Alnwick Dialysis Unit is operated by Renal Services (UK) Limited. The unit is a satellite dialysis unit contracted by Newcastle upon Tyne NHS Foundation Trust to provide haemodialysis to NHS patients over the age of 18. The service has been open since February 2015 and has six stations, located in one bay and one side room. The NHS trust refers clinically stable patients with end stage renal disease or failure who need haemodialysis. This is the most common type of renal replacement therapy offered to patients.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 July 2017, along with an unannounced visit to the clinic on 25 July 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 said to us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

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 also found the following areas of good practice:

• We found the unit to be visibly clean and arrangements for infection prevention and control were in place with no incidence of infection. The environment met standards for dialysis units and equipment maintenance arrangements were robust. Staff we spoke with were clear about their responsibilities for keeping the patient safe from harm, record keeping was thorough. Mandatory training was completed by staff working in the unit.

• Staff understood their responsibilities to raise concerns and report incidents and near misses. We observed systems that supported staff to learn lessons from incidents which were communicated to the team by senior staff.

• There was a good track record of safe practice, patient outcomes and access to treatment in the unit.

• Staffing levels were of an appropriate number for the unit and staff were knowledgeable, skilled and competence was assessed.

• Patient care and treatment was planned and delivered in line with evidence based guidance, standards and legislation. We reviewed evidence of effective multidisciplinary working and the team worked well together.

• We observed staff compliance with the medicines management policy and positively identify patients when administering medicines during treatment.

• We observed good practice to assess on-going competence of staff. The unit manager documented this.

• A culture of putting the patient first was evident in the unit. Staff showed commitment to providing high quality care for patients and demonstrated a caring and thoughtful approach in the delivery of care to patients with whom they had fostered positive relationships.

• Patient feedback was consistently positive in the unit with no formal complaints since the opening of the unit in 2015.

• Nursing staff had a high regard for their colleagues and for the senior team at a local unit level and across the organisation.

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

• A formal staff survey system was not in place at the time of inspection. However, there were plans to formally capture the views of staff across the organisation and at a local level.

• The waiting area for the unit was small and patients had commented about this during inspection.

• The team did not utilise a formal national early warning score to support the recognition of the deteriorating patient.

• The team did not have a formal arrangement with dietetic services. This would mean that patients were not always supported by the multidisciplinary approach to treatment around their nutritional needs.. Staff we spoke with told us that dietetic services was part of a proposed business case.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

Professor Sir Mike Richards

Chief Inspector of Hospitals