In two centres, clinicians were signing between 30 and 60 permission forms at a time
Serious problems have been uncovered at Marie Stopes International, the provider of a third of UK abortions.
A new 50-page report from the watchdog the Care Quality Commission (CQC) found that there was a lack of oversight and training, potentially putting women at risk.
In August, the CQC’s concerns led Marie Stopes to suspend several services until October, including the provision of abortions to under-18s and vulnerable women.
The new report, presented by Professor Sir Mike Richards, Chief Inspector of Hospitals, found a “lack of oversight” in the signing of permission slips for abortion. The law states that two clinicians must sign the forms, based on their assessment of the woman’s mental and physical condition.
The CQC found that in two centres, clinicians were signing piles of permission slips, of between 30 and 60 at a time. The report added: “We were informed by doctors that HSA1 forms were being signed on the basis of the ‘reason for termination’ information only, which was printed or handwritten on the back of the form. We were not assured clinicians had access to all patient information.”
The CQC were also “concerned” that abortifacient drugs were, in some cases, being handed out without the approval of the two clinicians. Marie Stopes claimed that this only happened in 5% of cases.
Two stories raised particular concern: at one centre, a new treatment was introduced without notifying the patient of the risks. The inspectors also observed a woman with a learning disability being given an abortion: “Consent to treatment for this patient was not carried out in a way they could understand and we observed the situation was poorly and insensitively handled by doctors.”
The report also raised concerns about adherence to basic standards. It found that Marie Stopes were not ensuring that the senior team were competent – a duty required by law. Nearly a fifth of staff lacked up-to-date safeguarding training, and there was “poor” monitoring and risk management over whether patients had given informed consent.
“Staff taking consent from children and young persons were not appropriately trained to explore issues such as female genital mutilation or child sexual exploitation,” the report said.
The CQC have made 14 principal recommendations to Marie Stopes, mainly relating to better oversight and implementation of standards. It said there should be “effective processes” to ensure that permission slips are signed in accordance with the law.
The campaign group Right to Life said that some of the report’s findings were “horrifying”. It applauded the CQC for “uncovering the abuses and failings” of Marie Stopes’s abortion practice, and called for “stronger regulations, transparency, and oversight in abortion practice”.
In a press release, Suzanne Ash, interim managing director at Marie Stopes UK, said: “We have worked hard with the Care Quality Commission to regain compliance and we’re grateful to them for their assistance.
“Since the inspections, we’ve made considerable changes to our management, governance and assurance processes, including extensive training of staff, and updating of policies”.