of Infection prevention and Control. Rates of
C.difficile at BPAS are reported through the voluntary reporting system at Public Health England on a monthly basis. This has remained at zero for the last 3 years.
Complications
2012/13
No %
2861 1.6
2013/14
No %
2890 1.5
2014/15
No %
2758 1.3
Complications
10%
8%
6%
4%
2%
0%
Surgical ToP
Medical ToP
2012
0.7
3.2
2013
0.7
2.9
2014
0.7
2.3
The main complication reported is ‘continuing pregnancy due to failure of the medication to work’
(this constitutes 90% of medical complications). This is in-line with comparative data and the clinical pathway anticipates this. Robust follow up and further treatment provided where necessary. The overall rate of complications remains very low.
13

Clinical incidents
2012/13 2013/14
No % No %
327
20
NIL
0.59
0.04
295
22
NIL
0.5
0.04
2014/15
No %
308
21
NIL
0.51
0.04
Reported
Serious Incident Requiring Investigation
Deaths
The rate of clinical incidents remains very low. 38% of the incidents in 2014 were classed as ‘minor.’ Of the remainder, 53% were classed as clinical incidents and 36% related to point of care tests or laboratory testing.
There were no reported patient safety incidents that resulted in death in any of the reporting years.
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The Board of Trustees of BPAS has produced this Report as a first step towards producing Quality Accounts.
It covers the key elements of a Quality Account that are relevant to our services and should provide a helpful overview of the quality of our services to a potential patient. We are accountable for ensuring the accuracy of the information contained within this Report and to the best of our knowledge, this information is accurate and a fair representation of the quality of healthcare services provided by BPAS. During 2015/16 we will work with our key stakeholders to further develop this report and ensure that it meets their needs.
We are proud of our staff and the quality of the services that they provide.
Cathy Warwick
Chair of the Board of Trustees
Ann Furedi
Chief Executive Officer
For further information, please contact: info@bpas.org
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Head Office: 20 Timothys Bridge Road, Stratford Enterprise Park,
Stratford-upon-Avon CV37 9BF.
T: 0345 365 50 50 or +44 (0)1789 508 211
Registered Charity 289145 as British Pregnancy Advisory Service
BPAS is registered and regulated by the Care Quality Commission
PRI-DEC-150
Issue 1
June 2015