Great Bridge Kidney Treatment Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found a positive culture within the service, with staff reporting good morale and feeling able to raise concerns. People were protected from harm, and managers maintained effective oversight of incidents, which were investigated appropriately with learning identified. The environment was clean, well maintained, and met the needs of people. Medicines were stored correctly and monitored well Staff received training and appraisals to support the delivery of safe care, and processes were in place to protect people’s rights in line with relevant legislation. However, some mandatory training had not been completed.

The service could not demonstrate effective oversight or assurance that medicines were optimised in line with antimicrobial guidance.

We identified for safeguarding that all clinical staff were not trained to safeguarding level 3. This is not in line with national guidance. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

We have not awarded this service a score for Safe.

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

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff described a clear focus on ensuring patients received high-quality care and treatment. We observed effective teamwork within the service.

Staff demonstrated a good understanding of duty of candour. They were aware of the requirement to be open, honest and transparent with patients if incidents occurred in relation to their care and treatment.

Staff understood incident reporting processes, including when incidents should be reported. Managers provided feedback on incidents and shared any identified learning with staff.

The service provided incident data from January to April 2026, during which, 200 incidents were reported. The information recorded for each incident included the patient identification number, details of the incident, the level of harm identified, and the actions taken. It was also clearly indicated whether incidents met the threshold for classification as a serious incident. This demonstrated a structured recording and oversight of incidents, supporting effective monitoring, learning, and governance within the service. However, while individual incidents demonstrated appropriate risk management and clinical decision-making, there was limited evidence of a systematic approach to identifying patterns of risk and embedding learning across the service to prevent recurrence.

There were several recurring themes in incidents. A high volume of incidents related to non-attendance for dialysis, often associated with hospital admissions, intercurrent illness, which is where a patient gets another illness when they already receiving treatment for an illness, transport issues, or personal circumstances. Transport and adverse weather conditions were also identified as contributing factors to missed or shortened treatment sessions. A number of incidents involved acute clinical deterioration during dialysis, including chest pain, shortness of breath and hypotension, which required escalation to emergency services and transfer to hospital. There were also recurring themes relating to early termination or reduction of dialysis sessions due to patient choice, clinical need or late arrival. Vascular access complications and circuit clotting were also identified, as well as cases involving suspected infection and sepsis, where appropriate escalation and treatment pathways were followed. Additional incidents included falls and injuries prior to attendance and a small number of events involving distressed or challenging behaviour. Actions taken included clinical intervention, stopping treatment where required, contacting emergency services, informing the renal team, and communicating with next of kin.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked with healthcare partners to establish and maintain systems of care to support patient safety. Referral and admission processes ensured that relevant information was obtained to determine whether patients’ needs could be safely met. Staff ensured there was continuity of care when patients moved between services, supported by regular engagement with the local NHS trust. Clear pathways were in place for escalation and transfer when required.

The service worked collaboratively with the local NHS trust. Between January and March 2026, 338 patients referred from the trust were seen. The service provided 4012 treatments for the months of January, February and March 2026. Regular meetings were held between the service and the NHS trust to support ongoing engagement and coordination.

When speaking with staff, concerns were raised regarding access to the system where staff accessed clinical guidelines and policies, staff reported they were required to use 2 separate systems, 1 for the service and 1 for the NHS trust, to access relevant information. This meant there was a risk that staff may not always be able to access the most up-to-date or relevant guidance in a timely way, which could impact consistency in practice. However, staff were trained in how to access both systems and described taking steps to ensure they followed the appropriate guidance. This feedback was shared with managers during inspection feedback.

The service monitored patients accessing care away from their usual residence. Arrangements, including referral processes, supported continuity of care for patients on holiday. These ensured patients could safely access and maintain treatment when away from their usual provider. Clear processes were in place to maintain safety for patients returning from high-risk countries.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately. However, all clinical staff were not trained in safeguarding level 3, which is not in line with national guidance.

Staff demonstrated a good understanding of safeguarding and were able to describe how to raise concerns where required. Staff were knowledgeable about safeguarding policies and described following relevant national guidance to support the protection of patients from harm.

