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 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.

The service mostly made sure children’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them. The service planned and delivered children’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 practice and standards. However, there was an inconsistent approach to completion of hospital passports and staff were not always able to locate these in patient files.

The service worked well across teams and services to support children and young people. Staff made sure children only needed to tell their story once by sharing their assessment of needs when they moved between different services. The service monitored care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

Effective is rated as good. This meant children and young 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 made sure children’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

Children, young people and their families said they were involved in their treatment decisions. We spoke with 18 children, young people and their families. They said as well as being involved in deciding about their care and treatment they received the information they needed to make their own decisions about their care.

Patients were mostly confident their individual needs had been appropriately assessed and fully understood. The service was using ‘All About Me’ documents and hospital passports. These documents stay with the patients at the end of their bed. Staff talked to patients and their parents about what reasonable adjustments they can make. One of the options was to give them a private cubicle. If this was recognised as a priority, children using one of the private cubicles would not be moved and would remain in the cubicle while on the ward. In addition, staff could provide weighted blankets, ear defenders and earplugs and there was an option to make personalised timetables and schedules for children that might need them using pictures and symbols.

However, not all individual needs had been fully documented. We reviewed some examples of ‘All About Me’ booklets which were used to identify patients preferred name and any additional support needs. It described their communication needs, sensory needs (for example not liking loud noises and sensitivity to smells). The document described triggers for distress and identified their comfort items such as a soft toy and how they calm themselves. Some documents did contain detailed and useful information about the child, young person and their family or carers. However, in the ‘Things I Don't Like’ box, nothing had been recorded. Some of the documents were incomplete and missing information about current medical conditions.

Patient’s needs were assessed using a range of tools. During the file review we saw a good example of a personalised timetable developed for a child to help them feel safe and know what was “now and next.” This specific timetable had been developed for a child to explain what happens on the day of an operation in order to support a child to understand what was going to happen when they came in for an elective surgery.

Assessments did not always consider the patient’s needs to enable them to receive care and treatment that had the best possible outcomes. We were told sometimes the process for assessing needs was not as effective as it could be in recognising the needs of children. Either nurses had not identified an additional need or not alerted support staff to the child or young person’s additional needs. The questions about a learning disability, autism or other neurodiversity were not in the initial admissions document, meaning this was not always effective and children with additional needs may not be identified for some time.

We mostly saw good documentation in the children or young people’s care plans once individual needs were identified, although some documents were not consistently completed. The care plans we reviewed included helpful levels of detail about how to care for the child or young person. If a child or young person required reasonable adjustments or a ‘hospital passport’ because they had additional needs, this was identified in their personal care plan. However, there was an inconsistent approach to completion of these passports and staff were not always able to locate these in patient files.

The staff told us they were passionate about supporting patients with additional needs including learning disabilities and autism, mental health and visual and hearing impairments. They offered support to patients, their carers, and ward staff, and were also responsible for monitoring and reducing restrictive practices.

Staff at the service had a good understanding of the needs of children with attention hyperactivity deficit disorder (ADHD) and how it presented differently in male and female children. For example, a young person who was neurodiverse was diagnosed with a food-related mental health condition. Staff worked with the young person and made adaptions to menus, practices and the environment to keep them safe and well supported. All patients were able to bring their own bedding, pictures, diffusers and electric candles.

The ward had communication aids which were small booklets with pictures and simple words to prompt communication about how children and young people were feeling. This included being too hot or too cold, lights being too bright or the ward being crowded or there were smells. This enabled children to be able to talk about their sensory issues with the member of staff. Another communication aid was used for pain assessment and management.

The service used experts by experience to assess the ward and the environment to further improve the experience of patients. Staff used a tool called 15 Steps. They invited in an external organisation working with service users, parents and young people who were neurodiverse or had mental health needs. The team conducted a walkaround the ward and the environment to review what things potentially could change or be improved. The service was in the process of setting up a working group of young people about the redesign of the ward and were awaiting the report from the external organisation about their findings.

