Warwick Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last inspection we rated this key question as ‘Good’. At this inspection the rating remained ‘Good’.

We assessed 4 quality statements.

We looked for evidence that people’s care and treatment achieved good outcomes and promoted a good quality of life, based on best available evidence.

Staff provided care and treatment that met people’s needs. They considered people’s physical health and personal circumstances to tailor care. Staff worked together and with others when making decisions about people’s care.

However, we did find some areas that required improvement. This included staff not always having easy access to the information they needed to deliver people’s care, treatment, and support. When working with other teams and services, staff often had to use multiple paper and electronic systems to communicate information. This impacted teams’ abilities to work together.

Documentation regarding Mental Capacity Assessments and Best Interest Decisions was not always complete or available. This meant the service could not be assured that decisions made on behalf of patients were always made in line with relevant legislation.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff gave people information about their care and treatment needed to support both their health.

Staff met people’s nutrition and hydration needs. They used tools for screening malnutrition and dehydration and acted on any indicators of concern.

Staff used information to implement new guidance and consider changes to existing procedures to improve patient care. The trust had created a Delirium and Dementia outreach team to support patients. We were told the output of this team included reducing patient stays by up to 10 bed days and introduction of activity coordinators.

The trust’s policies and standard operating procedures reflected current practice.

Staff followed ‘sepsis-six’ guidelines to manage adults with suspected sepsis.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. For example, the service had utilised ‘virtual wards’ to help care for people in the community and avoid admissions to the hospital where possible. This had saved 5,391 bed days since April 2024.

However, we found some care and treatment did not always reflect current evidence-based guidance and best practice. For example, NEWS 2 scores and VTE assessments were not completed in line with national standards. Staff did not always follow national clinical guidelines in relation to the use of restrictive practices.

The service worked well across teams and services to support people. We observed a number of meetings where staff from different grades and disciplines worked collaboratively to address patient needs. Staff we spoke to felt teams were supportive of one another.

Staff worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. For example, patients with diabetes in care homes were monitored via remote technology which recorded their blood sugar levels.

Staff we spoke to felt patients were at the centre and ward teams worked well to deliver good care.

The service listened to concerns about staffing. For example, staff on Victoria ward told us they had experienced delays in accessing specialist support from the mental health and psychiatry liaison teams for older patients, which impacted patient care. . There were strengthened links with another trust prior to our visit, to provide access to a Consultant Old Age Psychiatrist working with the Mental Health Liaison Team and improve the service for patients. The ward teams had access to the High Intensity User (HIU) Team specifically employed to support coordination and communication between partner agencies and improve experience and safety for mental health patients.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service did not always routinely monitor people’s care and treatment to continuously improve it.The trust provided us with results from Patience Care Indicator (PCI) audits for 11 medical wards. The PCI audit looked at 20 aspects of nursing assessment compliance including the completion of Waterlow scores, Malnutrition Universal Screening Tool (MUST), pain assessments and referrals including dietetics. The trust target for PCI compliance was 95%. Across all medical wards the trust target was not met in 12 out of 20 areas of the audit. For example, on some ward’s patients 65 years and older did not have a blood pressure reading lying and standing carried out at least once during their stay.

When we raised this with the trust, they took actions to improve the completion of patient care indicators and provided assurances that the impact of some of these assessments not being completed was limited.

In other areas outcomes were measured and showed good outcomes for patients. This included care delivered on virtual wards where the trust used national indicators to measure outcomes in relation to patient care.

In general, outcomes met both clinical expectations and the expectations of people themselves. For example, the trust had focused on falls prevention as an area of improvement and the number of patient falls have been on a downward trajectory since 2022. The trust had a formal Falls Prevention Strategy and monitored patient outcomes against this.

As part of improving people’s experience of discharge, the trust used ‘blood bikers’ to deliver patients' prescriptions to them at home. This meant that patients could be discharged back to their own homes sooner.

The service told people about their rights around consent and respected these. We saw examples where consent had been recorded appropriately before delivering care and treatment.

However, documentation regarding Mental Capacity Assessments and Best interest Decisions was not always complete or available to staff. This meant staff did not always have access to information regarding a patient's capacity to consent to a specific decision available.

). Mental capacity assessments and best interest decisions were not always recorded and we were not always able to find the documentation in patient records. This included decisions around Do Not Attempt Cardiopulmonary Resuscitation (DNACPR). We found these records were not always completed or easily accessible to staff. In particular staff had not recorded how they had made decision in the best interest of patients and other key principles of the MCA.

Staff we spoke to had varying knowledge of the Mental Capacity Act 2005 and restrictive practices. For example, staff did not always recognise or report the use of restrictive interventions.

Since we raised concerns with the trust in relation to the application of the Mental Capacity Act within the service, they have taken immediate action and sent assurances of how they will continue to improve and monitor this issue. This includes undertaking a Matron led audit of the use of the MCA and DoLS applications which identified that there were a number of outstanding assessments; the audit was repeated daily for the following 2 days until no outstanding assessments or applications were found.

New mandatory training modules covering the MCA and DoLS have been introduced for staff. The trust also carried out a ‘fast roll out’ of face-to-face training for wards on the use of restraint and the principles of MCA.