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.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on the latest evidence and good practice. Staff gave people information to support healthy living. They made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to patients to make decisions in people’s best interests where they did not have capacity.

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 people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff used a range of tools to assess and review people’s health needs. The tools were standardised, so staff understood how to use them. Some tools were used to monitor everybody, and other tools were used to record and monitor people’s health dependent on their individual clinical needs. For example, to measure important indicators of health staff monitored adult patients using the National Early Warning Score 2 (NEWS2) and children using the Paediatric Early Warning Tool (PEWS).

However, there was a missed opportunity to assess clinical frailty at triage. NHS England recommend assessing clinical frailty of all adults over the age of 65 when they present for urgent and emergency care. The Clinical Fraility Score (CFS) is an assessment tool that helps to identify patients at increased risk of adverse outcomes for those living with moderate and severe frailty and can help to guide clinical decision-making and care planning. The CFS can also identify when a comprehensive geriatric assessment is required. We raised our concern that the CFS did not form part of the triage. After our inspection senior hospital leaders confirmed CFS assessment was introduced as a mandatory element of the first assessment for all patients over the age of 65.

We saw staff assess and document skin viability, including pressure ulcers, for people when they came into the department. They reassessed people who were at high risk of skin damage. We saw staff source appropriate beds and mattresses to reduce the risk of pressure damage occurring/worsening while in the department.

Triage nurses initiated potentially time sensitive conditions tests concurrently with the triage assessment to speed up treatment for patients. For example, staff had introduced a process so patients attending with chest pain had an electrocardiogram (ECG) and blood test alongside their triage rather than waiting to see a doctor first.

Pain was assessed for all patients as part of the triage process. Analgesia was given in line with trust guidance. Pain was reassessed at regular intervals and patients told us they were provided analgesia when it was needed. Staff used pictorial pain charts to help assess pain levels in children.

Staff assessed people’s communication needs on arrival in the department. If a patient’s first language was not English staff would use a telephone interpreting service to ensure the person could understand treatment options and give their informed consent for treatment. If people lacked capacity to make a decision about their care staff would use the Mental Health Act (1983) so a best interest decision could be made by the people who were important to the patient, and by the clinical staff.

There was a safety huddle twice a day so important messages about patients, including their communication needs, could be shared with all staff. The electronic system for recording information about patients had flags that alerted staff to patients with additional needs, so they were aware of these needs before they went to see the patient. Staff were also made aware of patients with safeguarding risks, and high intensity patients.

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 and assessment tools to plan and deliver high quality care according to best practice and national guidance. For example, staff followed Sepsis UK guidance for the management on neutropenic sepsis and patients were regularly assess patients for signs of clinical deterioration.

Staff used checklists to ensure they had completed all of the steps required to meet best practise guidelines, for example for nerve blocks and chest drains.

The service took part in national audits. For example, the Royal College of Emergency Medicine (RCEM) audits. The RCEM audits help drive quality improvement, ensure patient safety, and set standards in EDs by benchmarking performance. Benchmarking helps clinicians see how their department performs against others and where they need to implement changes for better patient outcomes. The department was involved in the following RCEM audits, Mental Health – Self Harm, Care of Older People, and Time critical Medication. Participation in these audits demonstrated improvements in patient care. For example, falls risk assessments for people over the age of 75 improved from 83.2% in December 2024 to 90% in October 2025. However, the care of older people audit identified in December 2024 that patient’s clinical frailty was not being assessed. RCEM recommended the trust adopt frailty screening at triage for patients over the age of 75 but this was not introduced.

Policies were based on guidance from the National Institute for Health and Care Excellence (NICE) and from royal speciality colleges. Changes in policy were made to reflect national and local changes. For example, each month a list of new and updated NICE guidelines were circulated to department leads. The leads were asked to review the NICE guidance and advise if the trust policies were compliant. When the trust was not fully compliant, leads were asked to complete an action plan advising which elements of the Guidance were not being met and how this would be addressed. For example we saw evidence that medical and nursing staff were emailed updated guidance about changes to the management of head injury, the new guidance was made available to all staff on the trust intranet, teaching was provided to junior doctors, the new guidance was discussed at an ED audit meeting and governance meeting, and an audit was introduced to ensure staff were following new guidance.