Staff completed safeguarding children training at levels 1 and 2, with a compliance rate of 100%. Although the service did not treat patients under the age of 18, staff described occasions where children attended the service with adults. A policy was in place which required children to remain in the waiting area and not enter clinical areas.

The service did have a safeguarding lead within the organisation, and their contact details was clearly displayed in the reception area.

Staff completed safeguarding adults training at levels 1 and 2, with a compliance rate of 100%. The service provided evidence that 4 members of staff from approximately 24 staff members had completed safeguarding adults level 3 training; however, 2 of these staff were not based at the service. This was not fully aligned with the intercollegiate document, which outlined minimum safeguarding training levels required for registered healthcare staff who had regular contact with patients, families, or the public. This limited assurance the service had that all staff based at the service had the appropriate level of training to recognise and respond to safeguarding concerns.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and consent to treatment. Staff had completed training in line with this legislation, with a compliance rate of 100%. This supported staff to obtain and document valid consent in accordance with the Mental Capacity Act 2005 and associated guidance, including the principles of best interests’ decision-making.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service demonstrated that risks to people were identified, monitored and managed through the review of incident data and the actions taken in response. Staff recognised and responded appropriately to changes in patients’ conditions, including episodes of acute deterioration such as chest pain, shortness of breath and hypotension (low blood pressure). This included the use of clinical observations and National Early Warning Scores (NEWS2), escalation to senior clinicians, and timely referral to emergency services where required.

We reviewed 10 patient records, all of which were in paper format. Records demonstrated clear documentation of risk assessments, including moving and handling, falls, and frailty. These assessments were reviewed monthly and clearly identified whether there had been changes to patients’ care and treatment needs, or if they remained unchanged. NEWS2 were consistently calculated based on patients’ observations, supporting the monitoring of patient safety.

During the inspection, a patient became acutely unwell. Staff responded promptly by undertaking observations, monitoring the patient, and escalating care in line with procedures. Emergency services were contacted, and the patient was safely transferred to the local NHS trust. This demonstrated effective recognition and management of patient deterioration.

Dialysis treatment was adjusted or safely stopped when risks to patient safety were identified, for example in cases of clinical deterioration, persistent high venous pressure, or circuit clotting.

Staff acted appropriately when indicators showed potential issues, including recirculation, reduced access flow and concerns at the access site.

Appropriate actions were taken, including adjustment of treatment parameters, changing equipment, and escalation to the renal team for further assessment and interventions. Infection risks were recognised, and where sepsis was suspected, staff followed established escalation pathways, including undertaking blood tests and initiating treatment prior to transfer to hospital.

The service recognised risks associated with missed or shortened dialysis sessions. Staff contacted patients or next of kin when required, provided advice and support. External risks, such as transport delays and adverse weather, were acknowledged and mitigated through actions including adjusting treatment and ensuring appropriate clinical oversight.

There was evidence that staff communicated risks to patients and involved them in decisions about their care, particularly where treatment was shortened or declined.

Patients with a learning disability had patient passports in their records to support staff in meeting their individual needs. However, the patient passports reviewed did not include a documented review date. This meant there was no evidence to demonstrate whether patients’ care, and treatment needs had been updated.

The service used a RAG (Red, Amber, Green) rating system to identify and manage patients at risk, including those with additional needs or at risk of non-attendance. This supported staff to take action to reduce potential harm, including risks associated with missed or delayed dialysis. However, there was limited evidence to demonstrate that identified risks were routinely reviewed and updated, reducing assurance that changes in patients’ circumstances were consistently monitored.

The service demonstrated that it communicated regularly on behalf of patients, particularly in relation to transport arrangements and late attendance. Records showed that staff liaised with transport providers and followed up with patients when delays occurred. This supported the management of risks associated with reduced dialysis time, which can impact on patients’ care and treatment. Staff took appropriate action to mitigate these risks, including adjusting treatment plans, informing the renal team, and advising patients on the potential clinical impact of missed or shortened sessions.

