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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

Safe is rated as good. This meant there was a strong awareness of safety hazards and the risks. Solutions to risks were developed collaboratively, with the right people and system partners who can make improvements. Staff and leaders responded positively when people raised concerns about safety and ideas to improve care delivery were raised. The primary response was to view these as an opportunity to learn and improve continuously.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff had a good understanding of how to report incidents. They said they received feedback from managers, and of any outcomes or learning identified.

However, the completion of ‘All About Me’ paperwork and patient passports was not embedded. Patients accessing the day surgery unit did not have a pre-operative assessment.

The service mostly had enough nursing, medical and support staff with the right qualifications, skills, training, and experience to keep patients safe from avoidable harm and to provide the right care and treatment. However, there were high rates of sickness and use of bank and agency staff.

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.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff had a good understanding of how to report incidents. They said they received feedback from managers, of any outcomes or learning identified.

Staff held daily safety huddles and handovers where incidents were discussed. During our assessment we attended daily meetings and these were well attended by staff of all levels. A daily check-in newsletter was read out to teams at the handover, the newsletter acted as a reminder to read any updated policies such as infection prevention control (IPC) and data protection. The newsletter also gave positive feedback to teams.

Incidents were reviewed for seriousness and themes to make improvements or learn when things went wrong. Incidents reported were mostly graded as ‘no harm’ and predominantly for medication issues. Between 1 March 2025 and 31 August 2025, the service reported 4 low harm incidents and 84 no harm incidents. There was evidence of actions taken, including discussions at team meetings and for staff to attend training refreshers. There were 17 medication incidents reported, 4 of which were due to delays in take-home medication for patients. One of the incidents reported that pre-operation planning had not been completed for a neuro-diverse patient. It was good practice that the service was reporting these incidents and highlighting how it was important for certain patients to have opportunities to attend the service and ask questions prior to procedures.

The service did not have morbidity and mortality meetings at the time of our inspection; these were being organised for future dates. However, the team discussed cases for safety improvement and learning at quality improvement programme (QUIPS) meetings and certain mortality cases were discussed at the trust mortality surveillance committee. Minutes showed that following a case discussed at the mortality surveillance committee, which involved the review of a deteriorating child, the incident had been subject to an after‑action review (AAR). An AAR is an evaluative process used to review events where outcomes have been particularly successful or unsuccessful. Learning identified from this review had been shared with staff to support learning and improve future patient outcomes. Any cases of a sudden and unexpected death of an infant under 12 months of age, were additionally presented and discussed within the trust wide mortality and morbidity meeting chaired by the chief medical officer.

Minutes from the mortality surveillance committee, which met monthly identified actions and shared learning following of the review of a child death. This review was completed using the patient safety incident investigation process and learning was shared from the outcome of the investigation. There were joint reviews with other NHS trusts and community teams which showed effective multidisciplinary working in terms of learning and improvement

All staff understood their responsibility to be open and honest with patients and their families when things went wrong. Staff were able to explain and give examples of instances of applying the duty of candour and they had a good understanding of when this duty needed to be applied. They knew this involved an apology to those affected as well as an investigation into certain adverse events.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

Safety and continuity of care was a priority throughout the care journey of children and young people. There were good systems to support patient pathways. The service had good links with external agencies and community teams.

Staff had access to support from mental health teams, safeguarding teams and occupational therapy teams. They were able to identify who the designated service leads were for these services and told us they were easily accessible and responsive to requests for support for a child or young person. However, the mental health team was based offsite, and staff had to call and ask them to attend. Staff told us this sometimes led to a delay.

The service had on average 4 elective (planned) surgery patients per day on the ward. However, information about young patients with disabilities or autism were not always shared prior to their admission, which can be a problem especially if patients are distressed on arrival. Staff discussed the value of a hospital passport. If completed accurately and available at each hospital attendance, this would ensure that information about reasonable adjustments and sensory needs was already known and could be planned for in advance. Staff felt that the use of hospital passports should be embedded into practice and form part of the admission process. This feedback was provided to the trust following the inspection for urgent review.

