North Devon Satellite 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

Leaders did not always run services well. We found safe recruitment processes were not always followed for staff who transferred over from another provider. Not all staffing records had disclosure and barring service (DBS) certificates, or references. Staff were committed to improving the service though learning processes although changes in practice were not always embedded. Leaders supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services.

This service scored 62 (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 vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work, and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

There were clear processes and support systems available to ensure staff felt supported by their leaders. Staff had access to provider processes online.

Staff told us they knew how to speak up if they had concerns. They felt confident raising concerns and could easily access the Fresenius policy and process through the staff intranet. The leaders told us they continually communicated with staff and encouraged staff feedback to ensure the best service was available to patients. Staff understood what whistleblowing was and were aware of external agencies they could raise concerns with.

The service had a freedom to speak up policy which was easily accessible to staff. There was also a duty of candor policy which the service followed if things went wrong. The service had an open culture where patients, their families and staff could raise concerns without fear.

The service promoted equality and diversity in daily work, and provided opportunities for career development. Staff surveys were completed regularly and staff at the unit had high levels of participation. We saw action and review of these surverys which showed teh sevice took action to make improvements where needed.

The service provided support systems and processes for staff who required additional support. The service have introduced a new electronic platform and intranet hub for staff to access support from a wider range of medical professionals.

The service had clear governance processes but these were not always followed. There were tools to manage and monitor performance and safety. The service used a clinic assurance tool, which allowed staff and managers to focus on their highest risks for each day. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

There was an organisational governance framework which supported how risks and quality issues were monitored and managed. The service kept and updated a risk register which clearly showed action and task owners. This fed into governance meetings and was reviewed regularly by leaders. Policies were updated in line with provider requirements. However, we found the safeguarding policy had been updated to include Liberty Protection Safeguards which was not current practice. We shared this with the provider through engagement and were advised amendments would be made. Staff were clear and supported by leaders to understand their roles, responsibilities and accountability. The service had appropriate policies and procedures to support them with emergency preparedness. Workforce review was supported by skill mix analysis. All staffing at the unit was calculated using appropriate tools and the service ran with a 20% inflated staff level to ensure patients had the best experience the service could provide. Records were stored and managed securely. However, we found there was a lack of good governance processes for recruitment. Safe recruitment processes were not always followed for staff who transferred over from another provider. We found staffing records which did not have disclosure and barring service (DBS) certificates, or references. We highlighted this to the provider who responded with an action plan to ensure this was aligned with their regulatory responsibilities.

The service gathered feedback from patients and system partners to ensure it was meeting the needs of the community.

The service had regular meetings with the local NHS trust which commissioned its services. The meeting minutes were comprehensive and considerate of performance and capacity, service improvements, learning and forward planning.

The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.

The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.

Staff told us they all worked together to ensure the patients had the best treatment whilst maintaining their self-worth and wellbeing. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation.

Learning and improvements were not always made to to policy and processes and di not always results in changes to practice at the service as detailed in safe key question.