Three abortion clinics have been put into special measures and served with enforcement notices after the Care Quality Commission gave them all “inadequate” overall ratings, including for safety. Reports on BPAS locations in Merseyside, Doncaster and Middlesbrough highlighted serious concerns around patient safety and consent.

Following unannounced inspections in August, reports for each location state: “…we served an urgent notice of decision to impose conditions on the location’s registration as a service provider in respect of regulated activities. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so.”

If the requirements of the enforcement notices are not met within six months, the abortion clinics could have their registrations cancelled.

The reports detailed women being transferred to emergency care, being forced to travel hundreds of miles mid-procedure, and being given procedures they didn’t consent to. There were reports of women with learning difficulties being given abortions without proper consent.

The damning reports were highlighted by the Society for the Protection of Unborn Children (SPUC). Alithea Williams, Public Policy Manager for SPUC, said: “These reports highlight a shocking lack of care for women by the abortion industry. From women being given procedures they didn’t consent to, to children being inappropriately assessed for surgery – it’s a catalogue of horrors. We welcome the strong enforcement action the CQC is taking, and urge them to act swiftly to protect women.”

Key findings

• In Doncaster, 12 patients were transferred to the local NHS acute trust due to complications between December 2020 to May 2021.

• In Merseyside, Between July 2020 and June 2021, the service transferred six patients in an emergency due to complications or the patient becoming unwell.

• In Middlesbrough, five service users had to travel to another BPAS location in the North West at short notice for a surgical termination of pregnancy

Safety

• “Patients were at risk of harm as the service did not have a standard operating procedure regarding safe movement of patients to different BPAS locations in the event of service disruption.” (Doncaster report)

• “The service did not have a specific paediatric early warning score (PEWS) for use with appropriate children undergoing surgical terminations of pregnancy. This meant that any patients under the age of 16 were being assessed as adults.” (Doncaster report)

• “We saw data which evidenced 10 patients treated during COVID-19 for surgical termination of pregnancy (STOP) had not had pre-assessment scans impacting on incorrect gestation.” (Doncaster report)

•  “Staff did not always identify nor quickly act upon patients at risk of deterioration following a surgical procedure.” (Merseyside report)

• “The service did not always store medicines at safe temperatures and medicines issued for patients to take home were not correctly labelled.” (Middlesbrough report)

• “An incident occurred where the care of five women undergoing surgical abortion was not managed safely. The women were asked to make their own arrangements and travel to another BPAS clinic in the North West within 24 hours of expecting to have their treatment at BPAS Middlesbrough (we saw women travel up to 140 miles by car and four hours by train). The women took preparatory mifepristone at home before travelling to another BPAS location in the North West, putting them at risk of bleeding or aborting their pregnancy during the journey.” (Middlesbrough report)

Safeguarding and consent

• “Staff did not consistently support patients to make informed decisions about their care and treatment. They did not follow national guidance to gain patient’s consent. They did not always show awareness of how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. We saw one example where a patient’s records identified a learning disability, however there was no documented evidence of a mental capacity or best interest assessment being undertaken. This meant there was no evidence the patient had the capacity to provide informed consent.” (Doncaster report)

• “Staff did not consistently identify adults and children at risk of, or suffering, significant harm. We saw one patient where the safeguarding summary in their record stated they had post-traumatic stress following a history of sexual abuse which had not been reported to authorities. This was reviewed with the central safeguarding team who advised there was no statutory requirement to notify as the patient was now over 18.” (Merseyside report)

• “Staff did not consistently support patients to make informed decisions about their care and treatment. They did not follow national guidance to gain patients' consent. They did not always show awareness of how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. Staff did not always gain consent from patients for their care and treatment in line with legislation and guidance. Though staff recorded consent in the patients’ records this was not always clear nor in line with the treatment carried out. We also saw occasions where patients did not receive the procedure they consented for and the change was not documented or the reasons for doing so. One patient signed consent for vacuum aspiration under general anaesthetic, the procedure carried out was dilatation and evacuation as recorded in surgery notes, theatre register, discharge letter and HSA4 form.” (Merseyside report)

• “In another patient record we saw the patient had reported to the provider she was unhappy with her teleconsultation and felt she was not given enough information on her options for treatment between general anaesthetic and conscious sedation or location of procedure to make an informed choice.” (Merseyside report)

• “We saw an example where patient records identified a learning disability, however there was no documented evidence of a mental capacity or best interest assessment being carried out. This meant there was no evidence the patient had the capacity to provide informed consent. Managers told us there was only one member of staff who could carry out a capacity assessment and they did not attend the clinic every day it was open and were not there during our inspection.” (Merseyside report)

• “The way some medicines were prescribed for medical abortion was ‘off label’ or unlicensed. There was no evidence in the notes we reviewed that this had been discussed with women to take account of their preferences and allow them to make informed decisions about their treatment.” (Doncaster and Merseyside reports)