However, the use of hospital passports by patients is voluntary. While they represent good practice and can support a positive patient journey, some patients, families, or carers chose not to complete a passport or completed only some sections. In addition, completion may not always be appropriate, depending on the reason for attendance, for example during emergency presentations. Ideally, hospital passports would accompany the patient at every hospital visit; however, staff reported that these were sometimes forgotten.

There was an assessment process and we saw completed paperwork, for patients admitted to the ward prior to surgery. However, day surgery operations did not have a pre-operation assessment process. This was completed on the day of the procedure as opposed to in advance as with other inpatient surgical procedures. On occasions a day-case patient would need to be admitted to the ward due to complications. Staff told us that this could add to the acuity of the ward and add an increased demand to staffing, if patients needed one-to-one nursing.

Care and support was planned and organised with patients, partners and communities to ensure continuity. The service worked well with other departments in the hospital and with other NHS trusts. For example, the service worked collaboratively with the local NHS children’s hospital.

Children, young people and their families were involved in discharge plans. The service had a transition lead and evidence of systems to support young people from the age of 13 years of age in transition to other services. Each specialist nurse provided transition support either through dedicated transition clinics or through structured transition discussions with the children and young people on their caseload. This was done to ensure transition planning was embedded within routine care and tailored to the individual needs of each young person.

Children and young people approaching the transition phase, or who had specific transition-related needs, were discussed as part of regular local consultant and nurse clinic appointments.

Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.

Training related to safeguarding, adults and children’s levels 1, 2 and 3 met or were above the trust’s compliance levels at 85%. Staff completion rates for PREVENT (in relation to recognising the threat of terrorism and extremism) level 3 training for clinical staff exceeded the trust target at 99%.

Staff compliance with Mental Capacity Act and Deprivation of Liberty Safeguards training was just below the trust’s compliance level of 90%. The compliance level for both was 88%.

Staff demonstrated a good understanding of safeguarding procedures and the different forms of abuse. They could easily identify the service safeguarding leads and teams and how to get support and report a concern. There was evidence of actions taken to safeguard children and keep them safe from harm. The service had a standard operating procedure for safeguarding and for children attending the service in crisis.

Patient records clearly identified and flagged any safeguarding involvement on the children and young people’s records. These were easily identifiable to staff so they would not be missed.

There was a single point of contact with the safeguarding team, so all staff contact the same team, no matter whether it is a child or adult patient. The head of safeguarding told us they used examples of real safeguarding cases with the staff link group to share any learning. They had about 30 staff who attended the link group and it had moved to an online meeting each month, and this has helped increase attendance.

The safeguarding team also provided safeguarding supervision with staff to support their learning. Safeguarding staff gave an example where they had recently carried out a debrief with staff on MacGregor ward following safeguarding concerns involving a complex child who was neurodiverse. They said they aimed to ensure staff could easily engage in the safeguarding process.

The service monitored all safeguarding referrals and supported staff when they had any questions or queries, or if they were not sure of the next steps.

A safeguarding audit dated August 2025 showed the service had made 20 referrals in the previous 12 months. Positives from the audit were:

• Correct referral form usage remained consistently high throughout the year
• Consent documentation was well-managed
• Factual accuracy and clarity in distinguishing fact from speculation also showed strong performance.

The audit highlighted areas for improvement, for example:

• Completion of all information boxes on referral forms was consistently the lowest-performing area
• Providing comprehensive summaries of concerns showed some improvement in quarter 3, but scores declined again in quarter 4 indicating inconsistency.
• Details regarding the child, family, and significant others declined to 75% in quarter 4.

Some of the previous recommendations from the audit were to develop and implement a standardised referral script or proforma to be used during all telephone safeguarding referrals. This would act as a prompt for referrers to ensure that all key information was captured and communicated effectively. Evidence provided following our inspection confirmed this had been implemented for teams to use.

The service had a safeguarding action plan and actions included strengthening professional curiosity and improving information sharing between services. Actions and updates were shared at the safeguarding link group which was a multidisciplinary meeting across services such as community health visitors, staff at other NHS trusts and the paediatric crisis, neurodiversity and learning disability lead nurse.

