The Hamilton Renal Dialysis Unit has provided dialysis services since 1 June 2010. Fresenius Medical Care acquired this unit in 2011. The service is commissioned by University Hospitals of Leicester NHS trust. A haemodialysis service is provided by the unit through an NHS contract. The contract is a fully managed contract with the building, equipment, consumables and staff all supplied by Fresenius Medical Care.

The dialysis unit is located in north east Leicester and provides dialysis for people in the local area. The service is registered to provide haemodialysis to 19 patients at designated times. The service runs three dialysis sessions a day from 06.00 to 22.30, six days a week with the ability to treat 57 patients a day.

Hamilton Renal Dialysis Unit was selected for a comprehensive inspection as part of Wave one of single speciality inspections of dialysis units. As this was a pilot inspection we did not rate the service.

We carried out an announced inspection of Hamilton Renal Dialysis Unit on 27 July 2015. The inspection team inspected the renal dialysis service.

Our key findings were as follows:

Are services safe at this unit?

• We found systems in place for reporting incidents at the unit. Staff knew how to report incidents and were encouraged to do so by their managers.
• Staff monitored patients before, during, and after dialysis to minimise risks to individual patients.
• Nursing staffing was managed effectively to give appropriate care to patients.
• All patient areas were visibly clean; infection prevention and control processes were in place and equipment had been checked regularly.
• Medicines were stored and administered safely.

Are services effective at this unit?

• Evidence based care and treatment was delivered to patients, which followed national guidance.
• Clinical staff had completed mandatory training and most had received annual appraisals.
• We found an audit programme in place for 2015, which included audits of medical records, medicines management, infection prevention and control and the effectiveness of dialysis treatment.

Are services caring at this service?

• We saw care delivered which was very responsive to patient’s needs.
• Patients were treated with respect and dignity.

Are services responsive at this service?

• We saw a service delivered that was very responsive to patients’ needs. The opening hours catered for patients to complete their treatment after work and at weekends.
• The unit had measures in place to support patients’ differing needs such as interpreters and information in languages other than English.
• We saw evidence of the service responding to patient complaints.

Are services well led at this service?

• The leadership and governance at the unit promoted delivery of high quality care. Members of the management team were well respected amongst both staff and patients.
• There was a shared vision throughout the unit of providing excellent patient care.
• Staff felt valued and an ethos of teamwork was apparent.

We saw several areas of outstanding practice including:

• The data provided to compare services and the effectiveness of services demonstrated thorough analysis of dialysis treatment.
• The provision of extended opening hours catered for patient’s individual needs and gave greater flexibility for treatment.

However, there were also areas of poor practice where the provider needs to make improvements.

In addition the provider should:

• Consider a formal identification process for all patients prior to commencing treatment.
• Should consider a local risk register with reference to concerns that the managers highlighted during the inspection.
• Ensure all bank and agency staff have time set aside for orientation and induction prior to starting a shift and caring for patients.

Professor Sir Mike Richards

Chief Inspector of Hospitals

People told us they were satisfied with the care and treatment provided at the service. One person said: “It’s a very good service and one that I need.” Another person said: “My English is not very good but they (the staff) make it easy for me to understand and explain all to me.” People were involved and informed about their treatment and were confident that medical support was available if needed. Treatment plans were in place and people’s health was monitored.

The service was fully equipped for staff to provide the care and treatment safely. Additional dialysis equipment including the medical emergency equipment and hoists, were available. All equipment was serviced and maintained.

People were supported by staff recruited who were suitable and qualified. Appropriate checks were carried out on all staff. Staff received training to carry out their job role and were trained to use all the equipment. Qualified nurses trained to use the medical emergency equipment. Staff training and support had improved and steps were being taken ensure training records were accurate.

People had opportunities to make a comment or complaint about the service. Information about how to make a complaint was available to people including the contact details for support or advocacy services. People said they were confident to raise concerns with the manager. One person said: “I know I can speak with the manager or anyone of the nurses here if there was a problem.”

People using the service told us they were satisfied with the care and treatment they received. They said “When I come in, I collect my card and I weigh myself. Once my bed is ready, usually within this bay staff will come and sort me out” and “it’s like going to work 3 days a week but instead of getting paid we refreshed.”

People were involved, informed and made decisions about their care and treatment. We saw staff treated people with respect and maintained their privacy and dignity.

All areas of the service were clean and tidy. The provision of protective personal clothing and clinical waste management systems ensured measures were in place to protect people from the risk of infection. Private rooms were available for people with known or suspected infections, or were they had other personal needs for privacy.

Staff received induction training to deliver care and treatment safely. Improvements were needed to ensure staff maintained their skills and knowledge through regular training, support and supervision.

The provider had an effective quality assurance system, which monitored the day to day running of the service. These included audits and checks on the delivery of care and treatment, clinical management, environmental audits including waste management and health and safety.

Hamilton Renal Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. Fresenius Medical Care Renal Services Ltd. is a subsidiary of Fresenius Medical Care SE and is responsible for the operation and management of dialysis centers in the UK and Ireland, in partnership with NHS trusts and purchaser groups.

The building is situated in a business park in Leicester, which was converted and opened in July 2010 as an independent unit providing haemodialysis.

The main referring unit is University Hospitals of Leicester NHS Trust. The unit primarily serves the communities of Leicester and Leicestershire. It also accepts patient referrals from outside this area.

The hospital has had a registered manager in post since January 2016.

The service was last inspected in June 2015 as a pilot inspection using the new methodology.