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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This key question has been rated as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The service always made sure patients’ care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. Patients and relatives were involved in the assessment of their needs, and support was provided where appropriate to maximise their involvement. Staff told us about the comprehensive approach to assessing the needs of the patients. Staff were passionate about providing the best and most up to date evidence-based practice in line with national guidance to make sure patients had the best outcomes.

Risk assessment such as risk of falls, skin integrity, nutritional needs and pain management were assessed daily, we saw evidence these were assessed and documented daily, this was in line with best practice. The IPOC was used to assess people’ needs and measure the physical, psychosocial, social and spiritual impact of illness.

We observed one of the CNS’ assessing and evaluating a patient in relation to their symptoms. We saw this included a holistic assessment including pain, positioning of the patient, medication review and discussion with the family as to their preferences. The CNS’ discussed the care and treatment options with both the palliative care consultant and nursing staff on the ward.

Following the death of a patient, the bereavement team would contact the family, if there were any concerns with the care and treatment the patient had received, they would arrange a meeting for the family to raise concerns with the consultant and nursing team.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. The service followed National Institute for Health and Care Excellence (NICE) guidelines, including Quality Standard 13 End of Life Care for adults and NICE guidance 31 Care of Dying Adults in the Last Days of Life. People had personalised care plans and assessments took account of people’s emotional, spiritual and social needs. Care in the last days and hours of life delivered the Five Priorities for Care of the Dying Person. These priorities ensure that the person is treated with dignity, compassion, and respect, while focusing on their physical, emotional, and spiritual needs. This information was included in the IPOC document used by the trust.

Policies we reviewed were up to date and had been approved by the appropriate governance processes.

The trust contributed to an external website called Care and Support Towards Life’s End (CASTLE) the website had evidence-based guidelines, documents and policies. The website could be used by staff, patients and relatives across the local trusts, hospices and community services and voluntary groups.

We reviewed 4 patient care plans and found RESPECT which includes resuscitation decisions were completed in line with national guidance. One patient told us they were involved in the decision in the RESPECT form and this was reviewed on each admission to ensure that care preferences were always up to date.

Staff told us they had an annual appraisal and could raise any issues or learning needs or opportunities with their line manager. In the last 12 months, 100% of staff had received an appraisal. There were a variety of online learning platforms that staff could use to develop their skills and experience to enhance their development

Patients were assessed in line with national and best practice guidelines, and we saw evidence in the patient records that we reviewed.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There was good teamwork and communication throughout the MDT. We observed this within the SPCT and other teams on the ward, hospices and community.

Every morning, there was a daily daily video conference call held with the trust SPCT, community services, local hospices and other healthcare providers to discuss individual patient care needs and to support patients wishes with their preferred place of care. Staff told us the SPCT at the hospital and community staff were intertwined and work well with each other.

Staff told us there was a strong collaboration across the bereavement and palliative care sectors, allowing staff to call on one another for support.

Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support. All providers used the same IPOC care plan to ensure consistency of care when a patient moved or used a variety of services.

Staff on the ward had autonomy to decide how urgently a patient needed to be seen by the SPCT as the form has an option to tick for urgency. Staff were confident in escalating cases and often sought advice from the palliative care team, even for patients who were not at the end-of-life stage. Ward staff told us the SPCT were very responsive and always willing to support staff on the ward.

The mortuary staff were employed by a local trust and worked closely with hospital and portering staff when transferring a deceased patient to the mortuary.

There was a weekly bereavement huddle with representatives from the mortuary, bereavement team and medical examiner team. They reviewed the patients in the mortuary to establish any ongoing concerns and when patients could be transferred to funeral directors.

Staff told us they had good relations with local funeral directors and included them in some training and development of patient and family information booklets.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to promote the best quality and end of life possible.

Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. Patients had access to physiotherapy services, a dietician and other support services to promote people to maximise their wellbeing and independence.

People were encouraged to eat and drink what they wanted.

Patients were involved in planning their treatment and care and were able to chose options for care and treatment with the advice of the consultant and the hospital team.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There was participation in relevant local and national clinical audits and other monitoring activities such as reviews of services and benchmarking.

The trust implemented the Outcome Assessment and Complexity Collaborative tool with five phases of illness, stable, unstable, deteriorating, dying, and deceased. This was used to describe the patient's phase of illness and urgency of care needs based on changes in their condition and the effectiveness of the care plan. The tool was being implemented in other local trusts and the community, for continuity of care. The results are not yet available.

A variety of audits were carried out by the SPCT team including, National Audit of Care at the End of Life (NACEL), mouth care, completion of death certificates, anticipatory medication prescribing at end of life and fast track patient discharges.

The NACEL audit which is a national comparative audit of the quality and outcomes of care experienced by the dying person and families, showed the trust scored above average for entering ethnicity in records, anticipatory medication prescribing and staff feeling there is compassion and support for the dying person. The trust scored below average for documenting evidence of hydration and lack of face to face 7 day specialist and palliative care. Bereaved people rated the trust as 50% for overall care and support provided against an average of 67%. The trust had developed an action plan to address each area including training and a business case.

We saw one audit that was carried out by SPCT to review documentation by nurses specific to end of life care on one of the wards. The results showed poor compliance with documentation using the trusts tools, action plans were developed which included education, a review of complaints and dissemination of information and the tools. A re audit was planned for November 2025.

There were discharge checklist for both nursing and medical staff to use in the last weeks of life to ensure all referrals, care, treatment, medication and equipment was available. There were plans to audit compliance in 2026.

The bereavement team carried out an audit that reviewed how many bereaved relatives had received a telephone call the next working day from the team. The results showed 90% of the cases received an initial phone call the following day from the bereavement team or from the coroner’s office. Action plans were in place to improve documentation and communication between departments, as well as a shared spreadsheet with information.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Patients understood their rights around consent to the care and treatment they were offered.

There were systems and practices to ensure patients understood the care and treatment being recommended. This helped them make an informed decision.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients consented to treatment based on all the information available. Patients received information about care and treatment in a way they could understand and had appropriate support and time to make decisions.

Staff understood the Mental Capacity Act and their responsibilities when assessing capacity to consent. Staff recognised that a patients’ capacity changed regularly due to the nature of treatment and their clinical condition, so they ensured that capacity was assessed at each interaction.

Staff understood their responsibilities around Deprivation of Liberty Safeguards and there were hospital policies in place to ensure that staff were aware how to request Deprivation of Liberty Safeguards for a patient.