Staff completed training in basic life support, National Early Warning Scoring and management of cardiac arrest, with a compliance rate of 100%. However, service data indicated that compliance with adult sepsis training was just below the expected services target of 90%, with a score of 89%. This may limit assurance that all staff had up-to-date knowledge in recognising and responding to sepsis. Despite this, staff demonstrated understanding of escalation processes for deteriorating patients.

A review of incident trends, including falls data, identified the weighing scales area as a location of increased risk. The service had recognised this risk and implemented appropriate mitigating actions, including raising staff awareness. This had a positive impact, with a reduction in falls observed over time.

Environmental factors, including restricted visibility caused by a partition wall, were identified as contributing to reduced staff oversight. Refurbishment works addressed this through partial wall removal and height reduction, improving visibility while maintaining appropriate privacy.

Further improvements included repositioning the weighing scales to enhance access, flow and space for patients using mobility aids, reducing congestion and environmental hazards. These changes demonstrated a proactive approach to risk management, supporting improved supervision, reduced falls risk and a safer patient environment.

The evidence showed a mixed standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service was located on the ground floor and included a main entrance with a reception desk. There were 2 accessible toilets for patient use, 2 consultation rooms, and a meeting room. There was access to the clinical manager’s office from both the reception area and the clinical area.

Access to the clinical area was secure and controlled by staff. The clinical area was configured as an open-plan space, with screens used to create separate bay areas. There were 24 patient beds and 4 side rooms. Side rooms were used to accommodate patients requiring isolation, or those with additional needs who required a private space. An accessible toilet and a kitchen were located within the clinical area.

A secure door was located to one side of the clinical area, which was not accessible to patients. This area contained several rooms, cleaner’s cupboard, cleaning utility room, communications room, water treatment room, and a machine store. There were 2 staff toilets, alongside male and female changing rooms.

The service had access to appropriate clinical equipment to support the delivery of care. Equipment that was not in service was stored in a designated machine store. Once repaired, equipment was clearly labelled with a green “ready to use” tag prior to being returned to service.

The service provided evidence that all medical devices had been serviced in April 2026.

The service had 2 emergency grab bags containing equipment required in the event of an emergency, such as a fire. These were located in accessible areas, including near the nurses' station and opposite Side Room 4, by the exits on either side of the clinic.

At the previous inspection, the service was required to ensure it had sufficient equipment to deliver safe care and treatment, specifically in relation to weighing scales. This had been addressed. The service had purchased new patient weighing scales, and the previous set had been retained as a contingency in the event of equipment failure.

We reviewed a sample of consumables, including dressings and syringes, and found these were within their expiry dates.

General waste was stored externally. The bin was observed to be overflowing, presenting a potential fire risk. This was collected and emptied during the inspection. Clinical waste was clearly segregated and was also stored externally in locked bins, which were secured within a fenced area with a locked gate.

The management and disposal of sharps and waste was undertaken in accordance with the service’s policy.

The service monitored fridge temperatures for both patient and staff use. Records showed, over a 30-day period, temperatures were within the required range on 8 days. Entries indicated that thermometers had been reset. This was raised with the clinical manager at the time of reviewing the documentation.

The service had a resuscitation trolley located within the main clinical area. This was secured and regular checks had been completed. However, 2 items, an ear thermometer and an oxygen probe, were found to be out of date. When this was raised with the service, they provided evidence of a certificate which indicated that the equipment had been tested, and the company servicing them did not change the sticker. The service provided photographic evidence that the labelling had now been updated.

A staff shower room was available for use following exposure incidents, such as blood or bodily fluid spillages. At the time of inspection, this facility was out of use and had been unavailable for several months. Staff advised that, in the event of such an incident, sinks located within the changing rooms would be used instead.

There were two fire exits located at the side of the building. On arrival, two pallets of cement had been placed adjacent to one of the fire exits by external contractors undertaking work at the clinic overnight, restricting access to the exit route. The service provided evidence that a risk assessment had been completed and that concerns had been raised with the contractors, including clear instructions that fire exits must be kept free from obstruction. Staff subsequently removed the pallets to ensure the fire exit remained clear and accessible.

The evidence showed a good standard. The service made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

Staff reported that all new starters completed an induction programme, which included online training, shadowing experienced staff, and supernumerary shifts. During supernumerary shifts, new staff were not included in staffing numbers and were able to observe experienced staff delivering care and gain an understanding of how the service operated.

