Impact Statement & Annual Review 2019-2020

We lead the We Trust Women campaign to secure the decriminalisation of abortion across the UK. In June 2019 we advocated for a parliamentary bill to remove abortion from the criminal law in Northern Ireland, briefing MPs and ensuring our supporters made their voices heard. Abortion was decriminalised in Northern Ireland in October 2019, and we established a temporary Pills by Post service to support women while services were not yet available at home.

The establishment of the NI service meant we were well placed to extend this framework to the rest of the UK when COVID-19 struck in March. We successfully advocated for the Secretary of State for Health and Social Care to approve the use of the first medication for early abortion, mifepristone, at home, to eliminate the need to access a clinic during a public health emergency. We drew on our extensive network of stakeholders and allies to campaign alongside us to secure this essential framework that we knew would protect women’s health during the pandemic. We then played a key role with colleague from the Royal College of Obstetricians & Gynaecologists in developing the clinical guidance to support implementation.

We were part of the NICE abortion guideline group on evidence-based care and also made headway with our campaign to introduce buffer zones around clinics, with a zone introduced outside one of our largest centres. We successfully campaigned for the removal of a non scientific ‘fertility drip’ from sale across the UK and for a Clinical Commissioning Group to drop its refusal to provide funded care to single women on the non-evidence based assertion that their parenting would be poorer. We also secured a commitment from the Department of Health and Social Care to investigate issues accessing effective pain relief during childbirth, with widespread media coverage. We continued to press for the fortification of flour with folic acid to reduce the incidence of neural tube defects, for the reclassification of Emergency Hormonal Contraception so it can be sold directly from the shelf, and to protect women from further screening and regulation of their choices by non evidence based policies to reduce the incidence of Fetal Alcohol Spectrum Disorder (FASD)

We established the Centre for Reproductive Research and Communication (CRRC), a collaboration uniting our clinical and social sciences work to bring a woman-centred perspective to issues across the reproductive life course. Our Wellcome Trust funded WRISK project aimed at improving women’s experience of risk communication reached thousands of women, and our findings have started informing discussion and practice.

Through our research collaboration and student supervision, we have strengthened relationships with academic partners including Imperial College London; LSHTM; Lancaster University; Cardiff University, University of Chicago, Illinois; University of California, Irvine; and the University of Kent. We are co-hosting a PhD student from the University of Kent for the duration of their studies. Our research underpins both our advocacy and our service delivery, and aims to drive improvements in abortion and related care in the wider context.

A variety of different initiatives were investigated and implemented to address this objective. During this year we achieved significant progress towards consistently achieving national targets for access to later surgical abortion. This work will continue into 2020-21.

Developed a new BPAS aftercare service to meet the needs of service users and the organisation. We designed and implemented a new in-house aftercare service which provides a seamless service to our clients staffed by nurses and other staff dedicated to the aftercare service.

• A variety of activities for this objective began during the year. We engaged with staff, other internal and external stakeholders.
• We developed a demonstration project of early medical abortion without routine ultrasound scan which was on target to begin in May.
• During March 2020 we escalated implementation of the ‘Scan as indicated’ project as a necessary response to the COVID-19 pandemic.

We recruited a Director of Embryology, Dr Marta Jansa Perez who joined BPAS to lead the development and implementation of BPAS Fertility Services due for launch in early 2021.

We have been advocating for reclassification of emergency contraception and looking to develop other BPAS branded medicines alongside other items such as branded pregnancy tests.

98% of the services we provide on behalf of the NHS through arrangements with 271 commissioning organisations. We were awarded the sole contract for NHS Black Country which provides care to approximately 6,000 service users each year.

• BPAS provided 39% of all abortions undertaken in England and Wales during calendar year 2019, an increase of 4%.
• We performed 52% of all NHS funded abortions in England & Wales during calendar year 2019, an increase of 4%.
• We delivered 29,906 contraception services.
• We performed 86,757 sexually transmitted infection tests.

Our Digital Strategy and subsequent implementation of its work streams has been one of our biggest investments during 2019-20. Below is a highlight of some of the successes achieved.

