Overall patients we spoke with and evidence in satisfaction surveys told us patients were very satisfied with the service. Those we spoke to told us:

“Excellent, I am really impressed with the unit”,

“Its first class, perfect, couldn’t be better”.

We found that there were suitable systems in place to gain consent from patients. Staff who obtained consent were experienced and knowledgeable in renal care. They were able to describe the consent process and implications for consent in those patients who did not have capacity.

We found that patients care and treatment was assessed, planned and delivered in order to meet their needs. Care and treatment plans were reviewed regularly and patients were fully informed and involved in their care.

The provider had systems in place in order to minimise the risk of infection to patients, staff and other visitors to the unit. Infection control audits were undertaken regularly to monitor infection prevention and control. Cleaning schedules were delivered effectively and staff were aware of their responsibilities with respect to infection prevention and control.

There were sufficient numbers of suitably qualified and experienced staff in order to care for the patients.

We found the provider had effective systems in place for monitoring the quality of services. Regular audits were undertaken across the unit, there was an effective complaints process and regular patient satisfaction surveys were undertaken.

We spoke to people who use the service when we visited. They told us the service was "Excellent", “Very good” and “Very nice”. They all said they felt involved in their care and treatment and received plenty of good verbal information regarding their condition and treatment options. They were able to make choices about their dialysis treatment plan. They also told us they had seen written information in and around the unit and had been given a patient’s guide when they first started with their treatment. Those we spoke with told us they were treated with dignity and respect at all times.

People who use the service told us they were well cared for by staff. We were told:

“They are excellent, they bend over backwards and can’t do enough for you”, “They go above and beyond their duty of care”.

People whom we spoke with told us they felt confident with the skills and knowledge of staff working at the unit. They knew how to make comments or complain and had seen relevant information around the unit. They told us they had been asked to participate in the satisfaction survey on occasions.

Clatterbridge NHS Dialysis Unit is operated by Fresenius Medical Care Renal Services Ltd. The unit has 10 dialysis stations in the main ward and two side rooms.

The service provides dialysis services for people over the age of 18, and does not provide treatment for children.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 8 June 2017, along with an unannounced visit to the unit on 22 June 2017.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate dialysis therapy services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• There were processes to control and prevent the risk of infection. We saw that the environment appeared clean and audits of the environment took place to provide assurance.
• All dialysis equipment was approved and compliant with relevant safety standards. This was in accordance with the Renal Association guidelines.
• We saw there were appropriate processes to support those patients with blood borne viruses (BBV). There were two side rooms and there was routine blood testing for BBV.
• We observed that patients’ fistulas or central venous catheters were assessed pre and post dialysis for infection, with any variances recorded via the electronic system.
• The Fresenius service had developed a Nephrocare standard for good dialysis care based upon standards of best practice.
• The service had a multi-disciplinary approach to patients’ care and treatment.
• Information about the outcomes of patients’ care and treatment was collected and monitored by the service to ensure good quality care outcomes were achieved for each patient.
• 100% of patients were receiving Hi Flux dialysis. This is considered a better form of dialysis for patients.
• All patients we asked reported the staff were caring and respectful and they were happy with their care and treatment.
• Every patient had an individualised treatment prescription to ensure effective dialysis treatment.
• There was no waiting list for treatment. This meant that there were no patients waiting to start treatment.
• We observed that managers were visible and approachable on the unit and provided support to staff as required.

However, we also found the following issues that the service provider needs to improve:

• The service did not have a policy or provide training for nursing staff with regards to identification or process for sepsis management.
• We observed one occasion where staff did not confirm the patient’s identity prior to commencing dialysis.
• Dialysis assistants were not dialysing patients in line with the Nephrocare standard for good dialysis care or the safety bulletin dated 12 May 2017. Dialysis assistants were unable to access the trust prescribing system which would enable them to utilise saline during the cannulation process.
• We found that patient records had incorrectly completed or incomplete DNACPR forms stored in them.
• The service did not have or maintain a Workforce Race Equality Standard (WRES) action plan or publish data with regards to monitoring staff equality.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice(s) that affected dialysis services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals