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Emergency support framework: discussion questions for independent single speciality dialysis services

Categories:
  • Organisations we regulate

The conversation with your inspector will focus on four areas. The questions are for the inspector to answer, helped by the discussion prompts. This helps us to understand how you are managing currently and whether you need support with anything. Your inspector may not need to cover all the questions as things may already be clear, so you don’t need to spend time preparing for them.

1. Safe care and treatment

1.1 Are infection risks to people using the service being thoroughly assessed and managed?
  • Are you managing to keep up to date with current infection prevention and control (IPC) methods?
  • What challenges have you faced?
  • Have the arrangements been reviewed and amended in response to the challenges you have faced during the pandemic?

Also consider:

  • All dialysis patients have been advised to shield as they are identified as a vulnerable group; how is this fact being taken into consideration?
  • What arrangements are in place to ensure use and compliance with up to date infection prevention and control (IPC) guidance in relation to Covid-19?
  • How are changes in guidance and processes being communicated to staff and is necessary training being provided?
  • Have there been any changes to the configuration of services? Such as a reduction of sessions, or appointments?
1.2 Does the service have the resources to obtain, and reliable access to, all the supplies, personal protective equipment and COVID-19 testing it needs, for both staff and people who use the service?
  • Are you managing to access supplies of PPE and equipment?
    • appropriate standard?
    • sufficient amounts?
  • What assurances are there that staff are sufficiently skilled to use PPE equipment?

Also consider:

  • What arrangements do you have in place to access PPE, and do you know who to contact if you require additional support?
1.3 Is the location’s environment and layout support preventing and containing transmission of infection?
  • Have you identified any risks within your environment in relation to managing COVID-19?
  • How have you managed these risks?

Also consider (where relevant):

  • Have you made any changes to the layout/environment in response to COVID-19? (for example additional signage, waiting areas, separate entrances for patients who do not have COVID19 and for patients known or suspected to have COVID19, spaces between stations etc).
1.4 Are working arrangements and procedures clear and accessible to staff, people who use the service, their supporters, and visitors to the service?
  • Are patients screened and triaged to assess whether they are known or suspected to have Covid-19?

Also consider:

  • Have you considered whether anyone accompanying a patient to the dialysis unit may have COVID -19? how has this been assessed and how have you cohorted the patient/s appropriately?
  • Have you assessed whether dialysis could be delayed until their COVID-19 status is known?
  • How have you reviewed facilities to minimise cross-infection so that patients can be dialysed in cohorts based on their COVID-19 status?
1.5 Are medicines being managed safely and effectively?
  • Has COVID-19 affected your ability to manage medicines?
  • What advice and options have been explored and used to ensure patients receive their medicines safely and securely?

Also consider:

  • Are dialysis patients aware that they may use home delivery services for their medicines?
  • Are those involved in supplying medicines aware that drivers delivering medicines should have received training in the new guidelines, and also how to reduce risk of infection by using gloves and hand gel and keeping a 2-metre distance between the driver, patient and any household members?
  • What steps have been taken to track and take action on incidents related to medicines during the COVID-19 period?
1.6 Are risks to the health and wellbeing of people using the service being properly assessed, monitored and managed?
  • Are there systems in place to manage and review existing risks?
  • What action have you taken in response to new and emerging risks, including but not limited to those pose by COVID-19?

Discussion points:

  • Have there been any significant incidents related to COVID-19? If yes, how is learning from these being identified and shared taking into account the Serious Incident Framework?
  • Are the usual professional guidelines, standards and laws (including equalities, safeguarding, communication and mental capacity) that are ordinarily in place still being applied?

2. Staffing arrangements

2.1 Are there sufficient numbers of suitable staff to provide safe care and treatment in a dignified and respectful way?
  • Has the pandemic affected your ability to staff the service?
  • Have you been able to make sure that people get care and support from staff with the right knowledge and skills?
  • How are you supporting staff to deliver services where there have been significant changes to staffing arrangements?

