Warwick Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

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

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

We assessed 6 quality statements on leadership and governance.

Leaders embodied an open working culture. They had the skills and knowledge, experience and credibility to lead well. The service worked very well with local partners to improve outcomes for patients.

However, we found areas of improvement required around governance and risk management systems that did not always ensure safe and good quality care and treatment.

We have not awarded this service a score for Well-led.

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

The service had a shared strategy, vision and culture. The Trust had clearly defined its objectives for 2024 to 2025 included, providing ‘Home First’ care, embedding prevention into every service, and being a flexible employer. Staff were aware of and had contributed to the development of the vision and strategy.

The service was aware of challenges and changes in the local population and was working with local system partners to manage these demands.

Staff feedback was generally positive about the working culture of the hospital and their teams.

We found leaders had not always taken action to address some of issues within the service. For example, in interviews leaders at service level were aware there were issues with VTE assessments being completed but did not demonstrate sufficient action taken to address this. Some were aware that staff did not always have a clear understanding of mental capacity assessments but had not taken steps to rectify this. Following our inspection the trust provided information demonstrating ongoing work to improve these issues.

However, staff felt supported by their leadership and management team. Leaders, at all levels, were available when they were needed. They were knowledgeable about the issues and priorities for services and encouraged improvements.

Staff felt leaders supported their wellbeing and promoted good practice. Staff had opportunities to develop including for future leadership roles. The trust scored highly in the NHS staff survey when compared to others.

The trust had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the trust.

There was a positive work culture across the service. The majority of people felt they could speak up and their voice would be heard and action taken.

Staff could raise concerns, including anonymously if they preferred.

The trust had a Freedom to speak up team in place. They worked with staff to promote a fair culture. This included holding a ‘Speak up month’, undertaking walkabouts and working alongside the Health and Wellbeing Team and Anti-discrimination helpdesk to resolve issues. They also delivered training including; speak up training and civility, microaggressions and privilege training. The team met monthly with the Chief Executive, Managing Director and Interim Chief People Officer.

Staff understood their responsibilities under Duty of Candour and acted on them.

Different staff networks were in place to ensure staff from a range of backgrounds and demographics were represented and had a voice with senior leaders.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Although the trust had clear governance and oversight arrangements in place some of these systems had not always operated effectively. This had led to areas where delivery of care and treatment had breached regulations.

VTE assessments were not always completed to identify risks to the health and safety of service users. Data we received from the trust indicated VTE compliance with national guidance had been getting worse over time. After we raised this the trust introduced new measures to control this risk and reported an improvement in VTE assessment compliance.

The system used to record patients' NEWS2 observations highlighted patients with overdue observations even if not appropriate. For example, patients undergoing procedures outside their designated ward, or on an end of life pathway. This meant it was difficult to identify when observations were overdue compared to not required. This increased the risk of patients' deteriorating without prompt recognition. Although the trust was assured from standalone audits after our inspection that NEWS2 was being completed safely, there was no regular audit process to maintain oversight of this. Following our inspection the trust has taken action to strengthen audit processes and education for staff’

Patient record keeping systems were complex and did not ensure staff had easy access to contemporaneous, accurate information. We found 5 patient records where information about patient care and treatment had not been properly recorded. Staff did not have easy access to up-to-date documentation regarding patient's mental capacity and best interest decisions. We asked the trust to provide nursing risk assessment and care plan audits for the last 12 months. The audit we received indicated out of the 20 aspects of nursing assessments assessed, the trust target of 95% and above, was not met in 12 out of 20 areas of the audit.

The trust had not ensured enough staff had received an annual appraisal or completed mandatory training. This meant they could not be assured staff had the right qualifications, competence, skills and experience to deliver safe, effective care. For example, we found some staff showed varied understanding of mental capacity and restrictive practice, which had led to some incidents of restraint not being reported in line with trust policy. We were told by some staff there had been a recent change in the system used to monitor mandatory training rates which had made monitoring compliance more challenging. When we raised this concern to the trust they made improvements.

Mental capacity assessments had not always been completed in line with national guidance and legislation and were not easily accessible to staff. Staff showed varying degrees of understanding around mental capacity assessments. This had been identified in an audit from 2023, although some actions were taken at the time, these were not wholly effective as during the inspection we found staff understanding was still variable. Following our inspection the trust had undertaken a repeat audit in June 2025 which identified improvement. We will follow this up at the next review of the service.

Where we raised concerns following our visit the trust took action to address these.

The trust valued the benefits of working in partnership with other local services and teams and found ways to do this. For example, the trust attended a monthly Mental Health partnership group involving internal and external partners to build a shared understanding of challenges face by, and the needs of, mental health patient to improve services. This included partnership working to deliver staff training for the care of mental health patients.

The trust harnessed partnership working with communities to make a positive impact and improvements to patients and staff. For example, the service had worked collaborative with the local Fire and Rescue and ‘blood bike’ service to improve patients’ discharges.

An independent patient forum was in place. Members of the forum participated in food and environmental audits. The trust also had plans to improve its approach to engagement with patients and were also collaborating with a local university on an upcoming research project regarding patient engagement and co-production.

Ward teams worked well with other system partners, such as GPs, community nurses, social workers and members of the integrated care board, to enable continuity of care. For example, we saw support with district nurses was arranged prior to a patient’s discharge to ensure they had support in the community.

We found examples where ward teams had implemented new projects to test ways to improve the service for staff and patients. This included a range of projects form those that reduced paper usage on the ward, to larger schemes that had improved patient flow and heart failure services.

Whilst demonstrating a number of quality improvement projects, we found the trust had multiple quality and safety issues across service. This meant that innovation was not always actively contributing to safe and effective practice.

The trust had introduced a ‘Dragon’s Den’ panel which has encouraged QI involvement and ownership among staff. Staff pitched ideas for improvement initiatives once a year to a panel of judges with an allocated budget. Last year, the budget was £500,000.

The service was focussed on continuous learning and improvement across the local system. The service shared information with local partners and created joined up approaches to tackling wider system pressures. For example, improving local frailty care pathways and realising the benefits of virtual wards.