Abortion service bosses ‘out of touch’ with frontline staff

Bosses at the British Pregnancy Advisory Service (BPAS) have been told to offer staff more support and better manage risks after a leadership review by the Care Quality Commission (CQC).

BPAS provides abortion care on behalf of the NHS on a not-for-profit basis to more than 100,000 women each year, with 49 clinics in England falling under CQC regulation.

Inspectors visited the charity’s administrative headquarters in Warwickshire over two days in February 2023 to review its leadership and governance.

This was sparked by inspections at 12 BPAS locations between April and December last year, which found women were not always receiving care in a timely manner and that systems to safely administer and record medicines were not always in line with national regulations.

In its review, the CQC said some BPAS leaders lacked experience and knowledge and had an ineffective approach when it came to monitoring strategy.

It said some bosses were “out of touch” with frontline staff and the issues they were raising.

When it came to investigating incidents, the CQC said there was a “lack of clinical oversight and engagement” among BPAS leadership and risks and poor performance were “not always dealt with appropriately or quickly enough”.

However, BPAS was praised for its transparency when reporting incidents and its “active role” in researching abortion care.

The regulator has now told BPAS it must better manage clinical and corporate risks and make sure policies and procedures are consistent to support staff to deliver its services.

Carolyn Jenkinson, deputy director of secondary and specialist healthcare at the CQC, said: “We inspected a number of BPAS services last year as part of our planned and risk-based inspection programme. Those inspections found a number of examples of good practice, but in some cases, they also identified concerns.

“We’ve seen positive action in response by local services with steps being taken to act on CQC’s findings and address safety risks that were identified – and we continue to monitor this progress.

“However, that local action must now be supported by action at a corporate level to ensure that senior management and members of the board have true oversight and that robust governance arrangements are in place.

“We shared our immediate feedback from the inspection with senior leaders and they are clear on the governance issues that need to be addressed. We remain in regular contact with BPAS and will monitor the quality and safety of services as they progress their improvement plans.”

A spokesperson for BPAS added: “Over the past three years, we have cared for record numbers of women and are proud to have preserved access during the pandemic through the development of our world-leading telemedical abortion service.

“The pace of change has been intense and the rise in women’s needs has increased the pressure on our organisation. After a period of significant growth at a service level, we are now focused on ensuring that our policies, procedures and structures are fully suited to the size and scale of the charity we have become.

“As highlighted by the CQC in their report, we know we have changes to make to ensure we have clear and effective governance and oversight of our services across the UK – including improving risk escalation processes and involvement from floor to board, ensuring data are better reported and analysed so we can offer continual improvement and meeting structures and cycles reviewed.

“We are looking at all these areas in detail and are working closely with NHS England. We look forward to sharing our progress with the CQC.”

The charity said it will soon publish a strategy and improvement plan for the coming two years.