Bridgwater Satellite Dialysis Unit

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This is the first assessment for this service. This key question has been rated good.

This meant people’s needs were met through good organisation and delivery.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Care was planned so patients’ needs and preferences were respected with access to link nurses for support and advice where required.

Clinical nurse specialists provided onsite clinics for specific conditions. Clinics included haemodialysis, vascular access care and infection prevention control and was available for patients within the unit or for outpatient appointments.

We observed one patient receiving dialysis in a side room, this was at their request.

Patients were able to participate in shared care. Shared care is a way of delivering dialysis treatment where patients are actively involved in their own care. Some patients undertook shared care tasks such as weighing themselves, machine set-up and adjusting goal on the machine.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

There were strong links with the referring NHS trust. Managers alerted them to any vacant slots the service had so these could be filled. Patient preferences were noted, then days and times were adjusted at a later stage if a patient preferred slot became available. Admission criteria were set out, so all patients could access the services. At the time of inspection, there were no patients waiting to start dialysis at the service.

The service reserved and accepted patient holiday spaces all year round. There was a patient expected the week after our inspection for twilight sessions.

The referring NHS trust was not the local trust. Whilst there were clear pathways for patients to be transferred to the local NHS trust if they became unwell.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. However, the unit did not always meet the accessible information standard.

Patients could get information and advice that was accurate and up to date. There was a range of leaflets in the waiting area which included information about support services such as foot care, fatigue, mental health support as well as patient support groups and information on diet and eating out for renal patients.

The provider website had information about renal failure and the treatment of renal failure, including dialysis. This gave patients an insight into what to expect when commencing dialysis and the impact it would have on their and their family’s lives.

Staff gave people clear information about their care and treatment needed to support their health. Specialist support from dietitians was available for all patients as per national guidance. Dietitians from the referring trust attended the service to see patients on a monthly basis, they assessed dietary needs and provided advice and guidance on renal diets.

Staff made notifications to external bodies as needed. The service had information governance systems which kept patient records confidential.

Relatives were informed if patients had been taken to hospital.

There was a Fresenius Accessible Information Policy which stated information communication needs would be identified at the point of referral and met. However, the service had completed a disability access audit which demonstrated a lack of compliance with the Accessible Information Standard in the care environment. We saw evidence the information intended for patients to take away was not available in Braille or audio tape. British sign language was not available and there was no induction loop for hearing aid users.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Patients knew how to complain and raise concerns. There had been 2 complaints in the last 12 months. These had not been referred to the Ombudsman (the complaints Ombudsman is an independent service that investigates unresolved disputes). Patients said they were able to raise issues with staff members and these concerns were addressed by staff. We saw evidence that when patients complained or raised concerns, they received feedback.

Patient and staff surveys were carried out by the service, and the feedback was used to improve services. For example, after patients repeatedly raised concerns about transport delays, leaders met with the provider to address the issue. The transport company had plans to assign a dedicated transport liaison officer to oversee and improve the service.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

The service provided renal dialysis to meet the needs people in the local population who required renal dialysis. Staff worked with the NHS renal service to accommodate patients from the local area for dialysis.

The service had aids to support patients with accessibility challenges. There were accessible toilets and the service was wheelchair accessible. Staff made reasonable adjustments for patients. For example, people with mobility issues were provided with wheelchairs. There was level access to the building which was all on one floor. Patients had emergency call bells to use if help was required and there was ample parking for people using the services.

We did not see evidence staff completed training about supporting people with dementia. At the time of our inspection the service was not supporting any patients with dementia. However, the unit was expecting a patient with dementia and were making adjustments to the environment to suit the needs of the patient.

We scored the service as 2. The evidence showed some shortfalls. Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

However, we did not see evidence the provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff were aware of patients’ resuscitation orders and held a log which listed the patient’s decision.

Support for complex patients including symptom management and end of life care was initiated at the unit. Staff would speak with the renal consultant and obtain consent to refer the patient to renal supportive care nurses at the NHS trust. Discussions would be held with the renal support care nurses, the patient, family, GP and renal consultant and would include other healthcare professionals if required.