DaVita (UK) Ltd - North Poole

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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 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.

The evidence showed some shortfalls. Patients’ needs were not always assessed effectively or in a timely way.

Patients’ records did not always show how their needs were being assessed. There were gaps in some patients’ assessment records where checks had not been carried out at the expected frequency. For example, foot checks were recorded monthly, rather than weekly, for one patient with diabetes. We also saw entries referring to upcoming podiatry appointments rather than confirming staff had checked the patient’s feet.

Risk assessments were used to monitor patients’ skin. However, records showed that one patient with a score indicating the need for monthly review had not been reassessed within the expected timeframe. Their score increased from 12 to 14 between assessments, highlighting the importance of timely reassessment to ensure risks were identified and managed promptly.

The service considered patients’ information and communication needs as part of the assessment process. However, records did not contain person-centred detail about how individual communication needs were understood and supported. For example, although one patient’s record indicated they had a learning disability and had a care worker accompanying them during dialysis treatment, there was limited information about their communication needs or any adjustments required by staff to facilitate effective engagement.

Following a patient safety review, the service identified a discrepancy between a patient’s falls history and their falls risk assessment. The clinical team was taking action to review the falls assessment process to ensure risks were identified and managed.

Patients’ treatment schedules were clearly documented so that both staff and patients knew when treatment was taking place.

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.

Patients received care and treatment reflecting current evidence-based guidance and national standards. The service followed policies and procedures developed by DaVita UK alongside relevant policies from the local NHS trust which retained overall responsibility for patients’ clinical management.

Staff demonstrated an understanding of evidence-based approaches to care. The service had recently introduced a shared care programme in line with national renal guidance. This aimed to support patients in developing knowledge, skills and confidence to participate in their own treatment and, where required, transition to home dialysis. A structured competency-based process enabled patients to progress through stages of learning, supervised practice and independent performance of dialysis-related tasks. Staff used a shared care competency handbook to monitor patients’ progress and ensure patients had opportunities to develop skills in line with recognised standards. This ensured that patients had opportunities to participate in their dialysis treatment if they wished.

The service had an audit programme to monitor compliance with policies and procedures and standards of care delivery. These audits provided some assurance that staff practice remained aligned with national guidance and organisational policies supporting the delivery of safe and effective care.

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 demonstrated effective partnership working with a range of professionals, teams and organisations to ensure people received coordinated and joined-up care. The service was commissioned to provide renal dialysis to NHS patients, all of whom remained under the care of a named renal consultant at the local NHS trust. Staff described strong working relationships with trust colleagues and told us they could contact the team for advice and support when required. Some NHS staff were based within the clinic premises which further supported communication and timely access to patient information.

Staff were involved in multidisciplinary team meetings to discuss and plan patients’ dialysis treatment. Meetings supported effective information sharing, joint decision-making and co-ordinated care planning between professionals involved in patients’ treatment. For example, recognition and referral of patients with vascular access issues to the specialist nursing team had improved significantly over the past year. This demonstrated how the service worked closely with their partners to improve treatment effectiveness.

The service worked closely with a national kidney charity to provide holistic support for patients and their families. Staff described collaborative relationships with respect for each other’s roles and responsibilities. This ensured patients could access practical, emotional and financial support alongside their clinical care.

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.

Patients were supported to live healthier lives through access to personalised advice and wider wellbeing support. Information available covered healthy living topics including falls prevention, pressure ulcer prevention, exercise and wellbeing, nutrition, and women’s health. Information was tailored to meet the specific needs of people with kidney disease and included details of relevant support organisations and community networks.

Records demonstrated that staff supported patients to understand and manage their health conditions including recognising symptoms of concern and knowing when and how to seek appropriate help. Patients told us they received clear information about their condition, enabling them to make informed decisions and take an active role in their care.

Staff showed a holistic approach to supporting patients’ health by identifying when people would benefit from additional practical, emotional, or social support. Staff made referrals so patients could access the support they needed. This coordinated approach helped address factors affecting health, wellbeing and quality of life.

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.

Patient outcomes were monitored and reviewed to ensure treatment met their needs. Patients received ongoing review by their consultant at a local NHS trust, including regular assessment of dialysis prescriptions, to ensure they received appropriate treatment. Patient health and treatment outcomes were closely monitored, with records demonstrating communication and shared decision-making between hospital specialists, clinic staff and patients.

Staff described having timely access to advice and support from the renal team about patients’ health concerns ensuring prompt clinical review and continuity of care. This collaborative approach supported effective monitoring of patients’ progress and informed treatment decisions.

The service used key performance indicators (KPIs) to monitor the quality and effectiveness of care and treatment. Performance data was reviewed with the service commissioner to identify opportunities for improvement. For example, the service was undertaking work to monitor non-attendance at dialysis sessions and analyse reasons for hospital admissions. This information would be used to improve treatment adherence and identify improved ways of reducing avoidable admissions to hospital.

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.

Patients were supported to make informed decisions about their care and treatment. Records showed that patients had given consent for dialysis treatment after receiving information which included potential risks and side effects. Patients confirmed that treatment options and their implications had been explained to them.

Staff understood their responsibilities about consent. Staff sought consent before and during treatment maintaining an ongoing dialogue with patients about their care. Records demonstrated that staff acted promptly in response to patients’ decisions including where consent was withdrawn. For example, when a patient chose to end a treatment session early, staff ensured they understood the associated risks and offered alternative treatment sessions, counselling and review by the on-call consultant. The patient’s informed decision to decline these options was respected and clearly documented. Where there were concerns about a patient’s ability to make decisions or give consent for treatment, staff worked in partnership with the local NHS trust following their consent policy which provided guidance on consent, capacity, and lawful decision-making.