Monitoring questions for independent healthcare single speciality dialysis services

Page last updated: 12 May 2022
Organisations we regulate

During the monitoring call our inspector will focus on these specific key lines of enquiry. You can open the questions to see the type of detail they will be interested in.


S1: How do systems, processes and practices keep people safe and safeguarded from abuse?
  • Are infection risks to people using the service being thoroughly assessed and managed?
  • Have changes been made to the layout/environment of clinical and non-clinical areas to continue to provide services safely in this period? (for example, clean sites, vehicle layout, separate entrances and waiting areas for known/suspected COVID patients, additional signage, spaces between stations, isolation facilities, ensuring compliance with best practice guidance when visiting people in their own homes etc).
  • Does the service have the resources to obtain, and have reliable access to all the supplies, personal protective equipment and COVID-19 testing it needs, for both staff and, where appropriate, people who use the service?  
  • Are working arrangements and procedures clear and accessible to staff, people who use the service, their supporters and, where appropriate, visitors to the service?
  • Are people using the service being protected from abuse, neglect, discrimination, and loss of their human rights?
  • Where applicable, has the service identified when they may be depriving a person of their liberty, and followed the correct and lawful procedures (for example Deprivation of Liberty Safeguards application, Court of Protection)?
  • Are the service’s safeguarding and other policies and practice, together with local systems, properly managing any concerns about abuse and protecting people’s human rights?
S2: How are risks to people assessed, and their safety monitored and managed, so they are supported to stay safe?
  • Are risks to the health and wellbeing of people using the service being properly assessed, monitored and managed?
  • Are there enough suitable staff to provide safe care and treatment in a dignified and respectful way? Are there escalation plans in response to surges in demand (for example, a second wave, seasonal pressures?)
  • How is the service identifying and managing risks for patients including any restrictive practices or issues affecting their legal or human rights?
S3: Do staff have all the information they need to deliver safe care and treatment to people?
  • Does the service have access to and is it following guidelines around Treatment Escalation Plans (TEPs), anticipatory care planning, Do Not Attempt CPR (DNACPR) orders and individualised care plans? Are there plans for rapid transfer to preferred places of care? (for example, relationships and planning with primary medical services, district nursing etc).      
  • the service able to effectively manage referrals and, where relevant, discharges and ensure safe transfers of care? Where relevant, what are the testing arrangements, and how does the service handle transfers of known/suspected COVID patients safely? How is the service working with other partners?   
S4: How does the provider ensure the proper and safe use of medicines, where the service is responsible?
  • Are medicines being managed safely and effectively? Has COVID-19 affected the service’s ability to manage medicines?
S5: What is the track record on safety?
  • Are there any significant trends in non-COVID-19 activity (for example, never events, significant incidents, themes in incidents, mortality, unexpected deaths?) What is the service doing to assess and learn, including mortality reviews of non-COVID patients?
  • Are there any significant trends where groups of patients are doing worse in terms of safety concerns?


E1: Are people's needs assessed and care and treatment delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes?
  • How is the service identifying, cascading and keeping up-to-date with changes in clinical guidance?
  • Where people are subject to the Mental Health Act, how is the service ensuring compliance with the Act?
E2: How are people’s care and treatment outcomes monitored and how do they compare with other similar services?
  • How is the service collecting information about people's care treatment and outcomes? Where relevant, is the service continuing to submit to relevant national clinical audits?
  • How are outcomes being monitored for groups of people that may be at higher risk, such as people in different ethnic groups and older people?
E3: How does the service make sure that staff have the skills, knowledge and experience to deliver effective care, support and treatment?
  • How is the service ensuring that all staff, including those being flexibly re-deployed, have the skills and training to carry out their roles effectively?
E4: How well do staff, teams and services work together within and across organisations to deliver effective care and treatment?
  • How is the service ensuring that the necessary staff, teams, and services are involved in assessing, planning, and delivering people’s care and treatment?
E6: Is consent to care and treatment always sought in line with legislation and guidance?
  • How does the service ensure consent to care and treatment is always sought in line with legislation and guidance? Including, where appropriate:
    • ensuring that people are involved in decisions about not providing care and treatment, including advanced care plans and DNACPR decisions?
    • promoting supportive practice that avoids the need for physical restraint? Where physical restraint may be necessary, how does the service ensure that it is used in a safe, proportionate, and monitored way as part of a wider person-centred support plan?
    • ensuring staff apply relevant legislation where people may lack capacity to consent to particular care and treatment, including the Mental Capacity Act 2005 (including DoLS) and the Children’s Acts 1989 and 2004?


C1: How does the service ensure that people are treated with kindness, respect and compassion, and that they are given emotional support when needed?
  • How has the service adapted how is supports and engages with patients and their families/loved ones?
  • How does the service ensure the care delivered is compassionate and upholds people's human rights?
C2: How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
  • How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
  • Where appropriate, how is the service managing the impact of limited visiting on patients’ wellbeing?
  • Where appropriate, how is the service promoting and ensuring that patients know how to access advocacy support in the absence of ward visits?


R1: How do people receive personalised care that is responsive to their needs?
  • How does the service ensure that it meets the needs of the population served and does it enable flexibility, choice, and continuity of care?
  • Where relevant, do individual patients have choices about how, when and where they are seen?
R2: Do services take account of the particular needs and choices of different people?
  • How are services delivered, made accessible and coordinated to take account of the needs of different people, including those with protected characteristics under the Equality Act and those in vulnerable circumstances? This may include:
    • ensuring that each patient’s information and communication needs are identified, recorded, flagged, shared and met?
    • identifying and making other reasonable adjustments for disabled people?
  • Where new protocols for admission are being used, how are these being communicated to staff and how are they reviewed to ensure they are non-discriminatory?
R3: Can people access care and treatment in a timely way?
  • How is the service managing access to ensure that high-risk patients/pathways are being identified and prioritised appropriately, including re-instating services and handling backlogs of activity?
  • Is there a structured approach to patient flow that ensures all components of the system are appreciated and managed appropriately, and flow issues are escalated appropriately? How does the approach take account of the pandemic?


W1: Is there leadership capacity and capability to deliver high-quality, sustainable care?
  • Has there been any impact on leadership capacity as a result of the COVID-19 crisis? Are there plans and mitigations in place if it is affected?
  • Do leaders understand the challenges to quality and sustainability during this period, and can they identify the actions needed to address them?
W3: Is there a culture of high-quality, sustainable care?
  • Is the service monitoring and protecting the health, safety, and wellbeing of staff?
  • How is the provider taking action to protect the health, safety, and wellbeing of staff, for example, access to emotional support, supporting staff to raise concerns, adequately risk-assessing and placing staff in appropriate environments to protect their health and safety, including staff in different ethnic groups and other staff at high risk of COVID-19?
W4: Are there clear responsibilities, roles and systems of accountability to support good governance and management?
  • Is the service able to work effectively with system partners when care and treatment is being commissioned, shared, or transferred?
W5: Are there clear and effective processes for managing risks, issues and performance?
  • Does the service have effective systems and methods for monitoring the overall quality of the service and for responding to business risks and issues as they arise? How often are these reviewed?