Rochdale Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited and is located within a ward at an acute trust infirmary in Rochdale. The unit is a satellite unit to the renal unit of Salford Royal NHS Foundation Trust located elsewhere in Greater Manchester.

The unit has 14 dialysis stations in the main treatment area and two isolation side rooms. The service provides kidney dialysis for adults from 18 to 65 and adults who are over 65 years of age. There are no services provided to children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 May 2017, along with an unannounced visit to the hospital on 1 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, 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:

• The unit was run with appropriate staff numbers, equipment, medicines and records management, and infection control processes.

• Patients were assessed for risk before during and after treatment and there were processes in place to evacuate patients safely in the event of an emergency.

• Care and treatment at the unit was evidence based and provided in line with the provider’s Nephrocare Standard Good Dialysis Care. There was a comprehensive competency programme in place and staff were competent to provide the care and treatment that the patients required.

• Care was delivered to patients by staff who were caring and compassionate and patients indicated that they were treated with dignity and respect.

• There was a clearly defined management and reporting structure and the clinic and deputy clinic manager had the appropriate skills, knowledge and experience to lead the service effectively.

• There was adequate auditing in place and strategic aims and objectives were measured and benchmarked.

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

• The service does not have a policy or provide training for nursing staff with regards to identification or process for sepsis management. This was not in line with the NICE guideline (NG51) for recognition, diagnosis, or early management of sepsis. (Sepsis is a life-threatening illness caused by the body’s response to an infection). There was no sepsis care pathway in place.

• The unit did not undertake a Workforce Race Equality Standard evaluation in accordance with the NHS standard contract.

• The service needed to reduce the risks associated with language diversity and other protected characteristics.

• There was a new risk register that needed to be embedded within the organisation.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Ellen Armistead

Deputy Chief Inspector of Hospitals