Bassetlaw Dialysis Unit is under the management of Fresenius Medical Renal Services Ltd and is commissioned by Doncaster and Bassetlaw Hospitals NHS Foundation Trust to provide haemodialysis for patients with advanced chronic kidney disease who reside within the trust’s geographical area. The unit also undertakes haemodialysis for patients who are visiting the area. Haemodialysis is a blood filtration process, used when kidneys are unable to perform this function.

Bassetlaw dialysis unit is a standalone purpose built facility set in the grounds of a district general hospital. This hospital is not linked to the unit; all patient referrals are from the commissioning trust.

The unit has 20 dialysis stations including two single rooms providing haemodialysis to patients over six days per week (Monday to Saturday), averaging 700 dialysis sessions per month. There are two sessions, morning and afternoon on Monday, Wednesday and Friday with morning only sessions on Tuesdays, Thursdays and Saturdays.

The unit includes a reception area, two consultation rooms, offices, storage rooms, water plant, and kitchen and staff facilities.

The unit is primarily nurse led with clinical supervision by a consultant nephrologist, who attends the unit six times per month.

We inspected this service using our comprehensive inspection methodology. An announced visit took place on 19 June 2017 followed by an unannounced visit to the hospital on 27 June 2017. To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate renal dialysis services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• Staff knew how to report incidents and treatment variances.
• The unit appeared clean with evidence of infection control practices in place.
• Equipment was serviced and fit for purpose.
• Staff understood their responsibilities around safeguarding.
• Staff were up to date with mandatory training requirements.
• Medicines were administered in line with national guidelines and the nurse and midwifery council code of professional practice.
• Staff carried out patient risk assessments throughout dialysis treatment.
• Staff followed evidence based treatment and best practice guidance.
• All staff had been appraised within the previous twelve months.
• The service monitored patient outcomes and provided data to the commissioning trust.
• Bassetlaw Dialysis Unit figures were submitted to the Renal Registry by the commissioning trust.
• Mental Capacity Act (2005) and Deprivation of Liberty Safeguards training was included in staff induction.
• New starters were supernumerary and supported to integrate into the team.
• Patients were reviewed by a multidisciplinary team.
• Staff demonstrated compassion to patients and family members.
• Transport services were commissioned by Fresenius.

Summary of findings

However, we also found the following issues that the service provider needs to improve:

• New staff experienced delays in accessing information technology log-ins.
• Staff on the unit were not able to describe the Fresenius local unit vision.
• Patients did not feel informed about some changes taking place on the unit.
• There was not a local sepsis management plan.

All the above concerns were being addressed and an action plan was in place at the time of our unannounced visit.

Heidi Smoult

Deputy Chief Inspector of Hospitals