Warwick Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection we rated this key question as ‘Good’. At this inspection the rating has changed to ‘Requires Improvement’.

We assessed 8 quality statements.

Record keeping systems were complex and meant staff did not always have access to complete, contemporaneous information about patients. Risk assessments were not always completed. This meant staff did not always have the information needed about risks relating to individual patients.

The service did not always work with people to understand and manage risk in a person-centred way. We found two patients who had been subject to restrictive practices, but staff had not taken all steps to ensure this had been done safely or in line with trust policy or national best practice.

Staff had not received a regular appraisal of their work and some had not kept up to date with their mandatory training. This meant the trust could not be fully assured they had the right skills to meet people's needs and had accessed opportunities to progress. Following our inspection the trust provided information to demonstrate this had improved.

We have not awarded this service a score for Safe.

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

People using the service could raise concerns and complaints. These were taken seriously, people were involved in investigations if they wanted to be, and reports of the event were shared with them. People received a response in good time where concerns had been raised.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to improve practice and shared with ward teams.

We saw evidence of a safety practice alert for immediate action that was sent to all clinical staff which described a medicine safety incident and the action that clinical staff needed to take to prevent it happening again.

Most staff were confident to report incidents and felt supported when things went wrong. They knew what they should report and when via the trust’s formal reporting system.

The service did not always maintain safe systems.

Staff did not always have easy access to the information they needed to deliver safe care and treatment. Mechanisms for identifying, managing, and monitoring risks to keep people safe were not effective. Records were fragmented across multiple paper and electronic systems. Staff said it made it difficult to keep records up to date. We found examples where risk assessments relating to falls and pressure ulcers had not been completed. This was noted as an area for improvement at the services’ last inspection in 2019.

Staff did not always have the information needed when patients moved between teams. When working with other teams and services, staff often had to use multiple paper and electronic systems to communicate information. Staff told us sometimes this impacted teams’ abilities to work together. For example, they sometimes had difficulty sharing information with community services due to a lack of shared electronic records system.

Processes and practices to protect people from abuse and neglect were in place.

Staff were confident in raising safeguarding concerns and told us the process for completing safeguarding referrals was easy. Staff were able to tell us when they had recently completed referrals and demonstrated a good understanding of abuse and how to keep people safe.

Safeguarding information was displayed throughout the hospital.

The trust had a policies and procedures in place in relation to safeguarding adults and children. This included policies covering domestic abuse and children admitted onto adult wards.

The trust had identified leads for adult and children safeguarding including an executive lead. A Safeguarding Board was in place to maintain oversight across the hospital. All staff could also attend a monthly site link group where lessons learnt and updates about safeguarding were shared.

At the time of our inspection data from the trust indicated that some staff, for example 51% of medical and dental staff had not completed the relevant training in Safeguarding, Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). After we raised this with the trust, they sent assurances that over 91% of staff had completed level 1 or 2 safeguarding training and 81 had achieved level 3. The safeguarding training had included use of Mental Capacity Act and DoLS.

However, we found issues around the use of restrictive practices and the Mental Capacity Act 2005 which indicated the service had breached Regulation 13: Safeguarding service users from abuse and improper treatment under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found 2 patients had been subject to restrictive practices. Mental Capacity and Best Interest decision forms for these patients had not been completed in full. When we spoke to staff, they had not always recognised restrictive interventions had taken place or report these incidents in line with trust policy.

The service did not always manage or monitor risks to people’s safety well. We found assessments used to monitor potential physical health risks, including Venous thromboembolism (VTE) risk assessments and national early warning scores (NEWS2), were not always completed in line with national or trust guidance. We reviewed 175 sets of observations across 15 patient records on the electronic system and found 22% of NEWS2 observations were not repeated in line with guidance. This was a risk because these assessments help identify individuals at risk of deteriorating health.

After we raised these issues with the trust, they provided assurance that there had been limited impact in relation to patient care and safety. They also took action to improve completion of NEWS2 scores and VTE assessments.

The service did not always work with people to understand and manage risk in a person-centred way.Two patients had been subject to chemical restraint (also referred to as rapid tranquilisation) by administering the drug Haloperidol to the patient. Records did not capture actions staff took to support patients when medicines were used to calm a patients’ behaviour which was not in line with the trust’s restrictive intervention and restraint policy. This included the use of other available environments or mechanisms to provide alternative activity or stimulation. From a review of a sample of patient records during the inspection records did not show how alternative methods were used to de-escalate the patient’s behaviour. Records were not completed to show what specific observations staff had completed in relation to the patients’ physical health following the use of the drug. Following the inspection and a review of patient care the trust have taken action to strengthen audit processes to ensure that documentation is appropriate.

This meant staff could not be assured they had provided care in the least restrictive way possible, in the best interest of the patient and may have exposed the patient to avoidable harm. The care delivered had not been in line with trust policy or national best practice. Some staff told us they did not always report incidents in relation to restrictive practice or violence and aggression. Thisreduces opportunities for the service to learn and monitor.

