Renal Services - Newcastle is operated by Renal Services (UK) Ltd, an independent healthcare provider. It is commissioned by Newcastle Upon Tyne Hospitals NHS Foundation Trust (NUTH) to provide an outpatient satellite dialysis service to their patients. This is a nurse led service with patients remaining under the clinical management of the renal consultants employed at the trust.

The service is delivered from a purpose built facility situated in Orion business park, North Shields. It is a 10 treatment station unit, comprised of nine stations in the general area and one side room, which can be used for isolation purposes.

The unit provides haemodialysis for stable adult patients with end stage renal disease/failure. The service provides renal dialysis for patients over the age of 18 years.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 28 June 2017, along with an unannounced visit to the service on 11 July 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 when they are provided as a single specialty service. 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 demonstrated a clear understanding of the importance of incident reporting and learning from incidents was shared across the organisation.
• Mandatory training compliance was high and staff received adult and children’s safeguarding training to level two.
• Staff worked flexibly and the rota was planned to ensure safe numbers of staff were available to meet patient need.
• Treatment protocols and policies were based on national guidance including the Renal Association Guidance and National Institute for Health and Care Excellence (NICE) standards.
• The unit monitored clinical outcomes for patients in line with and against the Renal Association Standards and referring trust requirements.
• The provider monitored patient transport collection times following treatment, from January 2017 June 2017 over 90% of patients were collected from the unit within 30 minutes of their treatment finishing.
• There was a comprehensive 26-week ‘novice to competent dialysis nurse practitioner framework’ for registered nurses new to dialysis, which involved theoretical and practical competency assessments and all staff had received an annual appraisal.
• We observed that staff interactions with patients were warm, positive, caring and that staff were always available for patients.
• Patients said there was a good atmosphere on the unit and staff were good at calming people down when they were upset or anxious.
• Patient survey results indicated 93% patient satisfaction for the environment, 91% satisfaction for staff treating them with respect and dignity and 86% for helpful staff.
• There was no waiting list and no treatments had been cancelled for non-clinical reasons from May 2016 to May 2017.
• The clinic had not received any formal complaints from May 2016 to May 2017 and staff and patients told us how informal concerns had been dealt with in a caring and supportive manner.
• Staff were familiar with the organisational mission and values for the service, which was to provide ‘Inspired Patient Care’ through safety, service excellence, responsibility, quality, communication, innovation and people.

• We found that staff morale was good and there was high regard for the unit manager and senior team. Staff told us they were well supported by the unit manager and the senior team.
• We found the clinic manager and the senior team had a desire to learn and to address any issues as soon as practically possible.
• The service invested in devices to improve care and patient experience. For example, the service had purchased three devices, designed to provide Image-Guided Peripheral Intravenous Access.

We found the following issues that the service provider needed to improve:

• Patients did not have direct access to regular and timely dietetic support and regular contact with a renal consultant.
• The unit did not have individualised care plans or personal emergency evacuation plans (PEEP) for all patients. However, patients with mobility problems did have a PEEP in place and the service told us that it had subsequently implemented these for all patients.
• The clinic’s infection control policy did not include comprehensive screening guidance regarding new or holiday patients. However, holiday booking forms did ask for evidence that patients had been screened and were negative for CPE, as well as MRSA and blood borne virus status.
• There was no transport user group for the patients attending the service.
• Not all risks identified during the inspection had been identified and logged on the risk register.
• There had been no medicines audit for several months prior to the inspection and the audit tool in use did not include observation of clinical practice or competence. We did not see evidence of action taken following documentation audits.
• The clinic was not meeting the ‘Accessible Information Standard’ (2016) and the Workforce Race Equality Standard (WRES) (2015) at the time of our inspection, although immediate action was taken following the inspection to address the ‘Accessible Information Standard and understand how the organisation could meet the WRES standard.

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 one requirement notice. Details are at the end of the report.

Professor Edward Baker

Chief Inspector of Hospitals