Gloucester Royal Hospital Renal Units

Updated 24 August 2023

Gloucester Royal Hospital Renal Units is operated by B. Braun Avitum UK Limited. The service provides haemodialysis to NHS patients over the age of 18 under a contract with Gloucestershire Hospitals NHS Foundation Trust. The service operates 50 dialysis stations across 3 units on the site of Gloucestershire Royal Hospital. Cotswold unit is the main clinic, and the service also operates Severn unit, both of which are located on the hospital grounds. The service also provides care from a dialysis bay and side room on ward 7B of the main hospital.

Cotswold and Severn units operate from 7am to 6.30pm on Tuesdays, Thursdays, and Saturdays, and from 7am to 12am on Mondays, Wednesdays, and Fridays. The unit on ward 7B operates from 7.30am to 7pm 6 days a week, from Monday to Saturday for planned care. The service provides 24/7 on-call dialysis for emergency cases.

The provider registered this location in 2012. A registered manager is in post and the service is registered to carry out the following regulated activities:

• Diagnostic and screening procedures
• Treatment of disease, disorder, or injury

We last inspected the service in August and September 2022. As a result of a focused inspection, which included the safe and well led domains only, we served 2 Warning Notices under Section 29 of the Health and Social Care Act 2008. We notified the provider that they failed to comply with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to comply with Regulation 12(2)(d)(h)(i), Safe care and treatment, and with Regulation 17(1)(2)(b), Good governance. We told the provider they must make improvements in 7 specific areas and said they should make improvements in a further 3 areas.

We carried out this inspection in order to rate each domain and to assess the service’s progress in addressing the previous areas for improvement. We found the service had improved, or begun to improve, all the areas relating to breaches of regulation. While this reflected better care overall, there remained a need for more embedded and sustained improvement.

Updated 24 August 2023

Our rating of this location improved. We rated it as requires improvement because:

• The environment on ward 7B remained poor and damaged or malfunctioning equipment needed urgent repair.
• Updated safeguarding processes needed further development. There remained a lack of assurance that staff knowledge and understanding protected patients from harm.
• A minority of staff demonstrated impatience and a lack of kindness towards patients when working under pressure and patient surveys indicated a need for improved communication from staff.
• There were gaps in the provision of care for patients who could not communicate well in English and those living with mental health needs.
• Detachment between the provider and staff was marked and the senior team did not recognise or acknowledge the scope of challenges staff faced.

However:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills. The service managed safety incidents well and learned lessons from them.
• The provider had implemented significant improvements in infection prevention and control, the safety of the environment and in safeguarding. Improvements needed time to provide assurance of effectiveness and reduced risk.
• Staff provided emotional support to patients and their loved ones.
• Staff provided good care and treatment and gave patients enough to eat and drink.
• Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available to suit patients' needs.
• The service engaged well with patients to plan and manage services. Staff were clear about their roles and accountabilities.
• Staff coordinated a wide range of service adaptations to meet individual need, including to help people adhere to religious beliefs and cultural needs.
• Most staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.

The provider had improved governance and risk management systems through an extensive programme of work, which needed further time and development to fully embed into the service.

Updated 24 August 2023

We rated this service as requires improvement reflecting the need for sustained improvement in safe and well led. We rated effective, caring, and responsive as good. Please see the main summary.