Great Bridge Kidney Treatment Centre

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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

We looked for evidence that people had good outcomes because their needs were assessed and their care, support and treatment reflected these needs, including any protected equality characteristics. We also reviewed how leaders promoted a culture of continuous improvement and the use of best practice.

At our last assessment we rated this key question as good. At this assessment, the rating has remained the same. This demonstrated that people continued to experience consistently good outcomes, supported by positive feedback.

We have not awarded this service a score for Effective.

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

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

Staff were observed interacting with patients and their families and demonstrated an understanding of individual needs and had developed familiar relationships with patients, who also appeared to know staff well.

Patients’ protected characteristics were identified and recorded at the point of referral and reconfirmed at each appointment. Protected characteristics of parents and carers were also recorded where relevant.

During the inspection, 10 patient records were reviewed. Records contained clear evidence of completed health assessments and patient observations. All documentation was clearly written and completed to ensure the service met the care and treatment of patients.

Care plans were informed by patients’ assessed needs and were adapted where required to reflect changes in clinical condition or individual preferences. This had been observed whilst we were on site, where a patient required support to attend the local NHS trust due to their health deteriorating whilst receiving their treatment.

The service used a Learning Disability and Autism Inpatient Flowchart and Supporting Checklist to ensure staff met individual patient care and treatment needs in line with NHS trust standards.

The service had implemented a new pathway to support vulnerable patients receiving haemodialysis. This pathway aimed to ensure that patients requiring additional support were identified and received care tailored to their individual needs while undergoing treatment.

Patients were involved in the assessment of their needs, with their views and preferences taken into account when planning and reviewing care and treatment.

The evidence showed a good standard. The service planned and delivered people’s 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.

Systems and processes were in place to support staff to follow up-to-date policies and procedures, enabling the delivery of care and treatment in line with evidence-based practice and national guidance, these were in data and reviewed when required.

The service introduced a sepsis pathway to support timely antibiotic administration for haemodialysis patients. However, governance arrangements were unclear. There was limited evidence that the pathway, including pre-prescribed antibiotics, had been formally approved or overseen by relevant committees

During the inspection, it was observed that staff took time to engage with patients, discussing their care and treatment and monitoring their health and wellbeing.

The service demonstrated effective working relationships with the local NHS trust. Processes were in place to ensure that all relevant referral information was obtained and reviewed prior to patients commencing treatment.

Arrangements were in place to work collaboratively with other dialysis units. Where appropriate, patients were transferred to alternative locations closer to their home to improve accessibility to treatment.

Patients had access to refreshments, including drinks and snacks, which were made available in response to individual needs and preferences.

Clinical oversight was provided by consultants from the NHS trust, reflecting that care and treatment were delivered on behalf of the trust. Patients were also able to access dietetic support, with a dietician attending the service on designated days and providing patient consultations.

Staff were subject to appraisal processes, and records demonstrated oversight of performance to ensure staff were meeting the required standards to deliver safe care and treatment.

The clinical manager described processes for managing staff performance. This included identifying where standards had not been maintained and providing feedback and guidance to support improvement.

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

During the inspection, staff were observed working effectively as a team, supporting one another while maintaining a clear focus on meeting patients’ needs. Feedback from staff members indicated that they felt supported by managers, the general manager, and clinical leads.

During the morning handover, staff engaged in effective communication to ensure patients’ preferences were understood and maintained, supporting an individualised approach to care. The clinical manager provided updates on service developments, including environmental improvements and equipment, reviewed staffing levels, and highlighted outstanding training requirements. Daily tasks were allocated and reviewed, and staff were reminded of sustainability practices, including recycling.

The service worked closely with the local NHS trust, which was the main source of patient referrals. This supported continuity of care and ensured that patients’ needs were appropriately assessed and managed across services.

The service worked closely with the local ambulance service and raised concerns on behalf of the patients when they were late for appointments or late to be collected after their appointment had finished.

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

Staff were observed providing patients with health information and advice tailored to their individual needs. Information was available within the reception area, including resources relating to vulnerable adults and contact details for external support services such as safeguarding teams, police, domestic abuse services, mental health organisations, and women’s health services.

Information was displayed for patients regarding the identification and management of fistula, which is an abnormal tunnel or passage that forms between two parts of the body that are not normally connected, or graft bleeds, including guidance on recognising symptoms, immediate actions to take, and how to seek help and support. There was also information relating to dialysis support and kidney support charities.

The evidence showed a good standard. The service routinely monitored people’s 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 people themselves.

A review of national falls data demonstrated improved outcomes, with a 15% reduction in falls incidents from 42 to 37 in the past year, despite increased clinical activity. No serious injuries or RIDDOR incidents were reported.

Actions including standardised risk assessments, strengthened reporting processes, staff training, environmental checks and regular governance review which is a check that happens often to make sure things are being run properly, and contributed to these outcomes. As a result, there was improved identification and management of risks, enhanced staff awareness and reporting, and safer care delivery for patients.

Routine blood monitoring and vaccination programmes were in place and subject to monthly review. These processes supported timely identification of patient needs and enabled care and treatment to be reviewed with consultants. As a result, treatment plans were adjusted where required, contributing to effective clinical management and improved patient outcomes.

Audit activity for vascular access, National Early Warning Score monitoring, central venous catheter line connection and dialysis treatment supported the ongoing monitoring of clinical outcomes.

Findings were reviewed to identify trends and areas for improvement, enabling changes in practice where required. This contributed to improved oversight of patient outcomes and supported continuous improvement in the quality and effectiveness of care provided.

Staff demonstrated an appropriate understanding of the recognition and management of deteriorating patients. Processes were in place to ensure that changes in patients’ health were identified and responded to in a timely way. As a result, patients received care and treatment which was responsive to their clinical needs, supporting safe management and improved health outcomes.

Policies and protocols were in place covering key aspects of dialysis treatment, including the use of concentrates, water treatment systems, management of chemical and microbiological contaminants, and the type and frequency of dialysis. These supported staff to deliver care in line with recognised clinical standards and enabled ongoing monitoring of treatment effectiveness and patient outcomes.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Records reviewed for 2 patients who required a capacity assessment demonstrated that these had been clearly documented in line with the Consent to Care and Treatment with statutory requirements or expected standard. Assessments were completed and signed by an appropriate individual with legally authorised representation, ensuring that decisions were made in accordance with relevant legislation and best practice.

Staff were observed involving patients and their families or carers in decisions about care and treatment. Staff demonstrated an understanding of the importance of respecting patients’ wishes, feelings, culture, and personal history when planning and delivering care.

There was clear documentation in patients’ records to demonstrate that consent had been obtained annually. However, all records reviewed did not include the full name and professional role of the staff member completing the documentation. This may limit assurance regarding the accountability and traceability of consent processes.