DaVita (UK) Ltd - Boston Also known as Renal Services (UK) Ltd

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s needs were met through good organisation and delivery.

We have not awarded this service a score for Responsive.

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

The service made sure patients were at the centre of their care and treatment choices, and they decided, in partnership with people, how to respond to any relevant changes in patients’ needs. Patients understood their condition, care and treatment. Staff were able to answer the questions the patient had in respect of their treatment. This enabled patients to make decisions about their care and treatment. These were recorded in their patient records. However, we did not see any patients centred interactions that were not clinically focused.

The service used the Patient Reported Experience Outcomes (PREMS) system to monitor patient experience. This survey covered all aspects of care including “sharing decision making about your care”. From 2020 to 2024 the score for this aspect rose continually from 3.4 to 5.9 out of a potential score of 10. We reviewed the outcomes from the 2025 survey, and this had dropped slightly. Senior staff told us that this may be the impact of taking patients from other areas where there were capacity issues.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. The service mainly took patients from the local area. Where other services were having capacity issues, they would take patients on a temporary basis whilst these patients awaited space back at their original dialysis clinic. Patients attended the service 3 times a week. The schedule was generally set but could be flexed to meet their needs. Staff knew and understood the diverse needs of their patients, without reference to their care plans. Patients confirmed with us that staff were aware of their individual needs.

Staff at the unit reported that they had good working relationships with the NHS staff. They said that they could contact medical staff whenever they needed advice and support. Whilst the unit was unable to access the patients NHS system records of ward rounds were kept at the unit. There were clear escalation processes in place. Whilst “ward rounds” were held on the unit every 3 months, appointments for patients were held at either the local trust or at the Regional NHS renal centre. This did mean some travel was required to attend these.

We spoke to a friend who was supporting a patient from a care home. They told us that the staff in the unit wrote any changes to treatments or information on the session undertaken in a diary which accompanied this person back to the care home in order that care was provided in a cohesive manner across care givers. Staff spoke to us about a vulnerable patient who they had directed to the appropriate services to support them. The staff at the service liaised with the new service to identify areas of support required.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual care needs. There were many leaflets about a variety of medical conditions in the waiting room. Whilst these were written in English most patients we spoke with could understand the leaflet. They stated that if they were struggling the staff would assist them in understanding. A representative from a kidney charity was regularly available to speak to patients about their concerns and to sign post them to further support.

The service meets the requirements of the Accessible Information Standard by identifying, recording, flagging, sharing and meeting the information and communication needs of people with a disability or sensory loss. Staff were aware of the patients whose first language was not English. Whilst the staff spoke several different languages, they had access to translators should they be required. The service did not see carers and family of the patient unless they were involved in bringing them to the unit.

Staff ensured patients were fully informed about their dialysis treatment and the effectiveness of it. Multidisciplinary reviews included the centre staff, the NHS consultant and the patient. This meant the patient was fully informed about their dialysis treatment and any changes required in their treatment. This also enabled the patients to make informed decisions about their treatment. One patient spoke with felt fully informed about their condition and had explored the options as to when the best time to take their heart medication was with the clinical team. They felt that this enabled them to retain some control of their care.

The representative from the kidney charity visited the unit and provided access to further information and support to patients using the unit and their families. They attended the patient forums to support patients and provide advice and information as required

Patients did not have regular access to structured feedback sessions such as patient forums, which limited opportunities to listen and involve patients. However, the service made it easy for patients to raise complaints about their care, treatment, and support. They involved people in decisions about their care and told them what had changed as a result. The service held patient forums to gather feedback and involve patients in service development. However, the most recent forum had taken place in November 2025, which did not demonstrate regular or consistent engagement with patients.

Best practice was to hold patient forums at regular intervals to ensure feedback is current and used to drive improvement. Senior staff told us the lack of a patient forum was due to the manager leaving and a replacement being sought. However, when we explored this there was only a couple of months gap between managers. The lack of recent forums limited opportunities for patients to share their views and for the service to respond in a timely way. This meant the service had missed feedback from some patients about a preference for meaningful interactions and social activities.

We reviewed the minutes for this forum, May 2025 and November 2025, and saw that the main complaint from patients was around transportation of patients to and from the dialysis unit. However, other issues raised included a delay in medication from the patients GP, TV remotes not working and one compliment from a patient. A member of the transport service attended this meeting as did the kidney charity worker to provide support and resolve issues. Transportation was the biggest issues within the unit. Following this, the service met with the ambulance service fortnightly to investigate and try to resolve specific issues. However, we saw during our inspection that other issues were still not resolved such as enough working remote controls.

