Havant Renal Unit

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service promoted a positive learning culture. Staff understood how to identify and report incidents and were confident using reporting systems. Incidents and near misses were reviewed through established governance processes, including team meetings, handovers and clinical governance forums. Leaders used these discussions to identify themes, share learning and implement improvements to reduce future risks. Staff recognised the value of reporting near misses and described how learning was shared openly across the service to help prevent incidents from occurring in the future. A near miss is an unexpected or unplanned incident that did not cause harm to a patient or staff member but easily could have.

The service had clear policies and procedures for reporting, investigating, and managing incidents. Incidents were reviewed according to the level of harm caused and followed a process for investigation, escalation, and closure. Staff understood their responsibilities under the duty of candour. We saw evidence patients were informed, supported, and given an explanation when incidents occurred. Duty of Candour is a legal requirement for healthcare providers to be open and honest with patients and their families when something goes wrong.

Investigations looked at the causes of incidents, factors that contributed to them, actions needed to reduce future risk, and lessons learned. Learning was shared through clinic meetings, nurse handovers, and area meetings. Findings from investigations were used to update policies and procedures, provide additional training, and review staff competency where needed. For example, after a medication-related patient safety incident, the service carried out a full investigation and followed the duty of candour process. The investigation identified lessons learned and led to improvements in how medicines were managed. This included additional staff training and stronger checking processes to help prevent a similar incident from happening again.

The service also demonstrated learning from incidents involving patient falls. These incidents were discussed during nurse handovers, clinic meetings, and area meetings to ensure lessons were shared. Investigations highlighted the importance of regular falls risk assessments, personalised falls prevention plans, good communication between staff, accurate personal emergency evacuation plans, and environmental safety checks. Actions included providing more education for patients, improving supervision of those at high risk of falling, and strengthening communication about changes in patient risk.

The service had clear systems and processes to make sure patients received safe, coordinated care when moving between services. Havant Dialysis Unit worked closely with a local NHS trust to provide dialysis treatment and maintain continuity of care when patients transferred between hospital and community-based dialysis services. Staff shared important clinical information with referring teams to support safe and smooth transfers.

The service had a clear criterion for accepting new patients. Before treatment started, staff reviewed referrals to make sure they had all the information needed and only accepted patients whose needs could be safely met at the unit. This included checking patients were stable, had working dialysis access, and did not need equipment or treatment the unit could not provide. They also reviewed infection risks, oxygen requirements, medicines, and resuscitation decisions to ensure all relevant information was available before treatment began. More complex referrals were reviewed by senior clinical staff and consultants when needed. Any exceptions were recorded and monitored.

The service used electronic patient records to support communication and continuity of care. Staff recorded information from every dialysis session, including patient weights before and after treatment and other nursing observations. Consultants could access these records to monitor patients and support clinical decision-making.

The service had clear processes for managing patients whose health changed or who could not safely receive dialysis. If a patient became unwell before treatment, staff carried out assessments, checked observations, and sought medical advice when needed. They informed the renal team, escalated concerns, and arranged transfer to an acute hospital when required. Relevant clinical information was shared to support safe ongoing care.

The unit had clear emergency procedures for patients who became seriously unwell during treatment. Staff were trained to respond to medical emergencies, including cardiac arrest, and followed procedures such as calling emergency services, starting resuscitation, and arranging emergency transfer where necessary. Guidance was available to help staff respond quickly and consistently if a patient became unresponsive or unwell during dialysis.

The service followed an agreed transfer policy that supported the safe movement of patients between renal services and, when required, enabled patients to return to their local hospital for ongoing care. This helped services work together effectively, manage capacity, and ensure patients continued to receive specialist renal care.

The service had effective systems to protect patients from abuse, neglect and harm. A safeguarding policy, based on the Care Act 2014, provided staff with clear guidance on how to identify, report and respond to safeguarding concerns. It also outlined staff responsibilities for protecting adults at risk and promoting the welfare of children and young people when required.

Safeguarding leadership and training were well established within the unit. The Director of Nursing had completed Level 4 Adult Safeguarding training, while the Clinic Manager, Deputy Clinic Manager and Clinic Lead had completed Level 3 Adult Safeguarding training. Overall compliance with safeguarding training was 95%, with the majority of staff having completed the level of training appropriate to their role. This helped ensure staff had the knowledge and skills to recognise and respond to concerns.

Staff demonstrated a good understanding of safeguarding. They could describe the signs of abuse or neglect, explain how to raise concerns, and understood the correct reporting and referral processes. They also knew where to seek advice and support and gave examples that showed their commitment to keeping people safe.

Staff supported patients to understand their rights and provided care that respected their dignity, individuality and personal circumstances. They understood the requirements of the Mental Capacity Act 2005 and the Equality Act 2010 and described how they adapted care to meet individual needs. This helped ensure patients received inclusive care that respected their rights and protected characteristics.

The service involved patients in managing risks associated with their care and treatment. Staff completed individual risk assessments covering areas such as falls, pressure damage and emergency evacuation needs and developed care plans to reduce identified risks. Patients told us they were involved in these assessments, understood the risks associated with their treatment and felt comfortable raising concerns with staff.

