Clacton-on-Sea Dialysis Unit

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

We have not awarded this service a score for Effective.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

At our previous assessment in February 2020, staff told us that they did not have access to patients’ NHS records. During this assessment, we observed staff access patients’ NHS records to access information such as blood test results or recent hospital admissions.

Patient admission assessments were completed for all new patients. These reviewed patient’s needs such as communication, mobility, financial and emotional needs to ensure that support was in place for dialysis sessions.

‘My Care’ documents were also used to plan haemodialysis care, capture what was important and plan for future needs. Named nurses were required to review this monthly and update as health needs changed.

We looked at 5 patient care records and found that the care plan section was not completed in 4 out of 5 records. There was a lack of evidence to demonstrate that this had been reviewed by the nurse with the patient. This meant that care needs were not always personalised and updated to reflect individual needs. Audit data provided did not review the completion of the ‘My Care’ document.

The service used the Individual Patient Performance Scores (IPPS) to monitor treatment efficacy. This scoring tool was based on a combination of 31 parameters in 8 areas of renal care such as vascular access, adequacy of dialysis and blood flow rate. The scores were monitored and reviewed on a monthly basis to guide clinical care and prompt the medical team for further assistance such an anaemia management or changing flow rate.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service had access to the full range of specialists such as dieticians and pharmacists to meet the needs of patients in the service. Patients were discussed at virtual weekly multidisciplinary (MDT) meetings to review recent admissions, discharges and patients who may require admission for further management. Patients had a face to face monthly dietician review if nutrition and hydration needs were not met.

Staff were appropriately experienced and qualified and had the right skills and knowledge to meet the needs of the people who used the service. We saw evidence that all staff had completed training to ensure they had the skills needs for their job role. We observed care that was delivered safely and in line with national guidance.

Managers provided new staff with appropriate induction and staff told us that they were supported when they joined the service. Staff received an appraisal and mid-year review to receive feedback on performance in line with policy. The percentage of staff that had had an appraisal in the last 12 months was 100%.

Nursing nuggets training was provider led weekly training with focused learning designed to support practice, build confidence and keep knowledge fresh. Topics were tailored to learning identified through themes following incidents, audit or feedback received. Topics in the last 3 months included hand hygiene, Central Venous Catheter disconnection and quality of life survey.

Monthly staff meetings were held to provide organisational, quality and clinical performance. We saw evidence of feedback regarding the process for updating changes to prescription charts being communicated to all staff following the onsite assessment. Action logs were not always updated or completed within meeting minutes we reviewed. This meant there was a risk of not monitoring and ensuring accountability of tasks.

Managers dealt with poor staff performance promptly and effectively. For example, we saw evidence of manager feeding back to staff on poor performance identified at monthly audit review of care records.

The service used the patient perception of care audit to evaluate the lived experience of those that used the service. The audits were used to make changes to the service planning and delivery through an action plan. For example, providing blankets for patients that felt cold and providing cold spray to reduce discomfort during needle placement.

Care was delivered in line with National Institute for Health and Care Excellence (NICE) guidance, such as shared care and providing information.

We reviewed 7 policies and saw that they had been kept updated to reflect current best practice and national guidance.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service had good communication links with their NHS partners, such as NHS consultants, vascular nurse and dieticians. NHS renal consultants and dieticians attended virtual weekly MDT meetings and reviewed patients at the unit on a monthly basis. We saw evidence of the renal consultant writing to the patient and GP outlining the concerns and potential risk of not attending dialysis treatment.

Where patient care needed to be escalated, such as medication changes, there were clear processes in place. The on-call renal consultant or medical doctor at the local hospital was contactable by phone if a patient became unwell. Where the needs of the patient could not be met at the unit staff knew to contact the emergency services.

All patients had a named nurse who was responsible for reviewing patient blood results, referring to renal consultants and dieticians as required and ensuring all documentation was completed in accordance with policy. Each nurse was allocated 8-9 patients.

Staff were able to access NHS patient records to review recent admissions to avoid asking repeated questions regarding care.

Staff shared information about patients at the daily huddle and via the communication handover book. This included information such as swapping sessions or fistula access problems. This meant that staff were able to plan for the session in advance of arrival to avoid delays.

The service maintained and developed links with community partners to ensure the service was operating well for the patients. For example, monthly meetings with the patient transport service had commenced in June 2026 to address performance and improve patient outcomes.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff encouraged patients to have independence and choice over their care and treatment. Patients were offered to participate in shared care, where they were supported to be actively involved in the management of their care and treatment. For example, taking their own weight pre and post dialysis, blood pressure and temperature to more advanced skills such as self-connect. At the time of the assessment 4 patients had completed their shared care competency handbook giving them total independence in their care and treatment.

We saw posters displayed in the clinic waiting area reminding patients of the importance of infection prevention and control practice, fistula care and joining the kidney research community to access latest research news and opportunities.

The service had access to an NHS dietician who supported the nutritional needs of patients.

The unit kept prescribed nutritional supplements for those patients that required them but did not want them stored in their home. The patients were able to have these whilst they were receiving treatment to supplement their dietary needs.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised tools such as National Early Warning Score 2 (NEWS2) to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes.

Patient’s blood tests and individual patient performance scores (IPPS) were reviewed monthly at the MDT meeting to monitor and improve outcomes. For example, where a patient’s iron levels were low a dietician review was requested to try and optimise levels.

Quarterly reviews of IPPS scores allowed senior leaders to review treatment outcomes regionally for fairer comparisons and targeted improvements. It helped the provider benchmark outcomes, spot demographic-driven health inequalities, and share best practices.

The service used key performance indicators to monitor performance and safety. These included patient access, morbidity and mortality, patient experience and patient safety.

The service monitored the number of missed and shortened treatments and took steps to reduce this. In the last 12 months there were 131 shortened or missed treatments at the unit. The 2 highest factors were patient non-compliance and patient transport.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had an informed consent policy in place. This policy ensured that patients were provided with the appropriate information to enable informed consent prior to their first treatment. Staff were required to explain the benefits, potential risks and complications of dialysis and alternative treatment options and ensure that a written consent form was signed in the care records.

We reviewed 5 care records whilst on site and found that consent documentation was in place. We were told by the manager that this was reviewed annually by the named nurse. The care record audit reviewed documentation of consent forms to ensure that consent documentation was in accordance with policy for all patients.

The service used the local NHS trust’s language line to access translation services. Staff told us that they also had experience of using online translation services to communicate and gain patient consent.

Staff took all practical steps to enable patients to make their own decisions. A patient told us that when he requested a shorten treatment time the potential risks and impact of a shortened treatment was explained to him and was required to sign an early termination form.