Bath Kidney Care Centre

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• 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

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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 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.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Regular updates from leaders ensured staff felt informed and included.

The providers values were

• We Care: we show empathy and support to our patients and employees.
• We Connect: We foster collaboration, open communication and trusting relationships.
• We Commit: We take ownership, stay focussed and drive results.

Conversations with staff and observation during the assessment demonstrated staff were committed and working to these values.

The provider had 3 strategic priorities which were: strengthen core operations; drive profitable growth and innovation; and develop together and strengthen our culture. During the assessment staff demonstrated how their day to day working followed these priorities. This included working collaboratively with the NHS Trust to implement new processes to improve outcomes for patients,

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.

There was a registered manager who provided leadership at the centre. They were supported by the Senior Governance Manager and the Area Head of Operations from Fresenius Medical Care. The registered manager said they were well supported by the organisation. There was a deputy clinical manager and some of the nursing staff were assigned lead roles, such as infection prevention and control link nurse.

The registered manager had a good understanding of the service. They explained clearly how the service worked collaboratively with the NHS Trust and with other leaders form Fresenius Medical care to provide the best possible care and treatment to patients.

All staff spoke highly of the registered manager and said they were well supported by them. In the most recent staff survey comments included, “The manager is very supportive of her staff”, and “The manager takes pride in the unit and her staff.”

Leadership development opportunities were available, including opportunities for staff not currently in leadership roles. The provider’s Care Delivery Training Manual was designed to support the development of all staff, this included apprenticeships to develop leadership skills.

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

There was a culture of speaking up where staff felt able to actively raise concerns. The provider had the Freedom to Speak up Guardian that allowed staff to speak up/raise concerns about anything that got in the way of patient care or affected their working life. A Freedom to Speak Up Guardian is a designated individual in an organisation who supports workers to raise concerns they may have, especially when they feel unable to do so through normal channels. The guardians act as a safe point of contact and help ensure that workers are heard, their concerns are addressed, and feedback is provided on any actions taken.

Staff we spoke with knew about the Freedom to Speak Up process and how to contact the Freedom to Speak Up Guardian. They felt they would be supported to raise concerns without fear of detriment; they had not however had to do this.

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.

The service promoted equality and diversity in daily work. All staff completed equality, diversity and human rights training.

The service did not have any defined staff network groups, such as disability, LGBT and race equality networks. However, the workforce was diverse, and it was evident from conversations with staff and observation that staff respected each other’s cultural and social differences. Staff spoke about the support the manager gave to enable them to work flexibly around their personal circumstances.

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 act on the best information about risk, performance, and outcomes, and share this securely with others when appropriate.

There was a governance structure with lines of accountability through the centre, region and through to the UK section of Fresenius Medical Care. The registered manager had support from a provider governance lead.

Records of governance meetings at centre level and at the UK section of Fresenius Medical Care levels demonstrated the quality, performance and safety of the service were monitored and reviewed. This included monitoring and review of safety incidents, risks, staffing and training. All governance meetings followed the provider’s governance principles. This resulted in a standardised agenda for all governance meetings at all levels of Fresenius Medical Care services.

The service followed processes to gather information to gain assurance that staff were delivering safe and effective care that followed national guidance. This included but was not limited to medicine management audits, infection prevention and control audits and records audits. The service took action from the outcome of audits to drive improvement across the service to improve safety and patient experience.

The service was commissioned by NHS England specialist combining arrangements. As part of the commissioning contract review meetings were held. Records showed these were collaborative meetings, attended by representatives of Fresenius Medical Care and Bath Kidney Care centre, the NHS Trust and NHS England. These meetings included monitoring of key performance indicators and quality metrics.

Staff ensured all patient records were held securely. Electronic records were held securely on password protected computers and paper records were stored in secured cabinets.

The service had plans for emergencies such as loss of power, water leaks and gas leaks. The Emergency Preparedness plan gave clear guidance to staff about the action they needed to take in the event of an emergency. Paper copies of the plan were held at various locations in the building so staff could easily access them in the event of an emergency.

However, it was noted that some of the corporate policies provided by Fresenius Medical Care Renal Services Limited did not always reflect national guidance such as the safeguarding and management of incidents policy. This increased the potential risk that staff might not provide care and treatment and support patients in a manner that was in line with national guidance.

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.

Leaders and staff worked collaboratively with organisations and within their own organisation to support seamless care and treatment for patients. The registered manager and staff described close working relationships with the NHS Trust. This included multidisciplinary meetings where the care and treatment of patients was reviewed by the trust and staff from the centre.

Staff worked collaboratively with Fresenius Medical Care to provide support for patients wishing to go on holiday. Fresenius Medical Care had dialysis units worldwide. Staff would source and book patients into other dialysis units for holiday and ensured those units had the relevant information to enable seamless care and treatment for the patient.

Leaders and staff understood the importance of utilising kidney patient support charities to provide support such as practical, emotional and financial support to patients requiring dialysis. There were regular visits from a representative of a kidney support charity, when patients could speak and get advice and support from the charity representative.

The service 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 contribute to safe, effective practice and research.

Leaders demonstrated a commitment to improvement. Performance was used to promote learning and learning was shared across the organisation.

Staff were committed to learning and improving. Staff spoke about how the manager supported them to attend courses that supported their development and contributed to improving services. The service offered an apprenticeship programmes to allow staff to gain external accredited qualifications to further their development.

Records showed there was shared learning across the organisations UK dialysis unit. Examples of shared learning following incidents included ensuring patients’ Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms were reviewed at multidisciplinary meetings and the introduction of emergency/situational training,

The service worked in partnership with the NHS to trial new protocols of treatment. Following a successful trial at Bath Kidney Care Centre, a new protocol was being rolled out for patients at Bath and across other Fresenius Medical Care dialysis centres.