Health CommitteeWritten evidence from Fresenius Medical Care (ETWP 65)

1.1 This submission is from Fresenius Medical Care. We have been working in partnership with the NHS for over 20 years to deliver high quality dialysis services, for NHS patients. We provide over 530,000 dialysis treatments to almost NHS 4,000 patients a year. Our partnership model for dialysis services ensures that clinical care is shared between the NHS consultant and our nurse-led satellite units. We have worked with the NHS to help increase capacity for the NHS quickly, cost effectively, whilst ensuring NHS patients have access to the latest innovative dialysis treatments, close to where they live. We currently provide 56 dialysis satellite clinics in England and Wales for the NHS. As part of the Fresenius Medical Care group of companies we have a longstanding history in the development of innovative dialysis treatments, products and therapies.

2. Summary

2.1 As the leading independent provider of NHS dialysis services and the largest independent employer of renal nurses, we would like to highlight our contribution to the training and education of healthcare professionals. There has been a long history of independent sector involvement in the provision of NHS services, yet the contribution of independent providers in delivering high quality care as well as training for staff has often been overlooked. We hope that the Committee will find it helpful to hear of our experiences in providing training and ongoing development for clinical staff, as well as gain a clearer understanding of the level of training provided by the independent sector.

2.2 As an employer we are committed to providing ongoing training and development for all our staff, including clinical staff, throughout their employment with us, because we understand the benefits of motivating staff and supporting their professional development. We provide a range of e-learning and training in-house as well as funding external training courses for staff, study days and time off to take exams. We also provide clinical and technical training on dialysis treatments, our dialysis machines and products for NHS staff as well as NHS staff seconded to some of our satellite dialysis units. We have also funded general nurses to take further training to become renal specialist nurses, due to a shortage of renal specialist nurses.

3. Our Commitment to the Training and Education of Healthcare Professionals

3.1 We currently employ over 400 nurses, and 80 healthcare assistants. All staff who begin employment with us, including healthcare assistants, nurses, receptionists and other support staff, undertake a thorough induction programme which is tailored to their job role and covers infection control, a detailed course on dialysis treatment, health and safety, clinical governance, quality guidelines and standards, how we gather and respond to patient feedback, data protection and our clinical patient data management system. Through our appraisal process, staff are encouraged to take ownership of their own professional development. The training requirement of each person is discussed and an action plan is agreed with their line manager.

3.2 All staff have access to our comprehensive e-learning programme which covers a wide range of topics including infection control, data protection and nursing education, related to kidney disease.

3.3 Our dialysis products division provides both face to face training and online e-learning courses for NHS renal units as well as for our staff working in our dialysis clinics. We support all clinical, product, technical and device training for the NHS. As well as running therapy and clinical training courses in-house and locally in NHS renal units, we also run technical training to support the technical aspects of the dialysis equipment used in NHS units.

3.4 We currently have over 1,600 users enrolled on the Online Learning Centre, which supports the training on dialysis treatments carried out on site at NHS units. The online training complements the face to face training and reduces the time needed to be dedicated to traditional training, improving productivity and patient contact time. It also allows staff to train at their own pace and chosen location.

3.5 We currently run around four to six technical training courses each year, depending on demand, for technical staff both from the NHS and for our own in-house technical services team. On average we have 49 people attending our technical courses which includes those on new training and refresher courses on our haemodialysis treatments.

4. Improving Care Quality and Patient Satisfaction

4.1 In our experience, providing training for staff improves staff satisfaction, which in turn has been shown to improve patient care. Research carried out by the Aston Business School has demonstrated that high levels of staff satisfaction are linked to high-quality patient care.1

4.2 In a recent staff survey (November 2011) Fresenius Medical Care staff satisfaction was rated at 4.1 compared to NHS staff surveyed in 2010,who rated 3.51 out of 5 on the staff satisfaction index.2

4.3 We fund numerous training courses for staff each year. There are over 250 study days available for staff to attend throughout the year and all staff are able to attend. Our staff have attended courses and training days on a wide range of subjects including:

Attending UK and European Conferences.

Management courses through Open University.

Healthcare assistants have attended the level 3 NVQ in health and social care.

Registered Nurses have obtained Post Registration Course in Nephrology Nursing.

All courses are fully funded by Fresenius Medical Care.

In the last year over 50 staff have attended external courses fully funded by Fresenius Medical Care.

4.4 Many of these courses attract CPD points.

5. Workforce Planning

5.1 We believe that all providers should be involved in workplace planning and developing the future workplace for appropriate services. Through our investment in the provision of satellite dialysis units we have helped the NHS to increase capacity quickly and without the burden of capital investment for NHS Trusts. However in some areas we have experienced a shortage of renal specialist nurses and have therefore had to invest in training registered nurses to gain the additional expertise and knowledge required for this specialist service. We have also recruited clinical staff from overseas to fill the shortage. We therefore believe that there could be greater collaboration between commissioners, NHS and independent providers in the planning of services and future workforce requirements.

6. Creating a Level Playing Field for All Providers

6.1 We believe that all providers including those in the independent and voluntary sector should be encouraged to provide ongoing training for staff. Providers of NHS-funded services, whether they are NHS, independent or voluntary sector providers, should be treated on a level playing field. Throughout their careers, many healthcare professionals move around the health care sector, moving to other Trusts and between the independent, voluntary and public sector. For all providers to invest in training when they will not know how long a member of staff will remain with them, providers must not be penalised from recruiting from one particular sector over another. Many independent providers like ourselves are already investing in training and development programmes for clinical staff, beyond the minimum requirements and we believe that all providers should be encouraged to do the same.

6.2 Placing a duty on providers would help to ensure that all staff working in NHS funded services have access to a minimum level of training and stimulate a culture of CPD. Through the tendering process to provide NHS dialysis services we are able to demonstrate our commitment to funding training and development courses for staff. In the tender document we are able to outline the training we can provide and fund for clinics’ staff locally. The tendering process also ensures that providers employ clinical staff with a minimum level of qualifications, experience and/or standards. For example, specifying that a Registered Nurse has 1st/2nd level registration and is licensed to practice with the NMC and a Healthcare Assistant has a minimum of GCSE qualifications and a NVQ II or III level qualification would be desirable. We believe that this process should continue because it ensures that minimum standards are met whilst encouraging providers to go beyond the mandatory requirement.

December 2011

1 Department of Health, NHS Staff management and health service quality, 2011

2 2010 annual NHS staff survey, co-ordinated by the CQC

Prepared 22nd May 2012