The service had effective systems for monitoring and treating patients. There was a deteriorating patient pathway, and staff were able to explain this and how to escalate the deterioration of a patient.

Patient records showed observations for monitoring patients’ vital signs and assessing the risk of deterioration were carried out effectively. The service’s quarterly audit data for the recording of paediatric early warning scores (PEWS) from April to June 2025 and July to September 2025, showed that 100% of children and young people had an age-appropriate PEWS chart. The date, time and frequency of observations were recorded on the PEWS charts and were completed in a timely manner. If sepsis had been identified on the PEWS chart, it been escalated and the escalation level was recorded in 100% of cases.

The same audits for both quarters were competed for the neonatal service, and almost all charts were found to be well completed.

Individual risks to people were assessed, and people were involved in this process as much as possible.

The service worked with children, young people, their families and other community and NHS providers to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Files we reviewed detailed good mental health support, safeguarding records were completed, and there was evidence of psychiatric support where required. There was good multidisciplinary team working both with internal trust teams and external support agencies.

The service had a reducing restrictive practice policy. The service reported each occasion that restraint was used. There was a post- incident meeting (also known as SWARM) after each time restraint had been used. The SWARM meeting reviewed what happened and considered what could have been done differently and any learning from the incident.

Restraint was only used as a last resort. The service kept records and monitored the use of restraint if it was needed to manage risks to a patient and staff. Assessments were documented, and the type and reason for restraint was recorded. However, ward staff were not trained or permitted to use physical restraint. In circumstances where physical restraint was needed, ward staff requested support from security guards who were trained in this action as a last resort. The security staff were employed by a third-party company who provided their staff with their own specialist training.

Staff had a good understanding of Martha’s Rule. Martha's Rule is a patient safety initiative to enable patients, families, carers, and staff to request a rapid review from a critical care outreach team when they have concerns about a patient's deteriorating condition.

Children and young people were cared for in environments that were designed to meet their needs and were safe. The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

The service had suitable facilities to meet the needs of children and young people. The environment was visibly clean and designed with children in mind, such as the use of soft colours and paintings of characters on the wall.

Leaders and staff considered how environments could keep children and young people safe from harm and in relation to supporting their sensory needs. Staff supported children and young people with a learning disability, autism and neurodiversity to come into the outpatients’ area on the children's ward for treatment as it was a quieter environment. They could also involve the play therapist to endeavour to have the least impact on the child. The service recently treated a young person who was nearly 18 years old, staff and the family decided it was the best place to support the patient to have their blood tests to reduce anxiety. On MacGregor Ward staff allocated the cubicles as priority for children who had a learning disability, autism or neurodiversity to support their sensory needs.

The windows on all wards were safely secured to prevent the risk of falls. All electrical equipment had been tested and labelled to show it was safe to use. Wards and the neonatal unit had weighing scales, baby baths and baby changing units. These were in good condition, had been serviced, and the servicing date was visible on the equipment. Both wards used cots, which were in good condition. The ward had access to sensory toys, ear defenders and weighted blankets to support any children and young people who had additional sensory or other needs. There was a hoist to help move children and young people safely who could not weight bear.

Resuscitation trolleys were in good condition and equipment was in date, daily checks had taken place on both wards. Sharps boxes were stored correctly and were not overfilled. Oxygen tanks were stored securely, clearly labelled with an expiry date, and were in date. Spill kits were located on the ward and neonatal unit within the sluice room.

The service monitored equipment safety alerts. When there were concerns about equipment this information would be shared with staff by email, and within safety huddles.

Entrances were secure and kept children safe. Both ward entrances were locked, and visitors needed to use the intercom to enter after they verified who they were and who they were visiting. There was a security camera at the staff workstations, so staff could check who was at the door. There was additional security for babies in line with required guidance. All babies were tagged in line with the service abduction policy and protocol.

There was an area in the special care baby unit for visiting siblings to play, along with a quiet room and a milk kitchen. Fridge temperatures were monitored and checked in line with national guidance. The milk fridges had a secure locking system which could only be accessed by staff.

The ward was free from ligature risks, and the service had a ligature risk assessment and policy.

