Cardiff & Vale of Glamorgan CHC Members Monitoring Visit Cardiff North Renal Unit 7 th November 2012

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Cardiff & Vale of Glamorgan CHC Members Monitoring Visit Cardiff North Renal Unit 7 th November 2012 Cyngor Iechyd Cymuned Caerdydd a Bro Morgannwg Tydydd Llawr Tŷ r Parc, Heol Y Brodyr Llwydion

1 Cardiff & Vale of Glamorgan CHC Members Monitoring Visit Cardiff North Renal Unit 7 th November 2012 Cyngor Iechyd Cymuned Caerdydd a Bro Morgannwg Tydydd Llawr Tŷ r Parc, Heol Y Brodyr Llwydion CAERDYDD CF10 3AF Cardiff and Vale of Glamorgan Community Health Council Third Floor Park House, Greyfriars Road CARDIFF CF10 3AF Monitoring Team:- Miss Julie Williams (Lead) Dr Cathy Kerby Mrs Eleri Jones University Health Board Representatives:- Dr Richard Moore Consultant nephrologist and lead clinician for South and West Wales Renal Network Ms Catherine Wood Directorate Manager Ms Maureen Lewis Lead Nurse B Braun Representative:- Ms Denna Webber UHW Nephrology & Transplant Services The Nephrology & Transplant service at UHW serves a population of approximately 1.4 million in south east Wales for Nephrology and 2.2 million for Transplantation across the whole of south east and south west Wales. It provides a complete range of diagnostic and therapeutic services on a hub and spoke basis including: general nephrology outpatients clinics; inpatient services at UHW; haemodialysis in Cardiff and at satellite units across SE Wales (Cardiff North Renal Unit, West Wing, Cardiff Royal Infirmary, St Woolos Newport and Llantrisant); home haemodialysis service; peritoneal dialysis, and kidney transplantation. UHW is the regional tertiary referral centre for acute renal failure. More than 140 new patients per million population per year are accepted for Renal Replacement Therapy, and the unit performs around 150 kidney transplants a year. The comprehensive care of specialist nephrology patients is dependent on a trained multidisciplinary team. The team comprises of nephrologists; transplant surgeons, clinical nurse specialists; renal and dialysis trained nursing staff, dietetics, social work and clinical psychology support. The 11 Consultant Nephrologists (8.0 wte in Nephrology) are grouped in three geographically aligned teams to provide continuity of care to patients from designated hospitals, catchment areas and different modalities of therapy.

2 There are 467 patients attending the main Haemodialysis Unit at UHW or the subsidiary renal units located at St Woolos Hospital (Newport), Prince Charles Hospital (Merthyr Tydfil), Cardiff Royal Infirmary and in Llantrisant proximal to the Royal Glamorgan Hospital. In addition, there are 33 home haemodialysis and 91 adult peritoneal dialysis patients. Cardiff North Renal Unit The Cardiff North Renal Dialysis Unit is based in Pentwyn, Cardiff, and currently provides care and services to over 80 service users in the locality. It holds specialist medical equipment such as the haemodialysis machine which is commonly used by those who have lost the normal function of their kidneys. In haemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, where it is cleansed before the blood is then returned back to the body. The centre also hosts renal clinics and a renal psychology service. The Unit currently treats 128 patients a week (patients typically require dialysis 3 times a week). The Unit has 32 dialysis stations, with integrated TV, Radio and headphones. This specialist centre, a joint venture between Cardiff and Vale NHS Trust and B Braun Avitum, is led by Trust consultant nephrologist and lead clinician for South and West Wales Renal Network, Dr Richard Moore who is supported by Dr May Thwin, Staff Grade in Renal Medicine, and a Renal Registrar for two sessions per week. It is staffed with a multi-disciplinary team including doctors, nurses, dieticians, psychologist and other healthcare professionals. The centre is managed by B Braun Avitum, a European leader with world wide presence in providing top medical care services and equipments. Service users from Cardiff and the Vale can now receive their regular treatments in the community instead of going into a hospital which is traditionally a more clinical setting. B. Braun operate over 100 dialysis units in Europe, Asia and South Africa treating 8000 patients. B. Braun Avitum UK is an experienced supplier of dialysis services both in the UK and internationally, working in partnership with trusts in England and Wales. They manage 12 UK dialysis centres, employing more than 250 staff and caring for over 900 patients. All the centers are certified under ISO 9001 and Good Dialysis Practice (GDP). Approximately half of the secondary renal services in Wales are provided by independent providers. A single dialysis session at Pentwyn costs the NHS approximately 30 less per patient than if the NHS had provided the service directly. B Braun Avitum Staffing Nurse Manager 1 WTE Senior Dialysis Nurses (Band 6 equivalents) 2.12 WTE Dialysis Nurses (Band 5 equivalents) WTE Dialysis Support Workers (NVQ L3) 2 WTE Healthcare Assistants 6.64 WTE Clerical Assistant 1 WTE Pastoral Care

