Walsall Kidney Treatment Centre is operated by Diaverum UK Limited. It was awarded a 10-year contract from 2017 to 2027 to provide haemodialysis services for adult patients living with chronic kidney failure as part of a partnership agreement with The Royal Wolverhampton NHS Trust.

The service has 32 dialysis stations, including four isolation rooms.

We inspected this service using our comprehensive inspection methodology. This service opened on 26 June 2017 after it had transferred from another provider as the contract with the referring trust had transferred to the current provider. We carried out the announced inspection on 11 July 2017 along with an unannounced visit on 25 July 2017. Therefore, when we conducted our inspections the service was still in the early transitional stages of the contract provision.

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:

• All areas were visibly clean and tidy.

• There was a well-established team who supported one another on a day-to-day basis and in particular during the transition process from the previous service provider.

• Staff and patients told us the clinic manager was very approachable and fair and would be ‘hands on’ if necessary.

• Patients we spoke with were all complimentary about the caring nature of all staff and in particular the clinic manager.

• The IT systems were linked to the referring NHS trust to ensure continuity of care and were regularly updated.

• There were good links with the referring NHS trust and monthly quality assurance meetings took place to discuss any concerns and patient outcomes.

• Staff had a well-established relationship with the referring NHS trust’s renal team as it was the same team as when the service was run by the previous provider.

• Patients told us they felt involved in the decisions about their dialysis treatment and their care.

• Patients could access a translator via the referring NHS trust if required.

• There had been no cancelled treatments due to the transition from another provider since the clinic opened.

• Patients, relatives and staff had been involved in the transition process from the previous dialysis provider.

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

• There was no system for recording or oversight of risk. Therefore, we were not reassured the provider had yet fully assessed and planned for the risks to patients and staff at the new premises.

• Staff had not conducted risk assessments for the majority of patients since moving to the new clinic.

• Not all staff complied with aseptic non-touch technique and infection prevention control practices.

• Three patients did not have a signed consent form for treatment in place since transitioning from the previous provider.

• Staff had not carried out daily checks on the emergency resuscitation trolley each day the centre had been open.

• Some staff told us the training since transferring to the new provider had been unstructured. Staff had not been allocated protected time to complete training. They had to complete it ad hoc and it could be difficult finding the time between caring for patients.

• Staff did not always update patients regarding delays to treatment on the day of treatment.

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 two requirement notices. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals