We observed care being received by people when undertaking dialysis. People were seen to be treated with respect, their consent to treatment sought appropriately and their clinical needs met. Patient surveys suggested a high degree of satisfaction with the service. On the day of our inspection, most people undertaking treatment were resting or reading. We did speak briefly with two people receiving dialysis. Both people expressed their satisfaction over their care and the quality of the service. One person noted that the unit "did its best to involve us." The other person told us they had expressed an interest in the proposed "shared care" programme where people were trained to carry out many of the functions of dialysis themselves with minimum intervention from nursing staff. The manager told us that this programme, which was used in other dialysis units was being introduced into the Grimsby NHS Dialysis Unit.

The clinical areas were clean, tidy and there were systems in place to lower the risk of spread of infection. Staff were appropriately trained, supervised and supported and we saw evidence of a programme of auditing and monitoring of clinical practice and records.

As part of our inspection we talked with a number of patients. They spoke positively about the staff and care provided and told us that staff treated them with respect. Everyone we spoke with felt they were involved in their care and in making decisions about their treatment. We received comments such as “I like it here”, “The staff are fantastic” and “You build up a family bond here”.

Everyone we spoke with felt they had received sufficient information about their treatment and we received comments such as “You get good information”. Patients told us that staff attend to them promptly when they need assistance and respond to any questions they may have. We asked patients if staff maintained their dignity and privacy and they confirmed that they did.

Patients told us that they get sufficient support at home and are able to contact the unit or their GP if they have any concerns.

Grimsby NHS dialysis unit is operated by Fresenius Medical Care Limited (FMC), an independent healthcare provider. The unit has 12 stations (comprised of ten stations in the main area and two side rooms which can be used for isolation purposes) providing haemodialysis for stable patients with end stage renal disease/failure. It is contracted by Hull and East Yorkshire Hospitals NHS Trust, to provide renal dialysis to NHS patients. Patients are referred to the unit from Hull and East Yorkshire Hospital Trusts Renal Service.

The service is situated as a ‘standalone’ dialysis unit on the site of the Diana Princess of Wales NHS hospital. There are plans to increase to 18 stations later this year. The service commenced in 2008 and does not treat children at the unit.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 5 May 2017, along with an unannounced visit to the unit on 22 May 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? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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 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 issues that the service provider needs to improve;

• We saw ‘missed opportunities’ within incident investigation documentation including escalation of the deteriorating patient and lessons learnt were not consistently collated.
• Patient identification policies and processes were not in place in accordance with national guidelines and Nursing and Midwifery Council (NMC) standards in relation to medicines management.
• The unit appeared untidy, with litter and bins reaching full to capacity.
• Initial assessments lacked detail and care plans were not developed to support the care and treatment of patients with specific health needs.
• There was no clear system to ensure staff could consistently identify and manage deteriorating patients, which included sepsis identification.
• One of the water treatment plants had not been serviced according to the manufacturer’s instruction and documentation to mitigate against this was not available on the unit.
• The unit was not meeting the ‘Accessible Information Standard’ (2016) or the Workforce Race Equality Standard (WRES) (2015) at the time of our inspection.
• Staff training compliance was lower than the provider’s internal target in several areas and the unit staff had not received training in accordance with the intercollegiate guidance document "Safeguarding Children and Young People" (2014).

However, we found the following areas of good practice:

• Staff were clearly able to describe the incident reporting system and were able to provide examples of incidents and how to report them. Staff understood the classification of incidents as clinical, non-clinical and Treatment Variance Reports (TVR’s).
• We observed staff working with competence and confidence in the unit. Nursing staff were experienced and qualified in renal dialysis. We saw 100% of staff had received induction and appraisal and four staff were completing a renal qualification.
• We observed a caring and compassionate approach taken by the nursing staff and named nurses during inspection.
• We observed that consent processes were in place and documentation was accurate. Easy access to complex patient information in the unit and across the trust supported treatment and care of patients in the unit.
• Performance indicators for 2016/17 showed comparable performance against other Fresenius units nationally.
• The unit was able to provide haemodiafiltration 100% of the time during the last three months reviewed prior to inspection.
• Patients were supported with self-care opportunities and a comprehensive patient education process was in place. Holiday dialysis for patients was arranged to provide continuity of treatment and support the wellbeing of patients.
• Morale at the unit was high and staff spoke positively about the support they received from the clinic manager.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices that affected dialysis. Details are at the end of the report.

Ellen Armistead​

Deputy Chief Inspector of Hospitals (North region)