Gloucester Royal Hospital Renal Units

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

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 well led as Good.

Service management and leadership was clear, consistent and supportive. Leaders and the culture they created supported the delivery of high-quality, person-centred care. Staff were engaged with the vision of the service and the service had clear responsibilities, roles, systems of accountability and good governance. The service valued diversity in their workforce and worked on an inclusive and fair culture for both patients and staff members. The service understood their duty to collaborate and work in partnership with other units and external stakeholders.

We have not awarded this service a score for Well-led.

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

The service had a clear vision for the service and staff were engaged with the vision. The vison and values were global, so staff had not necessarily been involved in their development as the service had only been under the provider since December 2023. Senior leadership had communicated the vision of the future and staff could name the values and priorities for the coming year.

At our site visit, we observed a culture which was patient focused and innovative. The service cared for its patients and staff were able to suggest ideas for improvement.

Staff we spoke with felt very supported by the senior leadership team, both locally and at head office level. Staff told us it was no bother for very senior staff to respond personally to questions and queries which made them feel valued and seen.

Staff knew and understood the providers values and how they applied in the work of their team. We saw a values board which had values such as putting patients first, prioritising patient and staff safety and delivering exceptional care.

Managers reflected on all unit’s cultural shifts, noting increased staff engagement and openness to change after initial resistance. Trust in new management has grown and was supported by visible responsiveness to staff concerns and strong support from senior colleagues.

Leaders had the skills, knowledge, experience and credibility to lead effectively and by example.

Nurses at the unit knew who the senior management team were and stated they were at the unit from time to time. Staff felt supported by the clinic manager and the senior management team.

Staff told us there was a structured approach to handling issues with the day to day running of the unit and as they arose. Staff felt there was clarity and direction from the registered managers on all 3 units.

The service had policies and procedures for staff to encourage a positive culture where people feel they can speak up and that their voice would be heard. Staff we spoke with felt confident to use these resources.

The service had a dedicated freedom to speak up guardian to support staff in raising concerns. Staff were aware of the guardian. However, none of the staff we spoke with had used this service to raise a concern. As mentioned under “Shared direction and culture”, staff felt the leadership team would and did listen to their concerns or ideas.

There were internal policies around whistleblowing.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for staff. For example, staff were assisted to maximise their availability for shifts and bank work, whilst balancing their family and caring commitments.

Staff received training in equality, diversity and human rights.

Staff we spoke with spoke positively about career opportunities at the provider.

The service had an interim internal Workforce Race Equality Standard (WRES) report for 2025. It was a reporting requirement for independent healthcare providers who are commissioned by NHS services to produce an annual report. The WRES reports on how organisations are addressing race equality issues in a range of staffing areas. The report recognised Diaverum were looking to implement improved reporting to ensure accurate monitoring for the race equality standard based on self-reporting. In addition, the service had an action plan highlighting areas for improvement which included providing unconscious bias training for all managers, implementing ethnicity and disability reporting for non-mandatory training and reviewing workforce planning and training processes to create a structure that combined equity with business requirements.

The service had clearly set out role responsibilities, systems of accountability and good governance. They acted on the best information about risk, performance and outcomes.

Staff were clear about which policies the service was following. The service was overhauled in December 2023, and many existing Trust policies were found to be lacking and out of date. In partnership with the Trust and staff, Diaverum utilised its existing policies to implement changes which focused on quality and safety. All policies were available on a shared database to ensure staff were always accessing the most up to date version of a policy. All policies we reviewed were within the review dates, which varied from annual to three yearly.

The service had governance processes and policies which followed best practice. Through multiple performance and quality meetings the service had assurance, and oversight policies were being followed consistently.

Each unit had a risk register, which highlighted risks to the service and any controls to mitigate them. Each unit had between 6 to 11 risks recorded. All risks were RAG (red, amber, green) rated and reviewed monthly which was clearly documented alongside any mitigation and outstanding actions.

We saw a risk recorded around fire extinguishers on Cotswold unit. This equipment was owned by the trust who was responsible for its maintenance. We saw foam fire extinguishers were out of date, which was recorded within the unit’s risk entry. The registered manager showed us daily and weekly emails to the trust to alert them and try to rectify the issue. Following our inspection, the service sent confirmation all fire extinguishers had now been serviced by the manufacturer.

There was an emergency preparedness plan which gave details for who to contact in the event of an emergency. We saw the service regularly monitored key aspects of patient care and reported these back to the trust.

The service had regular meetings with partnership organisations to ensure the regular flow of information between services. We reviewed minutes from these meetings.

There was a quality assurance meeting which was effectively the multi-disciplinary meeting where patient care was discussed with the trust.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement.

There was regular collaboration between the unit and the local trust, which was reinforced by structured meetings.

The service also collaborated with the local patient transport company to help ensure those patients that required transportation had a timely service. There were some issues with the patient transport company however the service kept a log of these to raise with their dedicated liaison member of staff at the transport provider.

The service focussed on continuous learning, innovation and improvement across the organisation and local system. Staff were given the time and support to develop opportunities for improvement and innovation.

On Severn unit, the home dialysis service was preparing to install home machines and water plants for two patients in their own homes. There was a drive from the trust to roll this service out as quickly as possible, but the service had pushed back stating patient safety always should be, and would be, priority over speed of roll out.