The Piazza

Updated 28 February 2022

The Piazza is the registered location of Bionical Solutions Limited and represents the clinical side of their business. Their vision is to improve health outcomes for patients by tailoring services for individuals, including the use of technology to assist this. The service receives referrals from the providers of medical devices and prescription medicines commissioned through national and local NHS contracts. The service provides the clinical support to patients to use these medical devices and medicines.

Bionical Solutions covers the whole country and staffing consists of nurses and healthcare assistants, such as renal technicians. Patients do not visit the providers premises. Staff treat patients at home sometimes supported by the use of telephone calls and virtual technology. Staff participate in healthcare education with patients and their families around medical devices, their presenting condition and environmental considerations.

The provider’s headquarters are situated near Derby and they coordinate the service from there. A call centre operated from the headquarters offers a single point of access for patients to their care team. They offer a variety of different services supporting the use of medical devices and medicines. These include women’s health, osteoporosis, oncology, dermatology and rheumatology, cystic fibrosis, Parkinson’s disease, leukaemia and haematology and renal dialysis.

The service supports 20,000 patients across the country and employs 700 staff. They make up to 25,000 home visits a month, the majority being in the services commissioned by a national home-IV service to NHS patients. It includes a peritoneal dialysis service, including Continuous Ambulatory Peritoneal Dialysis and registered nurse managers, registered nurse clinical trainers and trained renal technicians to deliver this. They also support families with ordering treatments. Staff are employed by Bionical Solutions; initial and ongoing training is provided by both the renal client and Bionical Solutions. We reviewed the peritoneal dialysis service services, cystic fibrosis, Parkinson’s and dermatology and rheumatology services. The highest concentration of visits are made in the dialysis service and this is reflected in the focus of the report.

The service is registered with the CQC to provide the regulated activity of treatment of disease, disorder or injury.

We had not previously inspected or rated this service.

Updated 28 February 2022

We rated The Piazza as requires improvement because:

• Our concerns were mainly focused on the renal service. The provider's other services generally ran smoothly with high levels of staff and patient satisfaction.
• The provider had experienced staffing difficulties in the renal service over the last six months prior to inspection and had seen significant increases in missed visits and treatments. This had not impacted on patient safety but had caused anxiety and distress for some patients and their families.
• The provider had not provided any sepsis training for staff but had a clear escalation policy for managing the deteriorating patient.
• The provider did not have systems in place for staff to record COVID-19 lateral flow tests with the provider to ensure they were being done regularly and to demonstrate the current COVID-19 status of staff.
• Staff had not completed standalone risk assessments or care plans for patients. The provider had stored risk information about patients on its electronic system.
• The process for staff learning from incidents, service developments and complaints was not robust. Team meeting minutes and supervisions we reviewed did not indicate this was taking place.
• Patients and their carers in the renal service had not always found it easy to contact the provider for advice and information about their treatment. The provider had not completed complaints investigations in a timely manner and had a backlog of complaints that had not been completed within timescales laid down in their policy. The provider had not always fed back the outcome of complaints.
• Managers had not always operated effective governance processes throughout their services and with partner organisations. They had not co-ordinated missed visits in the renal service well to protect the most vulnerable patients and had not always established good communication and information sharing with patients, families and specialist hospital teams.
• The provider had stopped taking new referrals in some areas with no clear indication as to when this would resume.
• Not all staff felt respected, valued and supported to develop their skills.

However:

• Staff cared for patients and kept them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well.
• The service controlled infection risk well. They had put additional protocols in place for during the COVID pandemic and which they regularly reviewed to keep up with changing guidance.
• The service managed safety incidents well. Staff collected safety information and used it to improve the service. Staff updated care records during and after visits which they accessed through a tablet.
• Staff provided good care and treatment within the contractual arrangements with their commissioners. Staff managed treatments and medicines well, where appropriate.
• Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers and were focused on the needs of patients receiving care.
• The service planned care to meet the needs of people, took account of patients’ individual needs, and had systems in place for people to give feedback. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.
• Most renal patients accessed the service when they needed it and had not waited too long for treatment,
• Staff understood the service’s vision and values, and how to apply them in their work. Staff were clear about their roles and accountabilities.

Updated 28 February 2022

See overall summary for details.