Stockton Dialysis Clinic

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first rated assessment for this service. This key question has been rated Good: This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We assessed 7 quality statements from this key question.

We found that leaders promoted an open culture of continuous learning and improvement. There were robust governance systems and processes in place to ensure that services were safe and effective. Staff worked with NHS colleagues to deliver care that was person-centred and integrated. Staff told us that senior managers were visible and supportive and we witnessed that during our visit.

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 provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The organisation had a mission statement, vision, strategy, culture and set of values, which were clearly defined and which focussed on patient experience and care. We saw these values were demonstrated by staff during our visit.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Senior staff told us they felt supported in their roles and had been given appropriate shadowing and supernumerary working times in which to familiarise themselves with the role and complete any bespoke training that was allocated. Managers told us they could contact senior leaders at any time if they had any challenges and described communication as open and transparent.

Managers were supported to attend regional and national events and met regularly with their counterparts from other units to share any quality initiatives. Clinic managers were specifically supported by regional health and safety and business managers who provided both face to face visits and monthly calls to address areas for improvement following audits. Staff told us that local and regional managers were very visible and approachable and we witnessed that during our visit. The service had a clinic manager and deputy manager, who also had administrative time allocated to support management tasks so there was a management structure in place with clear lines of escalation.

All leaders we spoke to had good knowledge of the local context of the service and its staff and knew how to support staff as individuals as well as a wider team. Regular human resources visits to speak to staff in order to manage concerns or issues proactively rather than waiting for problems to develop was an example of this.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Managers we spoke with, were aware of the importance of promoting a culture of openness and transparency. Staff told us they knew how to raise concerns and could do so without fear of retribution. In the 2024 ‘My opinion counts’ survey, 80% of staff at the clinic agreed with the statement ‘I speak up if I have concerns or believe something is not correct, without fear of negative consequences.’ There were no culture concerns noted by inspectors at the time of the inspection.

The provider had a speak up policy which we reviewed as part of our inspection. We saw the policy was in date, ratified and reflected national best practice.

There were no concerns reported by staff at this clinic in the last 12 months, but we saw that there was a process in place to investigate concerns raised on the ‘Speak Up’ portal and we saw an example of how this process was followed in the wider organisation.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The organisation had both local and global policies and processes to encourage a diverse workforce and to promote equal opportunities. We saw commitment to Equality, Diversity and Inclusion in recruitment processes. However, in the 2024 ‘my opinion counts’ survey only 60% of the staff at the clinic agreed that there was equal access to opportunities for people at Diaverum, and that people’s differences were valued and encouraged, which was lower than the average rating across the wider organisation. We saw that there was an action plan in place to address this, by ensuring that all staff had equal access to training and development, reasonable adjustments were offered on the basis of disability, pregnancy, religious or health needs, and flexible working arrangements were supported where possible.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The provider had a clear governance structure in place, which supported management processes within the organisation. Senior leaders were supported by clinical leads at local level and regional business and health and safety managers. The organisational structure was displayed in the unit and staff told us leaders were visible across all levels.

A programme of integrated performance meetings had been developed which provided oversight of all aspects of quality, risk, financial, people and operational performance. The service also had several dashboards, which could be filtered to show both regional and national comparisons, including infection prevention and control, incident reporting, staff training and service user complaints.

We reviewed the provider’s risk register for the service and saw 10 risks covering both clinical and operational matters within the service, which were RAG rated in accordance with the severity of the risk. The health and safety manager ensured that staff had access to this register by printing off an updated version, following review by the board and following each business review. We saw a current version of the risk register was displayed in the staff room at the time of inspection, to ensure all staff understood service risk.

Risks across the service were formally reviewed on a monthly basis and it was ensured board members were fully sighted and involved in risk management. Senior staff told us that risk was also discussed each week as part of a regional risk meeting with a mandatory requirement to ensure appropriate and regular attendance.

Governance and management meetings were held monthly in accordance with company policy, and we saw that minutes from these meetings were comprehensive. We reviewed the most recent governance meeting minutes and saw that these meetings were well-attended by clinical leads and managers from all regions within the service.

All meeting minutes we reviewed had consistent agenda themes to ensure information discussed and recorded was thorough and comprehensive.

Appropriate policies were in place, providing clear guidance on processes and accountability. It was evident that policies were reviewed frequently to ensure both operational and clinical practice was carried in accordance with national best practice and guidance. However, several policies did not state the date when the next review was due.

Senior staff told us about the robust cybersecurity systems in place to protect data. This included measures such as simulation phishing emails sent to staff as an educational exercise to help them to detect potentially dangerous cyber activity. We also saw evidence of comprehensive data protection audits.

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

The clinic worked in partnership with the local NHS Trust. Consultants and dieticians from the trust regularly attended the clinic, and staff from the clinic attended monthly multi-disciplinary meetings with trust staff. During these meetings each patient receiving dialysis was discussed to include treatment changes, health changes and amendments to any treatment plans that may be required.

Staff at the clinic told us that they had good working relationships with their NHS partners and could contact colleagues via email or phone between meetings when needed.

The provider met regularly with NHS colleagues to ensure training and support opportunities were available as part of ongoing clinical skills development.

We saw minutes of meetings with local NHS partners where key performance indicators were discussed and saw how staff used these opportunities to raise service-users’ concerns over ambulance waiting times.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Learning was shared both regionally and nationally across the organisation, with weekly meetings to discuss emergency or investigated themes to prevent potential future events.

Incident reporting was embedded in daily operations. All staff were trained to report all incidents, near misses and adverse events, which were reviewed regularly. Thematic analysis of incidents were conducted to identify trends and inform proactive interventions.

Incidents were also discussed at every staff handover and monthly team meeting. Dashboards showed incidents data across all units to drive improvement and learning. Each morning staff huddles discussed key risks including recent incidents.

All staff we spoke with received protected induction time, which could be extended, should further support be required. Induction was further supported by bespoke training, designed in accordance with individual staff clinical competencies and operational processes. The service did not use any agency staff at the time of inspection, but we saw induction processes were in place to support these staff.

Weekly ‘Nursing Nuggets’ learning sessions were available to staff across the organisation to support staff in staying up to date with best practice.