Staff told us there were sufficient staffing levels in place, including a clinical manager, deputy manager, registered nurses, and healthcare assistants. The service used a staffing model based on patient numbers to ensure appropriate staffing levels. One registered nurse cared for up to four patients, supported by a healthcare assistant who assisted several nurses caring for up to 10 patients.

At the time of the inspection, staffing levels were sufficient to meet patient needs, with additional support provided by senior staff, including the deputy manager and clinical lead where required.

The service reported that they did not use agency staff. The service had a bank staff system was in place to provide additional cover when needed and the bank staff used were regular staff employed by the service, so familiar with the service.

Staff records were reviewed. They were complete and well maintained. Files contained evidence of appropriate pre-employment checks, training, and appraisal documentation, providing assurance that staff were suitably recruited, and supported to carry out their roles.

An induction programme was in place for all new staff. This included a period of supernumerary working, during which staff were supported by an experienced colleague to gain an understanding of the service and its processes.

The staff team was observed to have the appropriate skills and knowledge to meet the needs of patients, and the service target of 90% had been met with an overall score of 96% compliance. However, training compliance data indicated that some elements of mandatory training had not been completed.

The service completed staff appraisals, with records demonstrating that these had been undertaken in 2025 and clearly documenting the dates on which they were conducted. Appraisals assessed whether staff were meeting the expected standards and identified any areas where additional support, development, or performance improvement was required.

Sickness absence at the service remained relatively low overall during the period April 2025 to March 2026. Rates fluctuated month to month, with a peak of approximately 6% and the lowest rate at around 2%. More recent months showed a reduction, with sickness levels stabilising at around 2–3%.

The service had a system in place to monitor mandatory training, and compliance rates were 100% for most training subjects. However, training records showed compliance rates of 94% for both aseptic non-touch technique and the induction and management of anaphylaxis. This meant that 1 staff member had not completed these mandatory training requirements.

We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service had systems and processes in place to support infection prevention and control (IPC) and to protect patients from the risk of infection. The environment was observed to be clean and free from clutter.

Cleaning records were up to date and demonstrated that the clinical and non-clinical areas were cleaned regularly.

We observed staff cleaning bed spaces thoroughly between each patient. Staff demonstrated appropriate use of personal protective equipment (PPE), including gloves, aprons, masks and visors. All staff were observed to be bare below the elbows and demonstrated good hand hygiene practices.

The service had the appropriate equipment to maintain a good standard of cleanliness, including different coloured mops and buckets for different tasks and cleaning products which were stored correctly in the cleaning store. All cleaning products were in a locked cupboard.

The service monitored all cleaning products and there was clear documentation in relation to Control of Substances Hazardous to Health, there was a risk assessment in place for all cleaning products.

Staff demonstrated a good understanding of hand hygiene practices. Audit data for the period January to March 2026 showed that the service consistently met its target of 90%. IPC audits demonstrated compliance rates of 100% for each of the 3 months.

IPC was supported by policies outlining cleaning and disinfection of dialysis machines. These included use of PPE, approved cleaning solutions, and cleaning between patients.

Processes also covered routine cleaning, decalcification and disinfection of internal systems, with controls such as correct chemical use, rinsing and residual testing.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. They involve people in planning, including when changes happen.

Medicines were stored appropriately within a designated medicines room. All medicines were kept securely in locked cupboards or locked fridges. The medicines room was equipped with air conditioning to maintain appropriate temperatures and prevent medicines from being exposed to excessive heat.

The service did not administer controlled drugs. All medicines reviewed were within their expiry dates and clearly labelled.

Fridge temperatures within the medicines room were monitored and documented, and records indicated these were within the required range.

Patients were supported to participate in medicines-related aspects of their care. While patients did not self-administer medication, they were enabled to manage elements of their haemodialysis treatment through a structured competency framework, including the administration of erythropoietin and treatment management in accordance with their prescribed regimen. However, there was limited evidence of oversight and assurance processes to demonstrate that competencies were consistently achieved, monitored, and safely maintained over time.