Bodmin Dialysis Unit

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This service was previously inspected but not rated in 2017. This key question at this inspection has been rated requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Staff were not fully engaged with the vision of the service and the

service did not always have clear responsibilities, roles, systems of accountability or good governance. However, the service valued diversity in their workforce and worked on an inclusive and fair culture for both patients and staff members. The service understood their duty to collaborate and work in partnership.

The service was in breach of legal regulation in relation to good governance. We have requested an action plan upon publication of the final report.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a clear vision for the service. However, staff were not fully engaged with the vision and did not feel the senior leadership had communicated a vision of the future that motivated staff. This was an area highlighted for improvement in staff survey results for 2024.

At our site visit, we observed a culture that was patient focused but not innovative. The service cared for its patients but staff felt unable to suggest ideas for improvement or believed that they wouldn’t be listened to. Staff we spoke with did not feel supported by the senior leadership team. Some staff told us concerns they had raised around the management of the unit had not been addressed and feedback had not been provided.

Staff knew and understood the providers values and how they applied in the work of their team. We saw a values board which had values such as putting patients first, prioritising safety and delivering exceptional care.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively,

Nurses at the unit knew who the senior management team were and stated they were at the unit from time to time. Staff did not feel supported by the clinic manager or the senior management team.

Staff told us there was no structured approach to handling issues with the day to day running of the unit as they arose. They felt the unit lacked clarity and direction from the registered manager.

The service had policies and procedures for staff to encourage a positive culture where people feel they can speak up and that their voice would be heard. However, staff we spoke with did not feel confident to use these resources.

The service had a dedicated freedom to speak up guardian to support staff in raising concerns. Staff were aware of the guardian. However, none of the staff we spoke with had used this service to raise a concern. As mentioned under “Shared direction and culture”, staff felt the leadership team would not listen to their concerns or ideas.

There were policies around whistleblowing and staff were signposted to an independent whistleblowing charity.

The service valued diversity in their workforce. They work towards an inclusive and fair cultureby improving equality and equity for staff.

Staff received training in equality, diversity and human rights. Staff survey results were positive for the indicator, ‘I am treated with respect at work and I can be myself’ and ‘people from diverse backgrounds can succeed at our company’.

Staff we spoke with spoke positively about career opportunities at the provider.

The service had a Workforce Race Equality Standard (WRES) report for 2020/ 2021. It is a reporting requirement for independent healthcare providers who are commissioned by NHS services to produce an annual report. The WRES reports on how organisations are addressing race equality issues in a range of staffing areas. This had been added to the providers risk register in August 2024.

The service did not always have clearly set out role responsibilities, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes.

Staff were not always clear about which policies the service was following. Both Fresenius and the local NHS trust had sets of policies to follow. This led to some confusion amongst staff about which was the relevant policy to follow. For example we were not assured all staff knew patients with diabetes who were receiving dialysis should have their blood sugars monitored pre and post dialysis. On the day of inspection we saw one patient, who was taking insulin for diabetes, who only had their blood sugars monitored pre dialysis and not post dialysis, which was not in line with Joint British Diabetes Societies guidelines, ‘Management of adults with diabetes on dialysis’ (2023).

The service had governance processes and policies which followed best practice. However, there was a lack of assurance and oversight of these being followed consistently. For example, logs recording weekly deep cleans of machine and dialysis chair areas had significant gaps, which indicated this process was not always carried out.

The service did not act on feedback from relevant persons and other persons provided for the purposes of continually evaluating and improving the service. For example, patients had delays in being connected and disconnected from their dialysis stations. Despite this feedback the service hadn’t acted on this information to introduce staggered start and finish times for patients. One patient said they had tried to provide feedback to the unit manager and had been ignored and not given the time to explain his concerns.

The service had a risk register, which highlighted risks to the service and any controls in place to mitigate them. The unit had 85 risks recorded. The last risk to be added to the register was in August 2024 which was the requirement for Fresenius to report under the NHS workforce Race Equality standard. As mentioned in ‘Workforce, equality, diversity and inclusion’, the last WRES report was from 2021.

There was an emergency preparedness plan which gave details for who to contact in the event of an emergency. We saw the service regularly monitored key aspects of patient care and reported these back to the local trust.

The service had regular meetings with partnership organisations to ensure the regular flow of information between services. We reviewed minutes from these meetings. There was a quality assurance meeting which was effectively the multi-disciplinary meeting where patient care was discussed and a local trust and Bodmin governance meeting where the provision of the renal service across cornwall was discussed.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement.

There was regular collaboration between the unit and the local trust, which was reinforced by structured meetings.

The service also collaborated with the local patient transport company to help ensure those patients that required transportation had a timely service. There were some issues with the patient transport company however the service kept a log of these to raise with the provider at regular intervals.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. Staff were not always given the time and support to develop opportunities for improvement and innovation. We asked the service for information about innovative practice and did not receive any information on this subject.