Gloucester Royal Hospital Renal Units

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This service was previously inspected and rated under a previous provider but has not yet been rated under the new provider.

At this inspection we rated responsive as Good.

People’s needs were met through good organisation and delivery. We looked for evidence people and communities were always at the centre of how care was planned and delivered. We checked the health and care needs of people and communities were understood, and they were actively involved in planning care to meet these needs. We also looked for evidence people could access care in ways that met their personal circumstances and protected equality characteristics.

We have not awarded this service a score for Responsive.

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

The service made sure people were at the centre of their care and treatment choices. The service had holistic care plans and worked in partnership with people to decide how to respond to any relevant changes in people’s health or needs.

Dialysis care was planned so Severn dialysis unit treated patients whose conditions were not as complex as patients seen by ward 7b within the NHS trust. Cotswold saw most patients who had a variety of needs. For example, 1 patient had originally been on ward 7b when first unwell and transferred to Cotswold for ongoing treatment. Now their condition had stabilised, they were planned to move to Severn in January before eventually transitioning to home haemodialysis.

People who used services were able to access the service 6 days a week and were mostly offered the choice of the morning or afternoon session to receive their treatment. Twilight (evening) sessions were available on Cotswold unit on a Monday, Wednesday and Friday where the unit stayed open until midnight.

Patients said they felt safe receiving treatment at the unit, and we saw staff responded swiftly in emergencies or if a patient became unwell during dialysis.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The 3 units worked together alongside the NHS trust to make sure the right patients were seen on the most appropriate unit to meet their needs. The service alerted the local NHS trust about any vacant slots the service had so these could be filled with appropriate patients.

There were clear pathways for patients to be transferred to the local hospital if they became unwell. For example, Severn unit called 999 in an emergency but could also alert the hospital emergency team, who would attend if needed.

The service engaged with the local patient transport supplier to ensure patients arrived and were picked up from dialysis in a timely manner. In response to patient feedback, the transport provider had given the units a named contact who investigated all journeys and delays which fell outside the expected KPIS for the transport service. They also produced a leaflet for new and existing patients to help them understand what was normal in terms of shared transport, and what was outside of tolerance and should be escalated to the dialysis team.

An admission criterion was set out so all patients, irrespective of age, gender, race, religion, belief or sexual orientation, could access the service. For Severn unit, patients were required to be stable and required medical approval, from their lead consultant, for their suitability to have haemodialysis at the unit. Cotswold saw patients with more complex needs but who were also stable. 7b was reserved for inpatients and emergency admissions for the most unwell or complex patients.

The service supplied appropriate, accurate and up-to-date information in formats which were tailored to individual needs.

The service complied with the Accessible Information Standard. We saw information could be provided in different languages and there were processes to use should a person using services require translation services, including British Sign Language (BSL) translation.

The service which provided transport had produced a specific information leaflet around transport and what could and could not be expected of the service. This was designed to help manage people’s expectations around transport but also to help identify when something fell outside of the expected KPIs for the transport service. The service ensured patients had access to this information.

The service involved people in decisions about their care and told them what had changed as a result. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Patients we spoke with were all clear on how to raise both formal and informal concerns and complaints. Information on how to make a complaint was included in the patient handbook that each patient received, both in writing and via email.

Patient surveys had led to significant changes, such as replacing old dialysis machines, although the service explained this was always planned and not solely due to patient feedback. Positive feedback about staff engagement was also noted.

Patients said they were able to raise issues with staff members and felt assured these would be addressed.

Information on how to raise a complaint was not included on the service’s website. However, there was the opportunity for people to contact the provider through a feedback portal. The service largely treated older people, who may or may not have been comfortable using the internet but there was a telephone number provided for complaints to accommodate for this.

The service had received one formal complaint in the past year. We were told the service responded to verbal complaints right away. The service kept a formal complaints log which each clinic maintained. Complaints were also reported on the monthly KPI document and shared with the trust

On Severn unit, managers explained formal complaints were rare; the most recent involved a nurse refusing to give un-prescribed medication, which was resolved by explaining safety protocols.

The service made sure people could access the care, support and treatment they needed, when they needed it. The units worked together to minimise shortened dialysis sessions and to accommodate missed sessions.

Cotswold and Severn units were accessible for people identified as medically suitable for the service. There were gender neutral disabled toilets, and the service was wheelchair accessible. On Cotswold unit, patients requiring dialysis in a bed could be accommodated and there was appropriate equipment to facilitate safe transfers from transport to the dialysis chair or bed.

Severn unit was designed as a satellite unit for ambulant patients although manual handling aids were available to allow patients to self-transfer to their dialysis chairs.

There was level access to the buildings of both Cotswold and Severn units which were all on one, ground floor.

7b was located on the 7th floor of the tower block on ward 7, within the trust hospital. Access was by lifts, and the lifts were able to accommodate beds and stretchers. Patients did not have to move from their beds and could be moved into the dialysis bays in situ.

Patients on 7b had emergency call bells to use if help was required.

An on-call service was run from 7b which saw a senior nurse first on call every night, with another registered nurse as second. This had been changed from arrangements under the previous provider which utilised dialysis support workers on call.

On Cotswold and Severn units, not all patients had call bells, however the new machines had a call bell function and machines had lights and alarms if anything required attention in relation to the dialysis treatment itself, or if the patient used their machine call bell.

For both Cotswold and Severn units, there was ample, protected, parking for people using the services.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. All staff had completed equality, diversity and inclusion training.

As part of the drive to empower patients to be partners in their care, the service planned to use a phone app to allow patients to view and manage their own data. Outcomes, blood results, medications, information around their dry weight, fluid intake and diet and education could all be accessed through the app. At the time of our inspection, the app was awaiting NHS Trust approval through the information governance team.

On Severn unit, the phone app allowed patients to access their treatment data which supported self-management and shared care. Uptake was currently limited, but senior staff expected it to be promoted more with the home haemodialysis program, which was being piloted on Severn unit before expanding to other units.

People were supported to plan for important life changes, so they had enough time to make informed decisions about their future, including at the end of their life.

Staff were aware about patients’ resuscitation wishes. The staff held a log which listed the patient’s decision and the frequency this was to be reviewed. End of life planning was managed through discussions between the patient, family, GP and renal consultant.