North Devon Satellite Dialysis Unit

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

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.

At our last inspection we rated this key question requires improvement. The service was in breach of Regulation 17, good governance. The service had made improvements and is no longer in breach of regulation 17. At this inspection we rated this key question as good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard.The service 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 provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff. Staff said they knew who the senior management team were and they regularly visited the unit. The unit had a short term and long term vision, which included care planning and named nurse role out.

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 safety and delivering exceptional care.

There was an open and supportive culture at the unit. Staff we spoke with said the teams worked well together.

We scored the service as 3. The evidence showed a good standard.The service 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.

The clinic manager was visible and approachable. They had been at the unit for 8 months at the time of inspection. Staff spoke positively about the clinic manager and said there had been a culture shift where staff felt supported and were able to approach them with any issues or concerns.

Leaders had a good understanding of the service they managed. During the inspection we identified some areas which required improvement such as care planning and were satisfied these issues had already been identified and remedies were in the process of being implemented.

Staff were supported to develop their skills. We saw succession planning for staff was identified as an area to develop in the strategy and saw that the annual appraisal was used to identify staff who wished to progress forwards with their careers. We reviewed 6 appraisals and saw this was being actioned.

We scored the service as 3. The evidence showed a good standard.The service fostered a positive culture where people felt they could speak up and their voice would be heard.

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 raise any concerns with the unit manager and knew how to escalate concerns.

The service had a freedom to speak up guardian. This is a dedicated professional in the organisation who supports staff in raising concerns.

There were policies around whistleblowing and staff were also signposted to an independent whistleblowing charity.

We scored the service as 3. The evidence showed a good standard.The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Managers put reasonable adjustments in place for staff members to help them carry out their role. We spoke with staff members who were given additional breaks during their shifts for occupational health reasons. Staff who were experiencing perimenopausal symptoms had an adapted uniform to help manage some of the symptoms of perimenopause. Staff we spoke with said the unit manager had worked towards ensuring an inclusive culture.

The service valued diversity in their workforce. They worked towards an inclusive and fair cultureby improving equality and equity for people who work for them. One staff member said the mix of staff cultures was a positive aspect of working for the provider.

Staff received training in equality, diversity and human rights.

The service had a Workforce Race Equality Standard (WRES) report for 2020/ 2021. It is 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.

We scored the service as 3. The evidence showed a good standard.The service 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.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. We saw audits were focused and intended to drive improvement in patient care. We reviewed recent hand hygiene audits which the unit manager had undertaken. These audits were carried out over a period of time and feedback was given to staff with the aim to improve practice and patient care.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

The service had a risk register, which highlighted current risks to the service and any controls that were in place to mitigate risks. There was also 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 a patients care and reported these back to the local NHS Trust.

The service had regular meetings with partnership organisations to ensure the regular flow of information between services.

We scored the service as 3. The evidence showed a good standard.The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

There was regular collaboration between the unit and the local NHS Trust, which was reinforced by structured meetings to ensure there was a regular time and space for the collaboration to occur.

The service also collaborated with the local patient transport company to help ensure those patients that required transportation had a timely service. Feedback from patients and staff said the transportation to and from the unit was generally good.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

We scored the service as 3. The evidence showed a good standard.The service had a focus 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.

Staff were given protected time to carry out mandatory learning and were supported to attend training which improved their competency levels.