The service mostly had enough nursing, medical and support staff with the right qualifications, skills, training, and experience to keep patients safe from avoidable harm and to provide the right care and treatment. However, there were high sickness rates among staff. Managers calculated and reviewed the number and grade of nurse and healthcare assistants needed for each shift in accordance with national guidance. The ward managers could adjust staffing levels daily according to the needs of the patients. Managers used the acuity tool (a measure of the complexity of the patients on the ward) 3 times a day to check the staffing levels on the ward. There were low vacancy rates for staff and most nursing posts were filled.

Children and young people were supported by staff skilled in more social aspects of care and in liaison work. A play specialist and a play assistant worked on the ward, one full time, and one part time. The MacGregor ward had also recently recruited a family liaison worker for 22.5 hours a week, whose role it was to engage directly with children and their families and to liaise with the emergency department (ED), to support children as they arrived at the ED and help assess their needs.

The service had a paediatric crisis, neurodiversity and learning disability lead nurse. The lead nurse had completed autism training and trained staff in autism awareness and understanding. The training considered the impact on autistic children on the ward. To assess and support children and young people the service used a framework developed by the National Autistic Society, which was a person-centred, evidence-based approach to supporting autistic children and adults. It is a framework focusing on creating supportive environments and adapting approaches to individual needs.

The learning disability liaison nurse for adults within the hospital supported parents and carers who may also have a learning disability. They shared the hospital passports for parents and carers with the relevant paediatric services and sent other supporting documents, like communication passports or reasonable adjustment information.

Staff on the paediatric wards were trained in verbal de-escalation techniques.

There were mostly appropriate nursing staff levels and skill mix to make sure patients received consistently safe, good quality care that met their needs. Nursing staff we spoke to said that when bank staff were used to cover gaps in the rotas, they were mostly regular staff who knew the service and the wards. They felt the staffing levels were safe and any reduced staff cover was generally due to sickness. If staff numbers were not as planned, staff would be supported by other areas within the trust or bank staff. However, there was a high level of bank and agency staff used at times, although all with a full induction.

Any gaps in the resident doctor rota were covered by locum shifts, or consultants who worked within the hospital. The service always had a consultant on call during evenings and weekends and patients had a daily review by a consultant. Staff said they had always been able to reach a consultant for advice, or they had attended the ward if needed.

Training data showed that 80.76% of staff combined within the service were compliant with at least one life support qualification, including European Paediatric Advanced Life Support (EPALS), Paediatric Immediate Life Support (PILS), or Paediatric Basic Life Support (PBLS). This included paediatric nurses and consultants who were up to date with Paediatric Immediate Life Support and European Paediatric Advanced Life Support training.

During our inspection, staff we spoke with confirmed they had completed the required life support training and demonstrated confidence in recognising and responding to paediatric emergencies. Most staff were also trained in Neonatal Life Support, with a compliance rate of 88%. This was slightly below the trust target due to staff being on maternity leave; however, the service had adequately trained staff available to maintain patient safety.

Registered children’s nurses (RCNs) had undertaken additional specialist training on the recognition and management of the deteriorating child. Three RCNs had attended the Stabilisation of the Critically Ill and Injured Child course, a one‑day programme combining lectures, small group learning and simulation, accredited by the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Anaesthetists (RCoA).

Four RCNs had completed the Critical Care Emergency Medicine Education for Nurses pre‑Transfer (CEMENT) course, which focused on stabilisation and emergency medication management for critically ill children and young people prior to transfer, using a blend of theoretical teaching and practical workstations. In addition, seven RCNs had attended a High Dependency Critical Care course, which developed skills in caring for children who were acutely unwell or critically ill.

This additional training strengthened staff competency in identifying and managing deterioration and supported the delivery of safe and effective care for children and young people.

Staff received training appropriate and relevant to their role. The service provided mandatory training which was suitable to meet the needs of the children and young people using the service. The trust target for compliance was 85% and most modules were meeting the trust target.

The on-line E-Learning compliance rate for learning disabilities and autism training, which is a requirement for all staff, was 92.2 %. The completion rate for training for other learning disabilities and autism modules was lower at just 14% of staff for tier 1 and 21% for tier 2. Learning disabilities and autism training was a new national programme of mandatory training which was introduced in September 2025. The service told us more training dates had been added, and staff had been reminded to complete this training as soon as possible.

