North Ormesby Dialysis Unit

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

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

We assessed 6 quality statements for this key question.

Service users had the best possible outcomes because their needs were assessed. We checked that service users’ care, support and treatment reflected these needs and any protected equality characteristics, ensuring service users were at the centre of their care. Leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service made sure service users’ care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

Staff told us the electronic patient records prompted them to update care plans and risk assessments at every visit. These were available at service users’ bedside, and staff recorded the information immediately.

Staff were able to review the clinical notes from the doctors via the NHS IT systems to ensure continuity of care.

We observed staff asking service users how they were and if they had any concerns.

We looked at 6 care records whilst on site. All care records had evidence of risk assessments at first treatment and then routinely at every visit. Reminders were available in the electronic patient records to determine which assessments were required on the visit. Staff updated care plans at every patient visit. Staff monitored patients whilst in the unit for deterioration using a recognised national warning system, NEWS 2 (National Early Warning Score).

We scored the service as 3. The evidence showed a good standard. The service planned and delivered service users’ care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff were able to describe the process of accessing the medical staff and specialist support staff. Service users were routinely provided with appointments. Staff and leaders described the process of adding service users to appointments to see a specialist outside of these times. Staff could describe how they would contact a specialist at the hospital if they had a question or concern that required a response outside of the specialist visiting times.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Staff told us about the induction they had undergone. Leaders told us the induction was 8 weeks, but they could increase this timeframe for staff who did not feel confident and did not have all competencies assessed and signed off. Mandatory and specialist training was extensive to support the staff caring for service users.

We saw examples of policies stored on the internet which were managed by the central governance team.

Leaders ensured specialist training met the needs of service users using the service and had recently supported a member of the nursing team to undertake their nurse prescribing course.

Staff and leaders were able to describe the audits that were undertaken and how the results are shared.

We observed treatment being provided in a standardised way, as per guidelines, to ensure everything was undertaken safely and correctly.

We saw evidence of quality improvement initiatives from audits, incidents investigation findings, complaints, and service users’ satisfaction surveys.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support service users. They made sure service users only needed to tell their story once by sharing their assessment of needs when service users moved between different services.

Service users told us they were seen by specialist staff from the hospital as required.

Service users told us they arrived for their treatment via the ambulance service, and did not have long to wait for their treatment once they had arrived.

Staff told us service users who use the service attended regularly, which meant they got to know them well.

Leaders told us there was a good working relationship with the local hospital. They were hoping to improve this by appointing a member of staff from the local NHS trust as their new Registered Manager in August 2025.

We observed staff and managers working effectively together in the clinical area. Leaders and staff described regular staff meetings, and a weekly update named ‘Nursing Nuggets’ which covered topics such as anemia, fluid management, managing hypotension and frailty, advance care planning and supportive care. Staff said these were very informative.

Partners told us there was evidence of multidisciplinary working across the services. Leaders provided evidence of this.

Service users were referred to the unit from the local hospital and shared care was provided. Staff on the unit were able to access this electronic patient record as well as their own so they could review these records to avoid duplication.

The electronic patient record was used every time service users attended for treatment; this meant the staff could review this rather than having to ask the patient.

We scored the service as 3. The evidence showed a good standard. The service supported service users to manage their health and wellbeing to maximise their independence, choice, and control. The service supported service users to live healthier lives and where possible, reduced their future needs for care and support.

Service users told us they had access to the dietitian as and when required. There were multiple posters and leaflets/booklets available for service users to read to support healthy living.

Staff and leaders described shared care, which enabled service users to participate in some of their care. However, on the day of our visit, the only shared care we observed was service users logging onto the system and weighing themselves in preparation for their treatment.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored service users' care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of service users themselves.

Staff and leaders were able to describe and show us the electronic software systems and equipment which they used to monitor outcomes whilst service users were undergoing their treatment. This provided a quick response, by alarming, it anything was outside of normal measurements for service users. Each station unit had this equipment available, with 4 spares if there were any breakdowns.

Leaders told us how they monitored service users' care and treatment through audit, benchmarking and outcome and experience measure reports.

Audits undertaken were audit of dialysis records, prescription delivery, machine/equipment logs, infection control audit, hand hygiene audit and vascular access audit.

Blood results monitoring against expected outcomes were benchmarked and shared monthly.

Individual patient performance score data was monitored monthly.

Leaders told us each vascular site infection was reported and investigated as a patient safety event to ensure lessons were learnt. These were all reviewed and discussed at clinical review meetings with action plans produced if required.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The unit had an Informed consent for dialysis treatment policy in place which described the process for ensuing service users consented to their treatment at their first visit. All clinical notes reviewed included good consent documentation.

There was a clear understanding of the requirements of the Mental Capacity Act and staff could demonstrate how they put these into practice.

Staff told us they were provided with training, guidelines, posters, and telephone numbers to support service users who had additional needs. We observed posters in the unit. The unit had a mental capacity document to support with assessment if staff were concerned. We observed these in use in service users’ clinical records.

The staff had access to an interpreting and translation service, if required.