3 Two dieticians attend once a week. Psychological support is limited and there is now a waiting list for this service. A counselling service is available for individual patient referrals. The specialist social workers associated with the renal service have been reduced although a Renal social worker South and West service is available by referral scheme. End of life care can be accessed via the pre dialysis nursing service at UHW who will arrange Macmillan nurses and support as required. Transport Transport to and from the unit is provided for the approximately 80% of patients that require it by the Welsh Ambulance Service. The Renal Standards set out that all patients should access their renal dialysis unit within thirty minutes travelling time from their home. Transport is the primary issue that dialysis patients raise concern about across the UK. The Welsh Renal Clinical Network alongside the Welsh Ambulance Service Trust and Welsh Kidney Patients Association, have instigated a patient transport project that attempts to reduce delays patients experience with their transport. This project has already shown improvements in patient satisfaction. Part of ensuring that patients are able to access dialysis services within thirty minutes travelling time from home is the requirement for some patients to transfer to a different unit that is geographically closer to home. This has met with mixed responses from patients. The Directorate have put together a tiered approach to considering patients for transfer both in terms of their clinical and social circumstances. This process seems so far to have eased patients anxiety and has been rolled out for adoption across Wales. A few of the patients the CHC team spoke to were unhappy about the transfer of themselves or others to other secondary units. In addition, patients are encouraged to drive themselves wherever possible to retain their independence and normalcy. Temperature of Unit The majority of patient concerns focus on the temperature in the dialysis unit. With 32 patients at a time being dialysed, it is not possible that the ambient temperature will suit everyone. Patients are asked to bring any additional clothing or blankets they may need with them. Unit staff explained that this approach minimises the infection risk and does not require the Unit to manage and launder hundreds of blankets each week. Similarly, pillows are not provided as specialist chairs are used. Provision of Food and Drink Unit staff explained that, based on medical advice, patients were given only tea and biscuits following dialysis. No other food is available. Matters to be Commended The unit is well maintained with an excellent level of organisation and cleanliness. Housekeeping is provided by a contractor and a weekly audit conducted by B Braun staff. If standards are unsatisfactory, the contractor and B Braun repeat the audit together and the contractor takes any remedial action necessary. A single dialysis session at Pentwyn costs the NHS approximately 30 less per patient than if the NHS had provided the service directly.

4 Obtaining patient feedback. The Unit has a quarterly Patient Forum with each patient having a named representative. B Braun conduct an annual survey to obtain the views of patients and have an approximately 80% response rate. Feedback is very complimentary and we were shown the 2011 survey results; the only two concerns routinely raised are the temperature in the dialysis unit and the ambulance transport. Providing information to patients. The Patient Guide booklet is very comprehensive and is well presented. Sharing operations with the Trust. Meeting rooms at the Unit are shared with the Trust; Trust technicians are contracted to service B Braun equipment at Pentwyn and have a dedicated facility there. Supporting wider services. The Unit works closely with the Welsh Kidney Patients Association and provides an office for their use. The Unit promotes Befriending, and many of its patients are involved in befriending others. Waste Management. A special unit crushes then disinfects clinical waste so that it may be disposed of as (cheaper) general waste. Information on complaints procedures and statement of purpose are clearly displayed in reception. Matters of Concern Despite improvements already made and an ongoing dialogue on experiences, ambulance transport was highlighted as a matter of concern in the annual survey and also during conversations with patients. Concerns centered on the journey time, the timeliness and the routes. The Cardiff North Renal Unit provides a holding service for many new South East Wales patients requiring dialysis and often these patients are dialysed at Pentwyn while waiting to be relocated to a unit closer to their home. The Unit currently has no additional capacity whatsoever. Plans to ease this position are dependent on the provision of a new dialysis unit in Merthyr; at the time of the visit, the options for providing this service were still under review by the Welsh Assembly Government. Subsequently, a privately operated unit at Merthyr has been approved and is anticipated to become available in the first half of Around half of the patients currently attending the unit are from the Cardiff area, 24% from Gwent, 17% from Mid- Glam and 8% from the West. Several of the patients the CHC team spoke with were unaware of the Patient Representative and Forum arrangements. The Psychology service is currently under-resourced and its staffing arrangements under review. There is no longer a social worker associated with the unit and specialist social worker support can be difficult to access.

5 All of the staff we met stated that the Unit is not subject to inspection by any Welsh regulatory body. (B Braun Avitum operates in England and other European countries and follows English and European standards). Recommendations to be considered by Council That WAST be asked to present to the Council how the service monitors its performance and also how it seeks and utilises patient feedback on ambulance service transport by the May 2013 Council meeting. That the UHB be asked to comment on the proportion of patients from outside Cardiff & the Vale dialysed at the Pentwyn unit by the March 2013 Council meeting. That the Pentwyn unit reminds patients of the Patient Representative and Forum arrangements and reviews its procedures for disseminating this information to new patients by the May 2013 Council meeting. That the UHB provides a timescale for resolving the psychology staffing shortage at Cardiff North Renal Unit and the likely impact this will have on waiting times by the February 2013 Council meeting. That UHB be asked to provide details on the specialist social worker support available to dialysis patients by the February 2013 Council meeting. That information on monitoring and inspection of secondary dialysis units is sought from HIW by the March 2013 Council meeting. That secondary dialysis units at CRI and the Heath are visited by the same CHC members by the April 2013 Council meeting. Thanks The CHC team would like to thank all of the staff they met for their time and their helpful and informative approach and also the comprehensive briefing material provided in advance of the visit.

Your local NHS and you

South Wales Programme Local Engagement Document Your local NHS and you Local NHS services in Cardiff and the Vale of Glamorgan are run by Cardiff and Vale University Health Board (UHB). The UHB is one