Castle Vale Renal Unit

On this page

• 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This was our first assessment of this service, and we rated it good for effective. This meant people’s outcomes were consistently good.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Each patient had a named nurse allocated to them. The named nurse was responsible for reviewing care and treatment plans and undertaking assessments on an ongoing basis to ensure continuity of care. On a daily basis nursing staff assessed all people receiving their dialysis treatment. This involved a detailed nursing assessment that included monitoring their weight, general health and wellbeing and any symptoms experienced since their last treatment.

Staff had received training in assessing the wellbeing and communication needs of people with additional needs, including those with protected characteristics. We reviewed the care of a patient with a learning disability and saw their assessment included their communication needs. People had hospital passports where they had additional needs. This included a summary of how best to support them. However, not all staff had received training in relation to caring for people with a learning disability and autistic people. Training completion was at 60%.

The service planned and delivered people's care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up to date policies to plan and deliver high quality care. Policies and protocols were based on relevant guidance including National Institute for Health and Care Excellence (NICE) and Renal Association guidelines. People were offered dialysis 3 times a week in line with Renal Association guidelines and were generally dialysed for 4 hours. Staff routinely assessed vascular access as part of treatment, in line with NICE quality statement 72 for adults with kidney failure.

Staff took account of what mattered to people in relation to their treatment. This included offering, where possible, the option to receive dialysis at the time of day preferable to them, while still ensuring the length and quality of dialysis was in line with national guidance.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they need to appropriately assess, plan and deliver people's care, treatment and support. Staff held regular and effective multidisciplinary meetings to discuss people and improve their care. Discussions about individual people, their treatment and blood results were regularly held with input from a consultant nephrologist, dietitian, renal nurses, vascular access nurses and a renal social worker. A monthly multidisciplinary and quality assurance meeting was held. This included discussions of people with additional needs and risks, those identified as vulnerable and those at the end of their life. We saw nursing staff regularly liaised with specialist teams, such as the trust vulnerabilities team to ensure they were providing the most effective care and support.

Information was shared between teams and services to ensure continuity of care. Staff worked across health care disciplines and with other agencies when required to care for people. This included regular liaison with GPs and district nurses, including visiting professionals seeing people during dialysis to manage the burden of appointments.

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, reduce their future needs for care and support.

Staff assessed each individual’s health at every dialysis session and provided support for individual needs to live a healthier lifestyle. People could access support from renal specialist staff, for example a renal dietitian. The dietitian was involved in multidisciplinary team meetings, providing regular reviews and advice to people. People were given additional dietetic support in relation to blood test results where additional need for support was identified. In addition, nursing staff were skilled and knowledgeable in relation to advising people on managing their health. Each dialysis session included a review of treatment and an assessment of people’s needs. Information on health promotion and healthier lifestyles was available through the service. Staff had also worked with the trust hypertension team to provide education and blood pressure monitors for people to use at home.

People had access to a home dialysis team where people were taught to undertake their own haemodialysis at home. The team were supporting 29 people at the time of our assessment. The service included regular education and home visits to monitor progress and provide support, as well as time within the home haemodialysis unit. In addition, people receiving dialysis within the service were encouraged to participate in their treatment with aspects of self-care. This included family members who had received training to support aspects of care.

The service monitored all people's care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and they fully met both clinical expectations and the expectations of people themselves.

Staff monitored the effectiveness of care and treatment in line with clinical standards. Blood results were collated and monitored to establish the effectiveness of treatment in line with Renal Association guidelines. Results were discussed at haemodialysis governance meetings across the trust and divisional quality and safety meetings. We reviewed the most recent benchmarking data from the Midlands Kidney Network and found the trust was performing well. For example, the service had a target of 80% of people receiving dialysis through an arterio-venous fistula or graft as the best route of access for dialysis treatment. Its performance was 87% against a national average of 55%.

Outcomes for people were positive, consistent and met expectations, such as national standards. The service benchmarked itself against other dialysis services through trust and national reporting. For example, we saw the service performed well in relation to the effectiveness of dialysis treatment.

Benchmarking data from 2022 showed the trust's performance for urea reduction ratio (URR) was within the top 20% of the country for performance in this area. The urea reduction rate is one measure of the quality of dialysis. The standard for URR is to be above 65%. Monthly figures provided by the service showed the proportion of people meeting the standard of a URR greater than 65% was 89%. Other measures of the effectiveness of dialysis showed positive results for the service, for example, where the achievement of the adequacy rate of dialysis was 88% against a national target of 75%.

Monthly performance results were reviewed as part of provider governance and quality reviews. Managers and staff carried out a comprehensive programme of repeated audits to check improvement over time. The clinic monitored areas such as water quality, infection control, records, blood results and medicines management.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff were aware of the need for ongoing assessment and that changes in mental capacity could occur. They monitored people for any changes as part of their ongoing assessment processes.

Staff gained consent from people for their care and treatment in line with legislation and guidance. Staff clearly recorded consent in the people’s records. We saw evidence of consent sought by staff when delivering treatment and care.

Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act (1983) and Mental Capacity Act (2005) and they knew who to contact for advice. They understood the processes for making decisions in the best interests of people who did not have the mental capacity to make their own decisions.