When we raised this with the trust, they took immediate action to rectify this issue including refreshing staff knowledge about restraint and circulating safety practice alerts. They also updated incident reporting processes to prompt staff to consider if any form of restraint had been used when reporting an incident and ensure a ‘rapid post learning review’ took place following the use of any form of restraint. The trust also completed an audit of the use of Haloperidol which showed less than 1% of patients were treated with this drug with the lowest possible dose commonly prescribed.

Despite the above issues we did find examples where staff had worked with patients to manage risks well. For example, we spoke to one patient who was advised by medical staff to stay overnight which the patient did not want to do. The patient told us that the staff clearly explained the risks of being discharged against medical advice and involved the patient's wife in the discussions. Staff arranged for the patient to return at 8am the following morning to continue treatment. At multi-disciplinary meetings professionals worked together to find ways to manage patient’s individual risks.

The safety and upkeep of the premises was monitored. Cleaning audits took place each month across all wards. Data from the NHS Patient Led Assessments of the Care Environment (PLACE) showed there was no significant difference between Warwick Hospitals scores when comparted with national averages.

We observed equipment used to deliver care and treatment was suitable for its intended purpose, stored securely and used properly. Medical gases were stored in line with national guidance. Resuscitation trolleys were checked daily.

Staff wore Personal Protective Equipment (PPE) in line with national guidance and followed good hand hygiene principles.

However, during our visit on the 18 March 2025 we found a storage room was not locked on the ground floor. It contained multiple substances subject to the Control of Substances Hazardous to Health (COSHH) Regulations, for example limescale remover. This meant, these substances were accessible to patients and the public. This was raised with the leadership team on 18 March 2025. However, on 19 March 2025 the inspection team found the door was still unlocked. We spoke to a member of cleaning staff who explained that there was an issue with the door locking when it closed. We have since received feedback form the trust this issue has been dealt with.

Some wards were significantly older than others and lacked space. Staff told us they flet this sometimes-impacted patients. For example, on Oken and Victoria ward we found there was no additional space for families to have private conversations or for assessments to take place.

Leaders told us ward environments was a concern, some wards had recently been refurbished with others still awaiting improvement due to funding. They felt the condition of some wards impacted patient and staff wellbeing.

Some staff had not received an annual appraisal of their work. Data from the trust indicated staff did not receive regular appraisal of their performance in their role from an appropriately skilled and experienced person. Appraisal rates for medical and dental staff were 40.8% and 61.4% for nursing and midwifery staff. This did not meet the trust target of 85%. Following our assessment the trust provided information of improved appraisal rates.

Some staff had not kept up to date with mandatory training. We requested mandatory training rates for the last 12 months, including core and role specific competency training. The percentage compliance for medical and dental was 77.9%. The trust target for mandatory training which was 85%. Following our assessment the trust provided data showing improvement in mandatory training rates.

However, staff told us they felt the training was adequate for their role and they felt supported to develop and progress in their roles. For example, on Oken ward we were told the ward has link nurses to cascade training to the rest of the team, staff could express interest in particular areas and are supported with protected study time including time for appraisals. Volunteers also said they received good training and structured inductions.

The service generally had enough staff to keep patients safe. Agency and bank staff were well utilised to provide additional staffing when needed.Staff sickness and absence across the emergency division, had reduced from 6.27% in November 2024 but was still slightly above the trust target of 5%.

Vacancy rates across wards were low. The trust had faced historic challenges recruiting specialist staff within the cardiology service. Leaders had plans in place to address these risks and monitor them.

Leaders maintained oversight of staffing levels. For example, the ‘safe care tool’ had been used to complete a recent staffing audit. Where staff raised concerns about staffing levels, we were told leaders were responsive and open to improvement initiatives. On Fairfax ward a 3-month quality improvement project had been completed where an additional nurse had been on shift Monday-Friday as a co-ordinator to support the other staff with complex patients and focus on the flow of the area. Staff told us this had been beneficial in terms of workload and patient safety.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff followed infection prevention and control (IPC) guidance, washed hands between patient contact and wore appropriate PPE. Staff audited compliance with IPC standards. Patients who required to be cared for in isolation were able to have single rooms and staff managed effective barrier nursing.

Cleaning schedules were in place and followed.

The service made sure that medicines and treatments were safe. There was good access to pharmacy advice, emergency medicines and critical medicines out of hours.

Medicines, including controlled drugs, were stored correctly and securely. Medicines audits were completed and daily safety checks on emergency medicines and equipment were undertaken and recorded by staff to ensure the medicines were safe to use. Emergency medicines were checked daily and in the event of use, were replaced immediately.

The service had good systems and processes in place to safely support people with their medicines. Pharmacy staff were actively involved in reviewing people’s care and treatment with medicines, which was particularly good in the acute medical unit.

We reviewed 18 medicine administration records on the electronic prescribing medicine administration system. The information we looked at showed people were receiving their medicines as prescribed.

Processes were in place for reviewing antibiotic prescribing which included documenting a reason for the antibiotic choice and length of treatment.