Warwick Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last inspection we rated this key question outstanding. At this inspection the rating has changed to good.

We looked for evidence that the service met people’s needs.

We rated responsive as good. We assessed three quality statements. People did not experience discrimination and staff worked hard to provide equity in access to care and treatment. They made reasonable adjustments where required and listened to people’s concerns to improve the service. However, care was not always person centred because assessments were not completed regularly. Information was not always available or available in other languages.

We have not awarded this service a score for Responsive.

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

There were services and tools to support staff to make sure people were at the centre of their care and treatment whenever possible. Care records reflected physical, mental, emotional, and social needs of patients including some protected characteristics under the Equality Act. Patients were involved in decisions about their care where possible. People with specific care needs were supported as individuals.

There were in-reach services for frailty and pain, who arrived promptly when bleeped to provide specialised services to patients who had specific needs.

There were signs in the waiting room to notify staff if patients needed additional support or make reasonable adjustments, for example where patients had dementia, mental health needs or learning disabilities. The hospital had a delirium and dementia outreach team (DDOT) who reviewed medications for patients with these conditions, and referrals could be made from any department.

Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms area document that helps individuals express their wishes for emergency medical care. They were filled out appropriately and travelled with the patients throughout their journey.

Mental health assessments were completed for patients who had a mental health need and included information regarding their history and any social needs to help ensure they received the most appropriate person-centred care.

For patients who were frequent attenders at the department staff implemented individualised plans which highlighted specific needs, including emotional and social needs. Plans were monitored regularly.

Communication cards were available to help people communicate, especially when verbal communication is difficult or limited.There were specialist nurses to support children and young people in the department to ensure their care needs were met, especially if they required reasonable adjustments.

Staff said ‘all about me’ patient passports were used in the hospital to help inform hospital staff about the needs of the person with a cognitive impaired condition and how to support them. Staff told us they were planning to implement a smaller version of the passport in the paediatric department

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service did not always supply up to date information for people using the emergency department. Interpreter services were available, but staff told us it took too long to get support in the language they required. Information about waiting times was not displayed in the department.

There was no waiting times or information displayed in the waiting room, and patients were not provided with any information about waiting times when they booked in.

Patients told us they were aware of the plan for their treatment, but were unclear on timeframes or progress and they were not kept updated.

In the most recent friends and family test (FFT) results, some patients reporting inconsistent or conflicting information from different staff members.

Due to building works and redevelopment, the hospital signposting was not always clear including the route to radiology from the emergency department. There were volunteers at main entrances to signpost the public.

There were digital and printed patient information leaflets, however the ones we saw were only in available in English.

Staff told us there was an interpretation service available, but they did not use it routinely because it took too long to access relevant languages.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The service ensured people were provided care in a timely way. Performance data did not always meet national targets, but was better than the England average. The service had made some adjustments to enable access for all, but the waiting room did not always have enough capacity. Urgent tests and screening were timely, and staff streamed patients which improved access including the use of a GP stream and SDEC. There was a positive culture to prevent discrimination and inequalities, and work was ongoing with local minority groups.

There were 62 patients in the department during our assessment and 32 were waiting for a hospital bed. The longest wait was 22 hours. The service manager was trying to arrange beds for the longest waiting patients.

Patients were not always triaged and treated within the recommended safe timeframes, in line with national guidelines. The 4-hour performance in the department was declining from 75% in April 2024 to 64% in January 2025. Time to triage did not meet the 15-minute in the most recent 3 months, or in 8 out of 12 months in the last year. Performance was 53% in January 2025 which was around the England average. However, on the month of our assessment the trust 4-hour performance was better than the England average.

In February 2025, the mean time in ED was better than the England average for admitted and non-admitted patients.

Long waits in the emergency department are associated with increased risks to patient health, includinghigher mortality.

Warwick Hospital had the lowest percentage of ED patients who spent more than 12 hours in the Department than the national and regional aggregates. The percentage of patients who spent more than 12 hours in Warwick Hospital ED averaged 1.34% between April 2023 and July 2024. Patients were proactively moved onto beds if they had been in the department over 8 hours or were expected to be admitted.

The recommended minimum for the percentage of available beds to achieve efficient operations and transfer between emergency care and other hospital departments is 8% . Warwick Hospital has achieved the recommended value, since July 2024.

Ambulance handovers were not always in line with the national target of 15 minutes and monthly performance had not met the target for the last 12 months. However, the recent rolling 30-day position for average handover times was better than the target, and the trust ranked 4th in the region for average handover times out of 23 trusts.

A performance dashboard was used to monitor performance against national benchmarks and targets. The most recent dashboard detailed performance for January 2025. The overall ranking for the trust had improved from 50th in December 2024 to 29th in January 2025.

Ambulance staff described that all ambulance handovers were quick, and information could be shared effectively and efficiently.

The department was supporting system pressures in the local area so that patients could access care they needed. Data provided by the trust showed that that they had the around the 10th to 12th highest number of ambulance conveyances. Intelligent conveyancing is used to divert patients to different hospitals in the footprint where they may receive the timeliest most appropriate treatment on arrival at hospital, when there are pressures in the system for the ambulance service or other hospitals. Warwick Hospital ED took the 3rd highest number of intelligent conveyances in the local ambulance footprint in January 2025, supporting the local health and care system., although this impacted on the department’s performance.

127% more patients were attending this ED than in the last 5 years and 50% of those patients attended either by choice or from out-of-area ambulance conveyances. The rate of type 1 attendances had increased was one of the highest nationally and almost 30% higher than national increases. There was a decline in other neighbouring trusts, which showed patients attended from out of area. The trust reported the increase in attendances and supporting the wider system in regional meetings and at trust board.

There was not always enough space to deal with emergency patients immediately. Adult resus became full quickly and we observed it was full at the time of the assessment. However, staff described paediatric resus was always available for children and young people.

Patients could access urgent tests and screening when they needed them, and sepsis was screened for and responded to quickly.

Staff referred appropriate patients to a co-located GP service. We heard examples of positive support patients received as there was direct access to diagnostic tests and speciality input.

Streaming to minor injuries or the GPs was done immediately, and patients were seen quickly. The longest wait we saw in minor injuries was 48 minutes.

The department could flex bed space when it was needed to keep access for ED spaces for patients that needed it. The clinical decision unit (CDU) was opened for people waiting for beds.

The psychiatric liaison service was easily accessible and generally saw patients within an hour. They managed patients including their discharge and follow up, so they were not disadvantaged by being in an acute setting.

The service was proactive in managing health issues for minority groups accessing services. For example, the service was working proactively with an organisation for asylum seekers to ensure plans helped improve their access to the service.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.