Norfolk Dialysis provides treatment for people who are either on holiday or in the area for a short period of time. We looked at how plans for the delivery of such treatments had been developed. Records showed that the actions taken by staff were supported and directed by multi agency information for the continued health and comfort of the person receiving treatment.

At this inspection all areas of the service were clean and tidy. We found that the routines and systems in place supported the health and wellbeing of people. Documentation also evidenced that regular checks were in completed to again support the health of people using the service.

Records showed that servicing of equipment was up to date and all areas such as electrical items and the dialysis units being used were safe and fit for purpose. The premises were clean, orderly and well maintained with a tranquil environment that supported the comfort of people who had to undergo dialysis.

People we spoke with told us they were very happy with the services provided by Norfolk Dialysis. One person we spoke with told us, "The treatment I receive is first class". Records examined demonstrated to us that people were always asked to provide consent before treatment took place.

One person we spoke with told us that they felt involved in their own care and that they felt confident to discuss their treatment needs at any time. We saw that people were involved in making decisions about the nature of the treatment they received.

There were effective infection control and clinical waste management systems in place to protect people who use the service. People were cared for in a clean, hygienic environment.

Staff providing care and treatment were suitably qualified and experienced.

Records were seen to be accurate, detailed and they were stored safely.

Norfolk Dialysis is operated by Norfolk Dialysis Limited. Services are commissioned by NHS England. The service has two renal dialysis stations and offers short-term holiday dialysis for patients aged 18 years and over. The service does not offer regular, long-term dialysis services.

The service is open all year round and patients book their holiday dialysis in advance, with sessions available from Monday to Saturday. Morning and afternoon dialysis sessions are provided, with twilight sessions available on request.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 23 May 2017 and an unannounced inspection on 05 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? 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 areas of good practice:

• Clinical areas were visibly clean and there were established processes in place for the cleaning and maintenance of equipment.

• There were clear criteria for admission to minimise the risks of patients with more complex needs being treated at the service.

• There were clear processes in place for ensuring that patients accepted for holiday dialysis had been appropriately screened for infections such as Methicillin-resistant Staphylococcus aureus (MRSA) and blood borne viruses.

• Staff were up to date with mandatory training, including basic life support, Mental Capacity Act (MCA) 2005 and safeguarding adults training (level two).

• Dialysis sets were single use and CE marked and checked by staff to be intact and within sterility date. This was in line with Renal Association Haemodialysis Guidelines (2009).  

• Staff kept delivery notes with batch numbers for consumable items of dialysis equipment. This meant that if there were any problems identified with consumable items, staff could contact the manufacturer and refer to the batch number.

• Staff kept detailed records of care. We reviewed four patient records and found that all were signed, dated and legible.

• Patients received one to one nursing care. This was better than the nurse to patient ratio outlined within the Renal Workforce Planning Group guidance (2002) of one nurse to four patients.

• Policies and standard operating procedures were up to date and based on national guidance.

• Staff completed relevant local audits, for example audit of patient booking forms and prescription charts and identified recommendations for improving practice.

• Staff communicated with each patient’s local dialysis unit to make sure they had all the relevant information about the patient’s care, whilst adhering to data protection requirements.

• Staff obtained written consent to treatment from patients before starting their first session of dialysis treatment. We reviewed six patient consent forms and found that all six were signed, dated and correctly completed.

• Feedback from patients about the service was consistently positive. An audit of patient satisfaction surveys for 2015 to 2016 showed positive results, with 100% of patients saying they would recommend the service.

• Patients were encouraged to self-manage aspects of their care if they wished to do so. Staff told us how they would be flexible to patients’ needs and preferences, for example by offering flexibility in the timing of dialysis sessions, so that patients could enjoy their holiday.

• Staff offered patients support and reassurance while they were away from home. For example, the clinic manager told us they were available as a point of contact for patients outside the hours of their dialysis sessions.

• There was a clear complaints procedure, which was outlined in the complaints policy and shared with patients via a patient information leaflet. The service had not received any complaints from May 2016 to May 2017.

• No dialysis sessions were cancelled or delayed for non-clinical reasons from May 2016 to May 2017. An audit of patient satisfaction surveys for the period 2015 to 2016 showed that 100% of patients were satisfied with their dialysis times.

• There were clear objectives for the service, which were shared by the clinic manager and the deputy manager.

• Staff were experienced in renal dialysis. The clinic manager held the certificate in renal nursing.

• Staff were open in their approach to discussing the service and told us they were confident to challenge each other.

• There was external oversight of the service through yearly meetings with NHS England to review policies and ensure that quality standards were being met.

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

• Staff at the dialysis unit did not oversee or directly check resuscitation equipment because this was owned and maintained by the health centre where the dialysis unit was located. This meant that staff could not be assured that equipment was easily accessible and fit for use in the event of an emergency.

Staff completed competencies at a local NHS unit where they were separately employed. However, we were not assured that these competencies related specifically to Norfolk Dialysis or had been signed off in relation to the work staff carried out at this service.

• Translation services were not provided. Staff told us they used relatives to translate, which is not best practice.

• Staff had regular informal meetings to discuss the service, but did not keep records of these meetings. Staff did not keep a risk register to record and monitor risks to the service.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals