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Renal Services (UK) Ltd - Newcastle Good

Inspection Summary


Overall summary & rating

Good

Updated 31 October 2019

Renal Services Ltd (UK) - Newcastle is operated by Renal Services Ltd (UK). It is commissioned by Newcastle Upon Tyne Hospitals NHS Foundation Trust (NUTH) to provide an outpatient satellite dialysis service to their patients. This is a nurse led service with patients remaining under the clinical management of the renal consultants employed at the trust.

The service is delivered from a purpose built facility situated in Orion business park, North Shields. It is a 10 treatment station clinic, comprised of nine stations in the general area and one side room, which can be used for isolation purposes.

The clinic provides haemodialysis for stable adult patients with end stage renal disease/failure. The service provides renal dialysis for patients over the age of 18 years.

We inspected this service using our comprehensive inspection methodology and carried out an unannounced visit to the hospital on 16 August 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We rated the service as Good overall.

  • The service had enough staff with the right qualifications, skills, training and experience. Records were of a very high standard, they were detailed, clear, up-to-date, stored securely and easily available to all staff providing care. Staff understood how to protect patients from abuse. The service controlled infection risk well and completed risk assessments for each patient to remove or minimise risks.
  • The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff gave patients enough food and drink to meet their needs and improve their health. The service made adjustments for patients’ religious, cultural and other needs. Staff monitored the effectiveness of care and treatment and used the findings to make improvements.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • People could access the service when they needed it and received the right care in a timely way. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
  • Leaders had the skills and abilities to run the service. The service had a vision for what it wanted to achieve and was focused on sustainability and growth of services.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff, could raise concerns without fear.
  • Leaders operated effective governance and performance processes, throughout the service and with partner organisations. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
  • Managers and staff actively and openly engaged with patients, staff, and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients and were committed to continually learning and improving services.

However, we also found the following issues that the service provider needs to improve:

  • We found that a number of dialysis machines were overdue their annual service.
  • As a new clinic had been added to the portfolio of the Newcastle clinic manager we were concerned that they did not have the capacity to effectively manage and supervise three clinics.
  • Senior managers had not yet developed an action plan to improve the issues highlighted in the 2018 staff survey.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (Northern Region)

Inspection areas

Safe

Good

Updated 31 October 2019

We rated it as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse, they had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean and managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

  • The service used systems and processes to safely prescribe, administer, record and store medicines
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

However, we also found the following issues that the service provider needs to improve:

  • A number of dialysis machines were overdue their annual service.

Effective

Good

Updated 31 October 2019

We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients in their care.
  • Staff gave patients enough food and drink to meet their needs and improve their health. The service made adjustments for patients’ religious, cultural and other needs.
  • Staff assessed and monitored patients regularly to see if they were in pain or discomfort. They supported patients using suitable assessment tools when needed.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Caring

Good

Updated 31 October 2019

We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 31 October 2019

We rated it as Good because:

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • People could access the service when they needed it and received the right care in a timely way.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.

Well-led

Good

Updated 31 October 2019

We rated it as Good because:

  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action. The vision and strategy were focused on sustainability and growth of services and aligned demand within the wider health economy.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • Managers and staff actively and openly engaged with patients, staff, and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services.

However, we also found the following issues that the service provider needs to improve:

  • As a new clinic had been added to the portfolio of the Newcastle clinic manager we were concerned that they did not have the capacity to effectively manage and supervise three clinics.
  • Senior managers had not yet developed an action plan to improve the issues highlighted in the 2018 staff survey.
Checks on specific services

Dialysis Services

Good

Updated 31 October 2019

We rated Renal Services (UK) – Newcastle as good overall with a good rating for all of the key questions; safe, effective, caring, responsive and well-led.