• Updated all out of date hardware, upgraded to Windows 10 across our whole network and implemented a secure server estate.
• Sourced updated solution for technical storage.
• Sourced an implemented mobile working solutions including desk to desk video.
• Upgraded our Mitel telephony system.
• Implemented an IT Service Desk solution with unique ticketing and a central register of incidents and service requests.
• Created and appointed a new post of Digital Training Manager to support the Digital Change Programme.
• Launched a new, refreshed intranet.
• Appointed a specialised cyber security company to monitor our infrastructure 24/7 and to provide specialist and immediate advice and support in the event of a major cyber incident. This represents a significant improvement in our cyber defences.
• The speedy deployment of equipment to enable large numbers of BPAS staff to work from home in response to the COVID-19 lockdown using secure IT solutions.

This enterprise system build has been designed as an electronic patient record (EPR) to replace paper patients notes at BPAS. The implementation of this system will provide streamlined, standardised business and clinical processes across our organisation. This system will also provide robust governance of patient data. Much of the design, develop and build work has been completed for implementation of this year ready for test and implementation during 2020-21.

• We reviewed our existing training recording system to ensure timely and accurate reporting to managers
  and the organisation.
• Redesigned the Learning & Development Department and recruited an interim Learning & Development
  Lead to develop training strategy for implementation during next financial year.

Funding is received through fees charged for abortion and other sexual health services provided to NHS and individual paying clients.

The net expenditure for the year amounted to £495,000 (2018/19 - £151,000 net income). Total income was £39,237,000, representing a 14.1% increase over 2018/19 (£34,383,000). This was achieved through an increase in fee income of 13.4%, an increase in grant income £284,000 and stable investment income. Operating costs (Total Resources Expended) were £39,721,000 (2018/19 - £34,222,000), an increase of 16.0% on a like-for-like basis. This increase was due to significant further investment in service delivery, people, unit equipment and infrastructure.

Net cash provided by operating activities was an inflow of £1,219,000 compared to £935,000 in the prior year. This cash inflow together with the proceeds from the sale of Fixed Assets of £13,000 contributed to capital expenditure totalling £1,866,000. 

Total funds £14,482,000 (2018/19 - £14,311,000) increased as a result of a net deficit of £495,000 (2018/19 - surplus £161,000), a loss on the sale of Fixed Assets £11,000 (2018/19 - £6,000) and a gain on revaluation of properties £667,000 (2018/19 - £155,000).

The Board’s objective is to generate modest surpluses in order to facilitate investment in the infrastructure of the Charity, and to develop and then maintain sufficient General Reserves to mitigate cash flow risks and seasonality in the profile of income. The Trustees monitor the level of reserves, and at the year-end consider that the current level of General Reserves is more than adequate to mitigate cash flows and seasonality of income. £2,182,000 is held in General Reserve (2019 - £2,437,000) and £Nil in Restricted Reserves (2019 £Nil).

The remaining reserves (Revaluation and Designated Reserves) total £12,300,000 (2019 - £11,874,000). The BPAS Board previously adopted a policy to designate reserves equal to the historic value of Fixed Assets used for the provisions of the Charity’s services. During 2019/20 the BPAS Board reviewed the Reserves Policy in accordance with current Charity Commission guidance to a risk based policy enabling the organisation to safely reduce designated reserves in order to invest in solutions recommended in the Strategic Risk Register.

The Trustees have considered the major risks to which the Charity is exposed, in particular those related to operations and finances of the Charity, and believe there are adequate systems in place to manage the exposure to major risks. These risks include:

• credit and liquidity risk, which is mitigated by payment being received in advance for services in some cases, as well as having an agreed bank overdraft facility;
• an unstable economic climate and the drive down of costs in the NHS, together with competitive pressure, which is mitigated by continually reviewing service delivery and implementing and delivering efficiency savings across the service;
• and changes in the law relating to abortion, which is mitigated by working with and educating the policy makers.

The Trustees’ Risk Assessment Document is updated regularly and was last updated in 2019/20.