The service gave staff study leave each year to support them to complete training. Staff received an email from the service education team 3 months before any training was due to expire, with the expectation of staff to book onto training. If training had not been completed a reminder email would be sent to staff requesting completion. Managers monitored completion rates for training.

Staff we spoke to said they received appraisals and plans for development. The service compliance rate overall was 84.5%.

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

There was good identification of possible risks from infection and staff took safety precautions. The ward clearly identified rooms where children or young people were isolating if, for example, if they had been diagnosed with influenza. Staff washed their hands before contact with a child or young person, and once the treatment had finished.

There was a good standard of cleaning. All areas and equipment were visibly clean, and equipment was clearly labelled with an ‘I am clean’ sticker, with a date to show when it had last been cleaned. Cleaning schedules clearly identified when rooms and equipment were due to be cleaned and were up to date. The service completed environmental infection prevention audits including hand hygiene. Between October 2024 and August 2025, compliance ranged from 90% to 100%. There were action plans following audits with specific dates for completion.

Staff used personal protective equipment and stored waste safely. This included wearing aprons, gloves, and masks when required. There was antibacterial hand gel for visitors and staff to use. Visitors and people using the service also had access to handwashing facilities. The wards had an appropriate storage space for clinical waste, which had a locked door, and containers were emptied on a regular basis.

The service had safe systems for appropriate and safe handling of medicines to ensure people were given their medicines as prescribed. Medicines storage was locked and secure with access only to authorised staff.

Staff knew who the ward pharmacist and pharmacy technicians were. Staff told us they knew how to contact pharmacy for advice and there were effective processes for the supply of medicines.

Staff told us there was a good pharmacy presence with a clinical pharmacist based on the ward all day. The pharmacy department was available to support them with managing medicine processes such as ordering and receiving medicines. There was good access to pharmacy advice, emergency medicines and critical medicines out of hours.

Medicines were stored safely and securely in line with recommended practice. The pharmacy team checked the safe and secure handling of medicines and controlled drugs for safe medicine storage and provided reports to the wards with any actions to be taken for improvement. Systems for medicines storage were well managed. Medicines were stored and managed safely and securely with access only to authorised staff.

Emergency equipment and medicines were available and checked in accordance with national guidance to ensure the medicines were safe to use. We discussed with staff the location and accessibility of the resuscitation trolley under Resuscitation Council (UK) guidance. The trolley was kept in a utility room with only key card access. Following the inspection the resuscitation team completed a ward-based risk assessment for the accessibility of the resuscitation trolley in an emergency balanced against the risk of harm to patients on the ward. Staff were assured this was the correct location for the resuscitation trolley considering the risks if a child were to gain access to the equipment.

Medicines for refrigeration were stored securely with records available of maximum and minimum temperatures to ensure the medicines were stored safely. Staff knew what action to take if there were any issues to ensure the safe storage of medicines.

Processes were effective to ensure people received their medicines as prescribed. The service had systems and processes to safely support people with their medicines. Pharmacy staff were involved in reviewing people’s care and treatment with medicines and checked their medicine history was accurate and up to date using a variety of sources of information. Weights of patients especially for children were recorded, which helped support calculating weight-based medicines prescribing. Formulas and examples of frequently used medicine calculations were displayed in the treatment room. The information we looked at showed patients were receiving their medicines as prescribed.

Where antibiotics were prescribed, evidence showed prescribing for sepsis was in line with national and local guidance using a sepsis screening tool for acute assessment. Microbiology and pharmacy involvement ensured any queries about antibiotic prescribing were discussed and followed up with the prescriber. These decisions were documented in the patients notes.

Allergy status of patients was routinely recorded on all medicine records seen. This meant that allergies were highlighted, and medicines could be prescribed safely.

There was an effective process for managing and reporting any errors or incidents involving medicines. Reported incidents and trends were reviewed and staff were able to talk through the process that would be followed if this occurred. Examples of learning from incidents were available and the pharmacy team ensured trust guidelines were followed.