Renal Services (UK) Ltd - Skegness is managed by Renal Services (UK) Ltd and was established in its current location in May 2011. Previously based in Ingoldmells Lincolnshire the service had outgrown the facilities available at that site.

Renal dialysis was provided on a satellite basis through a service level agreement (SLA) with University Hospitals of Leicester NHS Trust under the clinical supervision of -consultant -nephrologists based at the trust. The unit was nurse led with the patients being assessed for suitability for treatment in a satellite unit by their consultant nephrologist prior to being referred to the unit. All patients receiving renal services at Skegness were NHS funded patients.

There are ten dialysis chairs at the Skegness site offering three - four hourly sessions on three days per week Monday, Wednesday and Friday providing a total regular capacity of 90 dialysis sessions per week. In addition, the unit accepts ‘away from base’ patients who may be visiting or taking a holiday in the area.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 03 May 2017 followed by an unannounced visit on 18 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 areas of good practice:

• Skegness dialysis unit had a positive working relationship with the commissioning trust.

• Treatment and care provided was considered safe and patient focussed.

• Patients were routinely asked their name and date of birth prior to dialysis interventions and administration of medication.

• The unit had a qualified non-medical prescriber, ensuring medication changes were carried out in a timely manner.

• Staffing levels were appropriate to meet the needs of patients. There were no vacancies at the time of the inspection and sickness levels where exceptionally low.

• All staff had equal opportunities for professional and personal development.

• A clinical nurse specialist was implementing reflective practice and action learning across all Renal Services (UK) Ltd promoting shared learning and development.

• Managers provided active support to all staff, were visible and highly respected.

• The service provided care based on current best practice guidelines.

• The unit was promoting sepsis awareness.

• The unit was flexible, meeting patients need for altered dialysis times, whenever possible.

• The unit provided holiday dialysis and had patients return year on year to receive their treatment. Feedback from visiting patients was consistently positive.

• The unit ensured there was always spare equipment, in case of failure, amounting to 20%.

• The unit and patients had a positive experience of the locally commissioned taxi service.

• All the taxi drivers received first aid training, carried a first aid box and had emergency contact numbers.

• The unit was actively involved in a ‘sox off’ programme. Promoting foot health in diabetic patients.

• Patient and staff feedback was consistently positive.

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

• The service should include a clear description of duty of candour within the incident reporting / being open policy. This was completed prior to our unannounced inspection.

• The nominated safeguarding lead should access safeguarding training at level three.

• The service should consider publishing collected workforce relations equality standards data.

Name of signatory

Heidi Smoult

Deputy Chief Inspector of Hospitals