Enter & View of the Sussex Kidney Unit at the Royal Sussex County Hospital
Background
The Sussex Kidney Unit (SKU) is part of University Hospitals Sussex NHS Trust (UHSx). The SKU is a specialist service providing renal care for the patients of Sussex. The hub is at the Royal Sussex County Hospital (RSCH), but bespoke services spread beyond the standard geography of UHSx. SKU is made up of:
- Haemodialysis departments – Providing care for over 500 patients across Sussex who attend for treatment 3x week for approximately 4-5 hours per session. There is the Main haemodialysis unit (at Brighton) and four satellite haemodialysis units across Sussex (in Bexhill, Crawley, Eastbourne, and Worthing). The Brighton unit has doctors on site and cares for patients with more complex conditions in comparison to the nurse-led satellite clinics.
- In addition to: Renal Outpatient services; Renal Transplant department;Home Therapies department; The Trafford Renal ward at Brighton has 28 inpatient beds and an Acute Dialysis area.
The Kidney PREM (Patient Reported Experience Measure), led by The UK Kidney Association in partnership with Kidney Care UK is an annual, national survey of UK kidney patients.
The results of the 2024 PREM ranked Sussex Kidney Unit as 63 out of 66 centres, making it one of the lowest ranking renal services in the country. The scores were generally not poor, with an overall mean centre score of 5.63/7.00. High scoring areas were ‘privacy & dignity’, ‘patient information’ and ‘access’. However, there were some areas that were highlighted as needing some improvement.
In consultation with the renal department’s clinical leads, we focused on asking patients about their experience of communication with their care team. We replicated lower-scoring PREM questions and gave patients the opportunity to comment openly on each. We also asked about the environment and conducted an environmental audit.
Our overall conclusions on communication
- Overall, our survey findings reveal that dialysis patients are generally happy with communications around their care. Patients scored communication highly overall (average score of 5.37/7.00) and there were many positive comments about the care they receive as well as an awareness of the constraints of the system.
- One patient was so pleased with their care, they said, “Recently, we considered moving to be closer to family. What stopped us was the thought of finding a renal team as good elsewhere.”
However, upon further discussion and when asked about more specific areas of care, patients did indicate some improvements that could be made.
- There were some quite mixed and polarised opinions about communications in some areas such as test results, dietary advice, and life goals discussion.
- Some explanations for this could be personal preference in how much detail they like to hear and how they like to be communicated with, different treatment rooms and/or different staff providing a different patient experience, and length of time the patient has been in renal care and the severity of their condition.
Recommendations based on patient feedback included:
- Improve communications about changes in care. [The department have informed us that they plan to send a ‘monthly patient information summary’ sheet which should help to improve communications about individual care.]
- Ensure sensitivity in letter communications when related to significant changes in care. Consider offering consultation to discuss bigger changes. [The department are struggling to keep up with demands of increasing haemodialysis numbers which means patients currently may need to be moved from Brighton for their treatment. Some patients have been upset by this and how it has been communicated via letter. The department are looking to increase letter sensitivity.]
- Ensure staff introduce themselves and wear clear ID badges.
- Increase discussions around life goals, concerns related to care and emotional feelings with patients.
- Increase patient information awareness and availability (including about patient groups).
- Increase support service capacity (e.g. dietitians and counsellors).
- Improve communications between GPs and the renal team.
Our conclusions on the environment
- We visited the outpatients waiting room, the Stirling day case unit, the four main haemodialysis rooms, and the dialysis waiting room.
- We scored all areas aside from the dialysis waiting room highly for the environments being welcoming, safe, caring, well-organised and calm.
- Scores were six out of ten for the dialysis waiting room, due to storage, information, and safety issues, but ranged between eight and ten for the other areas.
- The smallest haemodialysis room (room 1) lowered the results for its section as it felt cramped and cluttered.
85% of patients said they were either satisfied or very satisfied with the environment. However, they raised some concerns around the dialysis waiting room, parking, dialysis room 1 being cramped, ceiling tiles and the broken lift.
We note that the trust already has plans to improve the environment and enact some of the following changes.
Recommendations by Healthwatch representatives included:
- Improvements to storage
- Improvements to the dialysis waiting area (e.g. seating, placing a manned desk and WC repair)
- Improvements to patient information on display (e.g. information about staff)
- Replacement of some ceiling tiles
- Fixing the second lift which is out-of-order.
Read both our full main report and environmental audit report below.
“The staff have a warm approach. I don’t feel anything could be improved here but I do think more staff are needed as staff are usually very busy.” - Haemodialysis patient 1
“No one explained to me why it was happening or what caused it. That was really upsetting. It helps me if I can prepare mentally for the change rather than it just happening and no one telling me why.” - Haemdialysis patient 2 talking about changes to care during dialysis appointment that were not communicated well
"I think it is alright. You can feel a bit lost; they do not tell you what is going on and you have to chase to find out what is going on." - Haemodialysis patient 3 talking about communication
“I’ll ask if I want to. I don’t want all the detail.” Haemodialysis patient 4 talking about test results communications