Trained staff supported children’s mental health and education needs. The service had a nurse who was trained as a paediatric crisis, neurodiversity and learning disability lead nurse who worked with other agencies to provide mental health support. They used appropriate plans to meet the young person’s individual needs around their mental health. If a child was on the ward for 10 days or more, a teacher would provide education to children if they were well enough.

The needs to carers were assessed and met. This supported their wellbeing in their carer roles. There was support for grieving parents and families from the bereavement service.

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 had access to up-to-date policies and procedures which enabled them to follow national guidelines and evidence-based practice.

Staff told us they were actively involved in audits monitoring the quality and standards of the care provided to children and young people. This included but was not restricted to national data collection programme for epilepsy and diabetes. The service also conducted internal audits including paediatric early warning scores (PEWS), consent, documentation, and medicines management to ensure children and young people were receiving a good standard of care.

An audit of care records for all children and young people services demonstrated that for the 6 months from 1 April 2025 to 30 September 2025 the service was 90% compliant. Actions to improve this compliance included updating the CAMHS admission booklet, completion of the eating disorder care bundle, updating the nurse in charge handover sheet and improvements to the children and young people admission booklet. This audit was completed based on feedback from staff and family on the clarity of this process.

There was evidence-based care and treatment including pain management and specialised feeding techniques. Children, young people and their families told us where needed, pain had been managed well and pain relief was given promptly when required.

Patient’s nutrition and hydration needs were met in line with current guidance. Food and fluid balance charts were regularly updated. Staff were able to request support for patients needing specialised feeding from support teams.

The service promoted the use of specialist area leads, for example, epilepsy nurses and play specialists. Staff with this specialist knowledge could offer additional up to date advice or support to other staff working with a patient with additional or complex needs.

We saw good working relationships between nursing, and medical staff and staff felt supported by managers.

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

Staff worked well together. There was good communication between doctors and the nursing team to meet the needs of the children and young people. Student nurses told us they felt supported by nursing and medical staff; they also told us they felt like they were learning and developing well.

Effective multiagency working was clearly documented in patient records. The service had a mixture of staff, which included doctors, nurses, healthcare assistants, and a play therapist. There was a paediatric crisis, neurodiversity and learning disability lead nurse.

The service worked well with outside agencies. This included the local authority, local safeguarding teams, social workers, mental health teams and local care teams who attended the service to support an individual child or young person if they required additional support. The paediatric crisis, neurodiversity and learning disability lead nurse had good connections with an advocacy service, and they had links for patients, their families and carers to signpost then to obtain support. The paediatric crisis, neurodiversity and learning disability lead nurse also met with the community children's team to support the complex needs of some children and young people. They also use a tool called ‘I want great care’ which was a way to get feedback from family’s and carers about the service provided.

Information was shared between teams and services to ensure continuity of care. There were monthly meetings between the safeguarding lead, paediatric crisis, neurodiversity and learning disability lead nurse and the paediatric sister in the emergency department. In addition to the meetings the service had an I.T based channel for staff to share information and any updates. The trust safeguarding team worked with the Multi-Agency Safeguarding Hub (MASH). This is a social services central team bringing together professionals from different agencies for example social care, police, health services and education to quickly assess safeguarding concerns for vulnerable children or adults. The group shared information securely, and decided on the most appropriate, timely support or intervention to keep children and young people safe and improve outcomes.

The service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives where possible and reduce their future needs for care and support.

The team provided various health promotion activities and resources for children and young people.

The service promoted emotional wellbeing and signposted patients, parents and carers to appropriate mental health support in combination with referrals to the Child and Adolescent Mental Health Services (CAMHS). Information about specialist services was displayed clearly on the ward and consistently discussed during crisis assessments and safety planning.

Using charitable funds, the service developed “Wellbeing Packs” for children and young people who were in crisis. These helped promote grounding, self-care, and emotional support.

