Clifton Dialysis Unit

On this page

• 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

This is the first time we have rated this service. We rated well-led as good. The service did not have a current registered manager. An interim clinic manager fulfilled this role with support from a deputy manager and senior regional leads. The leadership team had the skills, experience and capability to manage services. A substantive clinic manager had recently been appointed and planned to become the registered manager for the service. There were clear and effective governance, management and accountability arrangements. Staff were clear about their roles and accountabilities. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. Leaders engaged well with partners and the community to plan and manage services. Leaders promoted a positive work culture based on equality, diversity and inclusion. Staff were supported to speak up or raise concerns.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us there was a friendly and open culture based on providing high quality care. They spoke positively about the support they had received from managers. Staff told us the provider’s objectives, values and behaviours had been shared with them and they had a good understanding of these. Managers told us progress against the business objectives was reviewed as part of routine meetings.

The provider’s purpose statement was; ‘creating a future worth living for patients, worldwide every day.’ This was underpinned by a set of 4 values and behaviours; collaborative (we team up), proactive (we get things done), reliable (we do what we say) and excellent (we exceed expectations). The strategy for the service was outlined in the corporate provider’s business objectives. The purpose, values and business objectives were displayed in the dialysis unit.

Staff spoke positively about the support they had received from the interim clinic manager and deputy manager. They told us leaders were visible, approachable and provided them with good support and guidance.

The service had not had a registered manager since the previous registered manager cancelled their registration in January 2024. An interim clinic manager from another of the provider’s locations oversaw the service and attended the dialysis unit 3 days per week and fulfilled the duties of the registered manager. The interim clinic manager was supported by a deputy manager and reported to the area head of operations. A new substantive clinic manager had been appointed during July 2024 and was undergoing induction training. The new clinic manager planned to become the new registered manager for the service. The clinic managers had the relevant skills and abilities to manage the services effectively. They understood the risks to the services and had clear oversight on safety, governance and performance issues through daily involvement and quality monitoring.

Staff told us they felt confident they could raise any issues with the managers and that managers responded positively when concerns were shared. Staff were aware of the whistleblowing policy and understood how to contact the freedom to speak up guardian if needed.

The provider’s whistle blower policy and freedom to speak up policy, provided guidance for staff around raising any concerns. Information was also available on the provider’s intranet and information on posters in the dialysis unit. The freedom to speak up guardian was based at another of the provider’s locations and was independent to the service. There had not been any significant whistle blower concerns of freedom to speak up concerns raised by the service or received by the Care Quality Commission during the past 12 months.

Staff told us the service had an inclusive working culture and they were treated with respect and equity. Staff told us managers engaged with them regularly and they felt confident their concerns were listed to. All the staff we spoke told us they had not experienced any instances of unfair treatment, discrimination or harassment. Managers told us equality, diversity and inclusion was embedded in the culture of the service. They told us staff recruitment processes enabled equal opportunities and they engaged with staff routinely to maintain an inclusive work environment.

Equality, diversity and inclusion was incorporated in the provider’s recruitment policies and processes. There were support mechanisms for staff with protected characteristics, including flexibility around working arrangements and shift patterns. Managers engaged with staff on a daily basis to monitor work culture and identify any bias or discrimination. The service carried out annual staff surveys to gain feedback from various staff groups about their experiences. Feedback from staff in the 2023 survey was mostly positive in key survey indicators relating to culture, support, equality and diversity and growth opportunities. Action had been taken to improve the work environment and staff engagement.

Staff told us information on performance, risks and governance was discussed during daily huddles and routine team meetings. Staff participated in quality monitoring and audit processes. They told us their performance was routinely monitored and they received feedback following audits to aid learning and improvement. Managers understood the key risks to the service and maintained a risk register. Staff were aware of how to record and escalate key risks on the risk register. Managers were aware of their responsibility to report notifiable incidents. They told us there was a system to ensure safety alerts were actioned and cascaded to all staff.

The service had clear governance structures that provided assurance of oversight and performance against safety measures. Staff took part in daily huddles, routine clinic meetings and integrated governance meetings to review information. Meeting minutes showed key discussions routinely took place around performance, risk, governance and audits, incidents. Action logs were in place for key performance indicators that required improvement and were followed up at subsequent meetings. There was regular communication and oversight from the corporate provider and the commissioning trust. The clinic manager reported incidents, performance and outcomes data to the corporate provider and commissioning trust on a monthly basis to enable effective monitoring and oversight of the unit’s performance. Routine contract review meetings with the commissioning trust took place every three months to discuss performance, outcomes and key risks. Managers maintained a risk register detailing the risks to the service. Key risks were identified with control measures to mitigate risks. Individual risks had a review date and an accountable staff member assigned. A risk scoring system was used to identify and escalate key risks to the corporate provider. Routine audit and monitoring of key processes took place to monitor performance against safety standards and organisational objectives.

People told us care and treatment was well co-ordinated between the service and the commissioning trust and care. They felt there was timely communication and sharing of information about their care and treatment between the services.

Managers told us they had an effective working relationship with the commissioning NHS trust. They told us there was routine informal and formal engagement between staff at the unit and the commissioning NHS trust. Staff working at the unit told us they worked well with the renal dietitians and consultants and received good support and guidance from the commissioning trust when required. Managers told us they routinely engaged with other stakeholders, including GP’s, the provider’s other renal dialysis locations and local renal networks to plan and coordinate care and treatment.

Service partners from the commissioning trust told us there was a positive working relationship with the staff at the dialysis unit. They told us they worked collaboratively and shared good practice and learning. They told us they were fully cited on service performance, outcomes, incidents and complaints and were involved in investigating these with the staff at the unit to identify improvements. The renal matron from the commissioning trust spoke positively about the interim clinic manager, who they felt had helped to improve workforce stability and culture within the service since the previous manager left. The renal matron told us they planned to work with the service to develop more link nurse roles.

There was a service level agreement between the service and the commissioning trust to provide joined up care. Formal contract review meetings occurred every three months. Meeting minutes showed key discussions around performance and patient safety took place. The service’s contract was due for renewal during 2025 and future arrangements for service provision were planned for discussion as part of the contract renewal negotiations. The renal matron from the commissioning trust carried out monthly visits to the service and undertook monthly safety triangulation accreditation reviews. The service achieved at least 95% compliance in the monthly reviews undertaken between April and June 2024. This demonstrated high levels of compliance against the commissioning trust’s accreditation standards. The service worked collaboratively with charities, local renal networks and healthcare professionals to develop and support community engagement initiatives and to raise awareness of chronic kidney disease within the local community.

Staff told us there was a culture of learning and improvement across the service. They told us incidents and complaints were investigated and learning was shared with staff to improve the services. Staff told us they worked closely with the commissioning trust and with the corporate provider to learn new ideas and improve the delivery of services. Staff spoke positively about improvements in recruitment of new staff and the new clinic manager and felt this would improve the working culture and delivery of services.

The service had made improvements in areas identified as shortfalls at our previous inspection, such as around sepsis management and safeguarding training compliance. Learning from patient deaths, incidents and complaints was shared with staff to help improve the service. The dialysis unit had undergone refurbishment during 2021/22 to expand the capacity of the unit and additional side rooms. The staff at the service had been nominated for an excellence award for teamwork during a period of high pressure on their workloads. The recent appointment of a new clinic manager and 4 additional nursing staff helped to improve overall staffing levels and reduce dependency on bank and agency staff.