BPAS is not well-led, reports CQC

BPAS is the largest abortion organisation in the UK, likely to have provided more than 100,000 abortions in 2023 (about 45% of all abortions). BPAS is collaborating with Dame Diana Johnson in her attempt to have abortion decriminalised in England and Wales. It is an organisation that has been struggling in recent years:

• In the five years to March 2022, BPAS made a loss of £4.3 million (income – expenditure)
• In June 2023, the Care Quality Commission (CQC) published a damning report about leadership at BPAS
• From September 2023, the governance structure at BPAS has been under review, no doubt in response to the CQC audit
• In December 2023, BPAS announced that its CEO, Clare Murphy, would be leaving the organisation.

Given its prominent position as the largest abortion provider for the NHS and its continued lobbying for parliamentary changes to the abortion law, it is essential that authorities and regulators ensure that BPAS is held to account and fixes all the faults and failings found by the CQC.

Tweet on X

I tweeted this thread on X on 07 June 2023.

Care Quality Commission (CQC) reports on its review of leadership at the British Pregnancy Advisory Service (BPAS) – https://www.cqc.org.uk/provider/1-116992830

BPAS – not well-led

The CQC has just published its report into the ‘leadership’ at BPAS. Not surprisingly, it found some significant issues.

Setting aside any views on abortion, I’ve been saying for some time that BPAS is a business that’s not well-led. CQC seems to agree.

Patient ‘safety’

In Aug 21, CQC found significant concerns at BPAS facilities. Whilst actions had been taken at some locations, CQC found similar concerns during subsequent inspections throughout 2022 ‘inconsistent governance, oversight, and monitoring to ensure patient safety.’

Strategic ‘leadership’

CQC found the strategic leadership team ‘did not always work cohesively…Not all leaders had the necessary experience, knowledge, capacity, capability to lead effectively…Not all leaders were recruited in line with the fit and proper persons requirements’

Board of Trustees

‘There was a lack of governance and healthy check and challenge at board… minimal evidence of discussion around operational issues and performance amongst senior leaders and trustees… minimal check and challenge in board sub-committees.’

Financial ‘management’

CQC notes its concern that the delivery of quality care and services was put at risk by financial challenges and finance-led decision making. In its annual report BPAS acknowledges the financial loss from its failed Fertility business.

Loss-making business

BPAS has annual income of ~£40 million, 99% paid by the NHS. In the last five years it made a loss of over £4 million. It now serves 95% of its clients by telephone, a business model that the RCOG suggests should yield savings of £1.2m pa.

Lack of governance – ‘core’ to BPAS business:

The correct legal documentation was not always completed before surgical termination of pregnancy.

Systems to safely prescribe, administer and record medicines were not always in line with national regulations and guidance.

‘Safeguarding’

CQC should have noted that because BPAS only ever engages face-to-face with 5% of its clients, it can never be certain that those under 18 are correctly identified and appropriate safeguarding measures applied in a consistent client-centred manner.

Incidents ‘investigation’

CQC reports limited clinical involvement in incident management and found none of the treatment unit managers were from a clinical background – so no assurance they had the training and competence to identify and escalate incidents consistently.

Ectopic pregnancies

CQC was told most incidents reported were not clinical, however, they found 97% of the incidents reported were done so by the clinical operations teams and related to care provided.

Worth noting, given 30% of these (n3020) were either potential or confirmed ectopic pregnancy.

Lack of timely care

CQC reports that in 8 of the 10 locations inspected women did not always receive timely abortion care and treatment in line with national targets, NICE.

CQC found no evidence that the Board or Clinical Governance Committee were demanding actions to comply with required targets.

Notifications

CQC could not be assured there were effective systems and processes in place to ensure all registered managers were aware of the legal duty to submit statutory notifications to CQC. Failure to notify the commission is a criminal offence.

‘No’ freedom to speak up.

The CQC was not assured that BPAS had sufficient processes in place to ensure staff in all registered and satellite locations could raise concerns without fear of reprisal. This is in breach of its NHS contract(s).