The service focused on identifying risks to people’s health and wellbeing early and how to support people to prevent deterioration. On the wards were QR codes linked to a specialist information guide specifically designed for neurodivergent children, young people and their families. This resource provided:

• Local support groups
• Guidance on navigating education and social care pathways
• Sensory support strategies
• Advice for families on managing emotional distress

Staff also worked closely with local substance misuse services, who provided specialist advice and intervention around:

• Alcohol and drug misuse
• Support for children and young people whose parents misuse alcohol or drugs
• Harm-reduction strategies
• Relapse prevention
• Pathways to community-based addiction support services

Staff regularly signposted children, young people and their families to these services using the referral link, face-to-face discussions, and as part of discharge planning. The service could also refer patients, families and carers to reliable, age-appropriate services that provided education, advice and support around healthy relationships, consent, sexual health and body autonomy. These resources were on display in the older children’s room, so all children and young people, regardless of their reason for admission had access to education and support around safe, respectful and healthy relationships.

The play team delivered a themed programme of daily activities. The themes varied and often aligned with national health-promotion events such as Dental Hygiene Week, World Mental Health Day, Children’s Mental Health Week, Patient Safety Week, and Play in Hospital Week. These themes helped introduce important health messages in a child-friendly, engaging way.

The service monitored people’s care and treatment to continuously improve it. Staff worked to provide outcomes that were positive and consistent, and they met both clinical expectations and the expectations of children and young people themselves. The service completed audits to determine outcomes and improve practice where needed.

The service was mostly providing good care for children and young people with diabetes but were below the national average in some key areas of practice. In the last national audit for 2023/2024, the service identified that the outcomes were improving year on year. However, key areas for concern were around newly diagnosed patients who should have blood tests chased promptly, however this was a delay that was being experienced nationally. Also, the audit highlighted for key health care reviews to be done promptly. The lead nurse for diabetes said the service was well staffed and had clear priorities for 2025\2026. There were 140 patients in the service and staff told us they had been working on assessing and, where appropriate, giving children and young people an insulin pump. At the time of our inspection, they had achieved this with 80% of the eligible patients. Patients and their families and carers were supported and trained to be able to use the pump. The outcomes for people with a pump were improved as there was less risk of complications. Staff in the diabetes team also had access to a psychologist to support patients as there is an increased risk of a need for mental health support with this cohort of patients. The diabetes lead nurse attended transition meetings to support patients moving to adult services.

The trust participated in the National Clinical Audit of Seizures and Epilepsies for Children and Young People (Epilepsy 12). This is a national paediatric audit that reviews the first year of care for a patient’s epilepsy. The trust had submitted data regularly for the past several years. Reports were released each year and were usually for the period 2 years previously. In the latest audit, the trust scored well for assessment of:

• Percentage of children with epilepsy with input by a consultant paediatrician with expertise in epilepsies within two weeks from first paediatric assessment: 92.6% this is above the national average of 50.8%

And in line with the national average for:

• Percentage of children and young people with epilepsy where there is documented evidence that they have been asked about mental health either through clinical screening, or a questionnaire/measure: 23.5%. The national average is 22.4%
• Percentage of children and young people meeting defined Children's Epilepsy Surgical Service (CESS) referral criteria with evidence of CESS referral: 38% The national average is 38%.

The trust told us that since the audit was completed in September, acute and community teams had met to create a new patient pathway for community patients. All suspected first seizure patients in the community paediatrics clinics will be referred to an Epilepsy Specialist Nurses (ESN) triage clinic. Nurse led clinics were available for acute and community services to support patients. However, these were typically used on a patient-initiated basis, and patients did not have regular appointments with an ESN in accordance with NICE guidelines, due to capacity. Recommendations were made to the trust following the audit and we saw evidence of action plans.

In addition to the action plan for improving the results of the above audit, staff also told us that all patients presenting with a first seizure or febrile convulsion were provided with The Royal College of Paediatrics and Child Health First Seizure leaflet. This offered general safety advice and outlined essential first-aid measures in the event of further seizures or collapse. Families were additionally signposted to the Epilepsy Action website and directed to information relating to their child’s specific epilepsy type to further support understanding.