Also consider:

  • Given dialysis is a specialist area, how have the considerations set out in chapter 9 (workforce capacity reduced) of the NICE NG160 been taken into account? (For example mental well-being of staff, identify staff in the regional network who have experience in dialysis but are not currently working in the area, tailored human resources advice to allow agile and safe staff deployment, fast track DBS where necessary etc.)
2.2 Are there realistic and workable plans for managing staffing levels if the pandemic or other causes lead to shortfalls and emergencies?
  • How has the pandemic affected your ability to staff the service?
  • What has this meant for patients who use your services?
  • What have you done to mitigate any impact on staffing levels?
  • Where do you go to seek support?

Also consider:

  • Have you been able to engage regional networks to enable rapid transfer of staff from one organisation to another to maintain safe levels of care?

3. Protection from abuse and protection of human rights

3.1 Are people using the service being protected from abuse, neglect, discrimination and loss of their human rights?
  • Are people’s human rights being recognised and respected?

Also consider:

  • Have you encountered any issues that may affect the equality, diversity and human rights of your patients? If so, how have you responded?
3.2 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?
  • Have there been any safeguarding incidents and how have you responded to these? Any themes/trends?

Also consider:

  • Have safeguarding arrangements and systems in the provider’s locality remained effective?
  • Have you needed to review safeguarding registers and reviewed communication with other agencies where necessary?

4. Assurance processes, quality monitoring and business risk management

4.1 Is the provider monitoring and protecting the health, safety and wellbeing of staff?
  • How are you supporting and protecting the health and safety of staff during this period?
  • Are staff being adequately risk-assessed and placed in appropriate environments to protect their health and safety, including BAME staff?
  • How are you managing staffing issues such as sickness and caring/childcare responsibilities?
  • What changes have you made to ways of working to support your staff and ensure their safety?

Also consider:

  • What systems are in place to manage the occupational health needs and obligations of staff in relation to infection?
  • Is debriefing being used effectively and, where appropriate, are staff being provided with appropriate access to emotional support, for example counselling?
4.2 Does the provider 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 are you keeping up to date with relevant standards and guidance relating to the delivery of care and treatment? For example transport arrangements for patients being treated as priority
  • How are ‘business as usual’ processes and systems being managed? For example medication reviews, dietary advice.
4.3 Is the provider supporting staff and people who use the service to raise any concerns and give feedback?
  • Have you made any changes to the way staff are able to speak up and raise concerns?
  • Are senior staff visible for advice and support?

Also consider:

  • Are you still able to have team meetings?
  • Have you been supported, and are you able to listen to and support staff?
4.4 Is care and treatment provided to people being properly recorded?
  • Are you experiencing any barriers to sharing or accessing patient information with other providers?
4.5 Is the provider able to work effectively with system partners when care and treatment is being commissioned, shared or transferred?
  • Have you been identified for expanding capacity of NHS dialysis services?
  • How are you working in your area, and sharing information with other services and/or providers?

Also consider:

  • How are you working with external partners and/or stakeholders, including information-sharing? For example commissioners, national bodies, Royal Colleges?

Data indicators we will use to prioritise assessments

Your inspector will use their knowledge of your service and will look at some specific indicators for the data that we hold to help decide what risk you may be facing.

The information we use will evolve as the situation changes, moving from this initial focus on what we know about services from existing data, to a focus on COVID-related priorities and recovery plans.

Data indicators for independent single speciality dialysis services:

  • Time since most recent rating published
  • Never been inspected
  • No registered manager in place
  • New complaints recorded in last 12 months
  • Qualified whistleblower reports received in last 12 months
  • Serious Injury notifications received in last 12 months
  • Unexpected Death notifications received in last 12 months
  • Safeguarding notifications received in last 12 months
  • Police Incident notifications received in last 12 months
  • Events that Stop Service notifications received in last 12 months
  • Abuse or Allegation notifications received in last 12 months.
Last updated:
03 July 2020