Castle Vale Renal Unit

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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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred, and sustainable, and to reduce inequalities.

This is the first assessment for this service. This key question has been rated good. This meant there was a strong culture of learning, improvement and innovation. Leaders and the culture they created ensured the delivery of high-quality care.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. People with protected characteristics felt supported. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There was a strong culture of continuous improvement with staff given time and resources to try new ideas, including attending and presenting at conferences. Staff had been awarded for their achievements in this area.

This service scored 82 (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 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.

The trust strategy had clear priorities around patients, people, potential, place and performance. A draft dialysis strategy was in the process of being developed, aligned with the trust strategy. Strategic priorities included creating a culture of research, working with system partners to address health inequalities and working across the Midlands Kidney Network to increase capacity of services to meet the needs of the community. The draft strategy was in the process of consultation with staff and other stakeholders before being finalised.

Management actions were aligned with the strategic priorities. For example, dialysis staff were encouraged to actively participate in research and present their findings at national conferences, sharing learning with colleagues and the local dialysis services.

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 dialysis unit manager responsible for the management of the unit, plus a renal dialysis matron who had oversight and responsibility for all dialysis units across the trust. Leaders were knowledgeable and experienced and clear about their responsibilities and reporting requirements.

Staff consistently told us service leads were visible and approachable, and they felt supported. People and their relatives told us they knew who the leads were, and they were approachable.

There was clear shift leadership on a day-to-day basis.

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

There was an up-to-date trust wide freedom to speak up policy. Staff understood how to access the speak-up guardians if needing to raise concerns. Staff told us they felt able to raise concerns directly with their manager and we saw daily huddles were held on the unit where staff shared updates and issues as needed.

A trust-wide staff survey was carried out annually. We saw results were reported for renal medicine as a whole across the trust. This included dialysis units and inpatient services. We saw 75% of the areas surveyed were shown within the results as positive or better than the trust average. Areas identified for improvement included staff experience of harassment, bullying or abuse from people. Results showed that within renal services this was slightly higher than the trust average. Leaders were aware of the results and were in the process of developing an action plan to address this.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust strategy included 4 inclusion / equality objectives. These included increasing representation across the workforce and building leadership capability and nurturing inclusive environments. Staff told us they celebrated diverse cultural events, including staff bringing in food as part of celebrations. Staff we spoke with demonstrated an understanding of cultural differences and leaders recognised this in terms of a positive impact on patient care.

The service had clearly defined responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Haemodialysis was managed within the specialist medicine clinical division group across the trust. Dialysis leads were involved in speciality meetings where strategy, performance and risk were reviewed. Lead dialysis nurse meetings were held monthly. These included a review of activity and performance across all trust dialysis units.

Policies and standard operating procedures were in use. We viewed a number of timely reviewed and ratified policies, including safeguarding and medicines management. In addition, there were other policies such as one relating to incident reporting in the process of being ratified by the trust.

Risk registers were maintained and risks managed appropriately. We saw that risk registers were reviewed at lead nurse meetings and updates were reported into the care quality board. In addition, incidents, safety alerts, performance metrics and governance data were collated within the care quality report. We reviewed minutes of governance meetings and saw relevant issues were discussed, for example, around performance, incidents and access.

Performance was managed operationally and data used to inform leaders of areas of good performance and those needing improvement. The trust participated in providing key performance indicator data as part of the Midlands Kidney Network dashboard. Outcomes were consistent and positive.

The service understood its duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learning with partners and collaborated for improvement.

Information about operational management including aspects of learning, improvement and performance were shared with all dialysis units across the trust. There were examples of improvements because of incidents that had occurred in other units. This included the development of accessible packs to make disconnecting people from dialysis during an emergency more efficient.

Staff and leaders recognised the importance of collaborative working to ensure a seamless transition for people. We also saw the service was connected within the Midlands Kidney Network and staff participated in conferences and engagement events.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. Staff always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research.

There were clear processes for continuous learning and examples where improvements had been made as a result. Leaders and staff had implemented safety improvements because of incidents that had occurred in other dialysis units. This included the implementation of a sepsis pathway, the use of an early warning score and enhanced evacuation plans to disconnect from dialysis in an emergency. The service had also adopted ultrasound guided needling due to evidence that this supported the maintenance of arterio-venous fistulas more so than ‘blind’ needling, with staff training and competency assessments in place to develop this further.

Staff actively contributed to research and development. We saw a presentation was scheduled for the 2025 UK Kidney Week Conference around optimising needle length when needling arteriovenous fistulas. Findings from the study undertaken at Castle Vale Renal Unit found that using shorter needles improved comfort and reduced complications.

Other areas of improvement included the development of an internal ‘kidney day’ where staff worked to educate people and their family members about genetic and familial factors contributing to chronic renal failure. Actions included working with the trust hypertension team to provide blood pressure monitors to family members where there was a strong history of high blood pressure and chronic renal failure in the family. This enabled family members to monitor their blood pressure and identify issues earlier than they otherwise would have.

Staff had been recognised and awarded for their work. This included a gold medal support award from Birmingham City University for their contribution to practice education and support for student nurses.