For children commenced on anti-epileptic medication, families received the relevant medication information leaflet. In cases where more than one medication was clinically appropriate, information on each option was provided and families were supported to make an informed choice. Discussions routinely included potential side effects and available formulations (e.g., tablets, liquids, granules), which was recognised as particularly important for patients with neurodiversity where sensory considerations may influence medication compliance. Where appropriate, children who were interested in learning to swallow tablets were given tailored written guidance and practical advice to support this skill.

Sudden Unexpected Death in Epilepsy (SUDEP) was discussed sensitively when clinically indicated, and families received leaflets outlining the known risk factors and evidence-based strategies to minimise these risks. Sleep hygiene was a frequent topic of discussion, given the close relationship between sleep quality, seizure control, and the impact of certain medications on sleep patterns. Individualised advice and resources from an external sleep advice agency were provided to families.

Patients and families were encouraged to make healthier choices to help promote and maintain their health and wellbeing. For teenagers, consultations included discussions around alcohol use, vaping, and contraception, with clear explanations of how these factors may interact with epilepsy or anti-epileptic medications. Young people were directed to the Epilepsy Action and Young Epilepsy support group for further age-appropriate advice. Where concerns about drug or alcohol use were identified, referrals were made to the relevant substance misuse team for support. Families experiencing psychological or emotional difficulties related to their child’s diagnosis were directed to appropriate support services.

The respiratory team provided comprehensive health promotion to all patients and families accessing the service. This included education on asthma and wheeze recognition and management, demonstration and correction of inhaler and spacer technique, and the provision of personalised asthma or wheeze action plans. The team also offered targeted advice on trigger identification and avoidance, supported smoking and vaping cessation through appropriate referral pathways, and promoted self-management strategies to reduce exacerbations and improve long-term respiratory health. Health promotion activities were reinforced through participation in national awareness initiatives such as Ask About Asthma Week and World Asthma Day.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service knew when any 16- and 17-year-old young people were placed on adult wards, as legally they were still classed as children. The service monitored this daily to provide support if needed to the children and the ward staff. Staff were in contact with the adult ward staff to ensure consent had been sought from the young person, and they felt happy and safe to receive care and treatment on an adult ward.

The service competed audits on consent form completion. The audit covered:

• Whether the consent was in the patient file
• If the name and date of the procedure was documented
• If the risks and benefits section of the form was completed
• If the form was signed, dated and the grade of the signatory completed
• If the form was signed and dated by the parent or carer

Audit results showed paediatric teams scores of 93.5% in August 2025 and 89% in September 2025 so some areas needed improvement. The service had a consent to examination or treatment policy which was in date and ratified.

Consent was obtained effectively. Staff spoke with the children and young people before any care and treatment was started. They obtained written, verbal or implied consent and checked children, young people and their families understood what was to happen next. We saw consent was clearly documented in records and had been discussed and given where relevant. Staff were obtaining consent in line with legislation and trust policy. Staff understood how some children were able to give their own valid consent, should staff assess them as mature enough to fully understand what they were being asked. Staff understood ‘Gillick competencies’ which covered the legislation relating to consent for children.

We spoke to staff about consent to treatment and use of the Mental Capacity Act. They told us they planned how they could support the child and uphold the United Nations Convention on the Rights of the Child (UNCRC). They made sure children understood what was going to happen and assessed how much information based on their age and understanding they needed to share. They used play to support understanding. They then created a plan for staff to follow recording the child or young person’s wants and needs. Staff explained that even if a child was sectioned under the Mental Health Act, they would still create a plan.

Where necessary, people with legal authority or responsibility could make decisions within the requirements of the law. Where consent could not be obtained, staff delivered care in the patient’s best interests. The service would ensure other professionals and family, or carers were involved in the decisions for the child’s or young person’s care and treatment.