Most patients knew how to make a complaint. There were posters around the unit which informed patients how to make a complaint. There had been three complaints, and these revolved around patient transport, communication and the appointment times. Whilst patient transport was not the responsibility of the service the senior team investigated and responded to complaints in a timely manner. A consistent complaint was around patient transport and fortnightly meetings with the transport provider had been arranged by the provider of the dialysis service to understand and to try to improve this. Patients were aware of these meetings.

The service made sure that patients who had been assessed as suitable could access the care, support and treatment they needed when they needed it. Staff could provide renal dialysis for up to 75 patients over the 5 set sessions. However, at present they had some capacity as they had only 70 patients regularly attending for treatment. This meant that whilst most patients were from the local area some patients had to travel to this unit whilst they awaited a space to become available at their local centre. There was a criterion for patients that the unit could accept. Any patients’ needs were discussed with the leadership team prior to admission to the unit.

The unit was on the ground floor so had been adapted to undertake dialysis sessions for people who used wheelchairs. Mobility aids were available for patients who required these such as hoists and slings. Staff were knowledgeable about the mobility issues their regular patients faced and how to assist them to manage these. Patients generally stayed in the same session for treatment. However, special circumstances could be arranged as the unit was running slightly below full capacity.

All staff had undertaken training on supporting people living with dementia. The staff were supporting a person living with dementia on our inspection. Whilst a friend was supporting the patient during their treatment, providing one to one care and observation, the units senior management were working with the local integrated care board (ICB) to provide specialist help to this patient. Staff could access additional support to meet their own learning needs in this area. Where required the unit had side rooms where patients who required a quiet space could be dialised.

Whilst patients could access the services of the unit some struggled with transportation to and from their treatments. A transport service which had been provided by the provider was now commissioned by the ICB. The patient transport service was provided for by the local ambulance NHS trust and patients complained of the waiting times they experienced when using this service. All staff were aware of this and the senior team met regularly with the service to investigate individual issues. All transport delays were logged in the electronic incident reporting system by staff. Some patients reported that journeys could take hours after their treatment. Patients who arrived late for their session always received dialysis. However, delays on return journeys occurred within the journey itself. Patients felt that others who lived further away were dropped first and those who lived closest were dropped last. Patients who did not arrive were contacted and encouraged to attend the unit. Persistent non-attenders had special appointments to discuss why they were not attending.

Staff and leaders understood about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. Staff had and were up to date with training in equity and diversity. The makeup of patients within the unit was very multicultural, which reflected the local population. Staff and leaders recognised the additional health aspects that this group of patients experienced. Patients with poor renal function are more likely to have other diseases which impact upon their kidney function such as a cardiac condition. A cardiac condition which is also influenced by several factors including race. Cardiac conditions would be managed by the patients healthcare provider and not the renal dialysis unit.

Boston has one of the highest proportions of Eastern European immigrants in England and Wales. With cardiovascular diseases being the leading cause of death in Eastern Europe this means that Eastern European patients at the unit would be statistically more likely to have both diseases. The unit provided information and advice to patients on cardiovascular disease. They monitored the mortality rate for all patients, and this was currently 8.9% the company target was 8% so Boston was out of line with the organisations target.

The unit did not have any patients who would be likely to experience inequality in experience or outcomes, apart from those whose ethnicity demonstrated higher rates of ill health. There was no evidence to suggest that the service had any patients who were homeless, suffered from any form of autism or otherwise may experience inequality. The service ensured that it could meet the needs of the individual on booking.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Patients we spoke with felt the information they were given was clear and accurate and provided in a way they could understand. Patients were supported to make informed choices about their care and plan for the future. Patients had personalised care and treatment plans to suit their needs based on their personal preferences.

Staff worked well together as an effective multidisciplinary team. There was input from NHS staff, including dietitian and medical staff which ensured patients were fully informed and supported in their care in line with national guidance.

Although staff were not actively involved in supporting patients with end-of-life decisions they respected patient’s choices. Throughout the patient renal care treatment, they were advised about the benefits and risks of having and not having dialysis. This meant if they made the decision to discontinue dialysis it was an informed decision and they understood the likely outcomes from the decision.