Farnborough Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The unit is accommodated in a modern purpose built building. The unit consists of 26 stations configured in three bays; two of eight stations, one of six stations and four side rooms.

The unit is contracted by an NHS trust to provide haemodialysis to adult patients who are referred by the NHS trust. All the patients are under the care of the NHS consultants at the NHS trust.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 10 May 2017, along with an unannounced visit to the service on 16 May 2017.

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?

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

We regulate dialysis services but we do not currently have a legal duty to rate them. 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:

• Staff reported incidents which were investigated and actions taken in response to share learning.

• The unit was clean and organised. There was suitable provision of isolation rooms to minimise the risk of cross infection when needed.

• We reviewed the records which demonstrated the service monitored and maintained the environment, equipment, including dialysis machines and water systems to ensure dialysis services were provided safely.

• The majority of staff were up to date with mandatory training and all permanent staff had received an appraisal in the previous 12 months.

• Patients’ dialysis care was transferred to the unit by the NHS trust when a suitable slot became available. There was no waiting list for the unit. Patient outcomes were monitored and reported to the host NHS trust for submission to the Renal Registry. The clinic manager monitored ‘treatment variances’ to identify themes and trends.

• Staff followed evidence based treatment and best practice guidance to ensure patients’ care was planned and delivered effectively. This was documented in the Nephrocare standard for good dialysis.

• The unit had close links with the NHS trust to ensure care was patient centred and appropriate communication was shared between the unit and NHS trust.

• Staff demonstrated a caring and compassionate attitude to patients.

• Patients were very positive about the care they received. They felt they were treated with respect and dignity and engaged to share their views through meetings and surveys.

• The service investigated complaints, took action and responded fully to the complainant..

• The unit was led by an experienced manager and senior team who were available and accessible to their staff.

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

• Nursing staff were not trained to safeguarding children level 2 in accordance with national guidance.

• The service did not follow strict procedures for checking medicines before administration which increased the risk to patients of medication errors.

• The service did not carry out medicines management audits to identify compliance with procedures and actions for learning.

• The service did not have full documented consent to care and treatment for all patients in line with legislation and guidance.

• Staff did not always follow infection control procedures to ensure the clean field was maintained.

• The service did not have sufficient arrangements for appropriate information and interpreting services for patients who cannot communicate in English, in line with the Accessible Information Standard.

• The service did not record all patient transfers from the unit as clinical incidents. This meant they were not always investigated for learning points.

• The unit had a high level of staff vacancies which was managed by the use of agency and bank staff.

• The response rate for the 2017 unit staff survey was 59% which did not indicate a high level of staff engagement.

• The response rate for the 2016 patient survey was low at 34% which did not indicate a high level of patient engagement.

• The service had not implemented the Workforce Race Equality Standards 2015 (WRES).

• The provider did not formally monitor or audit, arrival and pick up times, for patients who used patient transport services, against NICE quality standards.

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 two requirement notice(s). Details are at the end of the report.

Professor Edward Baker

Deputy Chief Inspector of Hospitals (South)