Staff monitored patients’ health through regular assessments, consultant reviews and monthly blood test monitoring to identify emerging risks and changes in clinical need. Clear pathways supported the recognition and escalation of clinical deterioration, including the use of the National Early Warning Score (NEWS2), escalation procedures and access to advice from the local NHS trust. Staff used the SBAR communication tool during handovers and transfers to ensure important clinical information was shared effectively. When required, patients were transferred to the local NHS trust with relevant documentation to support safe continuity of care.

During the assessment, we observed staff respond promptly to a patient whose condition had deteriorated. Staff increased the frequency of observations, administered oxygen, sought support from senior nurses and contacted paramedics. They remained calm and organised throughout the incident, maintained the patient’s privacy and dignity and ensured emergency equipment was readily available.

Staff took steps to reduce risks associated with dialysis treatment. They followed procedures to safely secure and monitor dialysis needles and bloodlines, helping to reduce the risk of needle dislodgement and blood loss. Patients told us they could clearly see their dialysis lines during treatment, allowing any concerns to be identified quickly.

The service also managed operational risks effectively and had arrangements to maintain continuity of care. Following a water treatment system failure, staff implemented business continuity plans, informed patients and worked with the local NHS trust to safely transfer patients to another dialysis unit. As a result, no patients missed their dialysis treatment. The incident was reviewed through governance processes and plans were made to replace the water treatment system.

Staff followed up patients who did not attend dialysis appointments, explained the risks of missed treatment and encouraged them to contact the unit if they experienced difficulties attending. Where patients could not be contacted, staff carried out welfare checks to help ensure they remained safe. These arrangements demonstrated a proactive approach to identifying and managing risks.

The service provided a safe environment for patients, visitors and staff. Clinical areas were clean, tidy and free from hazards, and treatment and storage areas were well organised. Staff completed regular environmental and equipment checks, including daily monitoring of the water treatment system and monthly checks of emergency evacuation equipment. Waste was managed safely, sharps bins were not overfilled, and emergency equipment, including an evacuation chair, was available and ready for use.

Equipment was maintained through a planned servicing programme. Records showed dialysis machines, water treatment equipment, infusion pumps, defibrillators, weighing scales, hoists and therapy chairs had been serviced and tested at the required intervals. Staff also completed regular checks of emergency equipment, and records confirmed resuscitation trolleys were checked consistently. Fire drills and emergency simulation exercises took place every 6 months to support staff preparedness.

Staff took prompt action when equipment faults were identified. Damaged items were removed from use until repaired and confirmed safe. Records demonstrated oversight of maintenance, safety testing and environmental monitoring.

We identified a small number of areas for improvement. Four wheelchairs and 2 infusion pumps did not display servicing labels, making it difficult for staff to immediately confirm servicing status at the point of use. Although maintenance records confirmed the equipment had been serviced and was safe to use, the lack of labels represented an inconsistency in practice. Leaders accepted responsibility for this and committed to ensuring equipment was clearly labelled in future.

We also identified concerns about the security of clinical waste storage. An external clinical waste bin had been left unlocked within a compound that could be accessed by members of the public, creating a potential risk of unauthorised access. Leaders responded immediately by securing the bin and strengthening oversight of the area. Although this was an isolated incident, responsibility for the safe storage of clinical waste remained with the service, and leaders recognised the need to reduce the risk of recurrence.

The service had enough staff with the right skills, qualifications and experience to meet patients' needs safely. At the time of inspection, the unit employed 28 staff members and had no vacancies. Managers monitored staffing levels, staff turnover and sickness absence to make sure staffing remained safe. Although 4 staff had left and 2 had been recruited or rehired in the previous year, the turnover rate was low at 13.8%, showing the workforce was generally stable.

The unit mainly employed permanent staff, with limited reliance on temporary workers. Records showed a bank nurse had worked only 37 hours in the previous 6 months and no agency staff had been used. This was particularly important given the specialist nature of the service, as it enabled leaders to maintain a consistent workforce with the skills, experience and competencies needed to deliver safe and effective renal care. Leaders told us staffing levels had remained above the minimum requirement and they could respond flexibly to short-term staff absences. While sickness rates varied during the year, there were no staff on long-term sick leave.

Staff described a clear process for managing unexpected absences. Managers reviewed patient numbers and staffing levels daily to ensure care could be delivered safely. The service aimed for 1 registered nurse for every 4 patients and 1 healthcare assistant for every 8 patients. Leaders told us dialysis treatment would not start until staffing levels were safe At least 2 trained nurses were always based on the upper floor to provide support for patients. The unit manager was also a trained renal nurse and could provide clinical support when needed.

Staff told us there were enough colleagues on duty to meet patients' needs and described a supportive team culture. They said staff helped one another complete training and development activities during working hours. A range of shift patterns ensured cover throughout the day, and structured handovers between shifts supported continuity and patient safety.

The service supported staff learning and development. Staff received appraisals twice a year, alongside annual performance reviews, to monitor performance and identify development needs. Records confirmed appraisals had been completed. Staff told us they were encouraged to develop their skills, and some were preparing for new roles and responsibilities. Leaders spoke positively about the organisation's mentorship programme, and 2 nurses were completing specialist renal training.

The provider had effective systems to make sure staff were competent to deliver dialysis care. Staff completed a structured training programme covering areas such as renal physiology, vascular access, dialysis treatment, patient assessment, incident management and emergency response. Training records showed 100% completion of the programme and competency assessments. Staff also completed additional haemodialysis training on the safe use of dialysis machines, responding to alarms, troubleshooting problems and managing emergencies.

The service promoted ongoing learning through weekly education sessions. Topics included patient experience, central venous catheter management, air embolus management and personal emergency evacuation plans. These sessions helped staff keep their knowledge up to date and support their professional development.

Recruitment processes included pre-employment checks. We reviewed 3 staff files and found all necessary checks, including Disclosure and Barring Service (DBS) checks, had been completed.

The service followed good infection prevention and control (IPC) practices to help keep patients safe. Staff handled and disposed of clinical waste correctly and completed regular hygiene and IPC audits. Cleaning standards were consistently high, with cleaning audit scores of 100% in May 2026 and 99% in June 2026. During the inspection, staff practised good hand hygiene, with handwashing facilities, hand sanitiser and IPC information available throughout the unit. Staff washed their hands before and after contact with patients, remained bare below the elbows, wore personal protective equipment (PPE), including visors, and cleaned equipment between dialysis sessions. Staff also used Aseptic Non-Touch Technique (ANTT) when disconnecting patients from dialysis machines, helping to reduce the risk of infection.

Although there were no doctors based at the unit, staff had clear processes for escalating infection concerns. They could contact an on-call renal registrar for advice and told us they received timely support when they needed clinical input about possible dialysis access infections. This helped ensure patients received an assessment and treatment when required.

The service monitored cleanliness and infection risks within the environment. Earlier in the year, legionella was found in some sinks. Leaders acted quickly by putting in an action plan and taking the affected sinks out of use until the problem was resolved. The service also monitored infections linked to dialysis access lines. There had been no cases of central venous catheter (CVC) infection in the previous 6 months, demonstrating effective infection prevention measures.

An environmental cleanliness survey carried out in May 2026 scored 93.2%, showing generally good cleaning standards. Most areas, including floors, walls, ceilings, doors, equipment and frequently touched surfaces, were clean. However, the survey identified some dust on low-level surfaces and debris behind a patient bed. Staff told us there had been challenges with cleaning services during a change of cleaning contractors, which meant the planned cleaning audit was not completed in June 2026. Leaders added this to the risk register and introduced an action plan, including recruiting dedicated staff to provide additional daytime cleaning. Clinical staff worked to maintain cleanliness standards while the new arrangements were put in place.

During the inspection, we observed good infection control practices throughout the clinic. Staff cleaned equipment between patients, wore appropriate PPE and followed hand hygiene requirements. Gloves and aprons were available outside side rooms. Two side rooms were available on the ground floor and could be used for patient isolation when clinically indicated. Staff told us IPC signage was displayed at the entrance to identify the required infection prevention and control precautions when the room was in use for isolation. Isolation signage was removed when the room was being used for non-isolation purposes. In one room, we found tape residue on a blood pressure cuff, some staining and ingrained marks on the floor, dust in high-level areas and watermarks on a patient mattress. While these issues did not reflect the generally good IPC standards seen elsewhere, they highlighted areas where environmental cleanliness and equipment maintenance could be improved.

The service managed medicines safely and followed national guidance. Staff worked in line with the provider's medicines management policy, which explained how medicines should be ordered, stored, administered and disposed of. The policy also included guidance on managing patients' own medicines and aimed to ensure legal requirements were met and medicines were handled consistently and safely.

Medicines were stored securely. During the inspection, we found 2 medicine cupboards that were locked, well organised and well stocked. All medicines we checked were within their expiry dates, and there was no evidence of overstocking. Haemodialysis fluids were stored in a dedicated storeroom maintained in line with guidance. A reminder notice was displayed to ensure staff kept the air conditioning running to maintain the correct temperature. Compressed gases were also stored safely in a locked room.

The service monitored storage conditions effectively. Staff carried out and recorded daily temperature checks of medicine refrigerators, and records showed temperatures remained within the required range. This helped ensure medicines were safe and effective to use.

Staff completed mandatory medicines management training and administered and recorded medicines in line with national guidance and professional standards. Patients' dialysis prescriptions were regularly reviewed through multidisciplinary discussions involving the NHS renal consultant’s and staff from Havant Renal Unit to make sure treatment continued to meet patients' needs.

When changes to prescriptions were needed, staff acted promptly. They contacted the prescribing doctor and told us they usually received a quick response, allowing treatment changes to be made without unnecessary delay. This helped ensure patients received the right treatment at the right time.