We also saw changes had been made to a standard operating procedure for patients presenting in the department with fever and respiratory symptoms to reflect seasonal changes. The changes meant staff were required to screen this cohort of patients for COVID-19, Respiratory Syncytial Virus (RSV) and flu to assist with treatment, monitoring and reporting.

An audit was performed on the use of medicine designed to tranquilise patients who required this. The audit showed some variation in the types and combination of medicines used which did not consistently reflect best practice. To ensure staff followed best practice and patients received safe care a consultant led a ‘grand round’ that demonstrated which medicines provided the most efficacious tranquilisation. Grand rounds are educational meetings where doctors and other healthcare professionals discuss complex patient cases to learn about diagnosis, treatment, and research. They are a form of continuing medical education that helps improve clinical skills and patient outcomes.

The trust used an RCEM guidance document for the management of acute behaviour disorder which included information about rapid tranquilisation. The RCEM guidance was designed to guide trust’s how to develop their own policy and was not intended to be used as a replacement for a trust policy.

There were two substance misuse practitioners based in the ED 5 days a week. These practitioners could provide people with harm reduction advice, information and refer people to their local substance misuse services. The practitioners provided training and supported other staff, for example with information about alcohol dependence.

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

The local ambulance service provided a ‘Hospital Ambulance Liaison Officer’ (HALO) who was based in the ambulance receiving area. A HALO is a paramedic who can help speed up patient handovers from ambulances to the hospital, reducing delays and freeing up ambulance crews to respond to people in the community.

We spoke to paramedics from the local ambulance service, including the HALO. They said they felt valued and listen to by staff in the ED and PED. The also said they typically waited for less time to handover patients to the department than they experienced at other local hospitals.

Staff in the PED told us they received training and support from staff at their local children’s hospital in the transfer of acutely unwell children.

We paged the hospital’s speciality teams to measure their responsiveness to the ED. Surgery answered in 14 seconds, paediatrics answered in 40 seconds, medicine in 56 seconds, and trauma and orthopaedics answered in 1 minute and 26 seconds. The specialities told us their average response time to review a patient in the ED was less than 1 hour. The speciality teams were aware of the trust’s internal professional standards and their duty to respond quickly.

The trust had a team of Admiral nurses who could support patients with a diagnosis of dementia and their relatives while in the ED, this extended to sitting in an ambulance with a patient if the patient could not be immediately brought into the department. The Admiral nurses provided dementia training to staff, including education to support staff with communication techniques. The trust used ‘this is me’ documents to provide staff with a better understanding of individual patient’s, for example how they express pain. These could be printed off the electronic patient information system and added to patient’s notes.

The service supported people to manage their health and wellbeing.

We saw posters on notice boards in the waiting area that gave members of the public health promotion information. Staff had access to health promotion information for patients. However, this was only available for patients whose first language was English. Senior trust leaders told us they were working on making leaflets available through quick-response (QR) codes which would make the leaflets available in a range of languages.

Hot meals were available for patients twice a day. There was a choice of food for breakfast and patients could request sandwiches outside of mealtimes.

Patients presenting with a mental health crisis sometimes had a long wait in the department, specifically those who were waiting for a bed in a mental health setting. Staff were aware that the ED environment was not always suitable for patients with mental health issues. They told us some patients had spent several days in the department, and they recognised they may have found it difficult to relax or sleep.

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

The time that patients waited for triage, waited on ambulances, waited to be seen by a doctor, and the total time patients spent in the department was collected and reviewed. The entire staff team was invested in reducing these waits and improving the experience for patients. There was a process for staff to follow when waits went over the expected time frame set by the department and in line with national guidance.

Regular meetings were held throughout the day with internal and external partners to identify ways to improve flow in the hospital. The aim was to reduce the amount of time patients waited to be discharged home or transferred to wards, and to improve capacity in the department. Demand on the hospital was high as was demand on the other services within the system. The trust had hospital avoidance initiatives to try and stop people coming into the department if their health needs could be met faster and better elsewhere. Despite the work to make sure that only people in the department were the people that really needed to be there, demand on the service continued to grow. Our second day on site saw unprecedented numbers of people accessing treatment. Almost as many people that the department was designed to see in 6 hours arrived within 1 hour, and in the 24-hour period nearly 3 times as many people came to receive urgent and emergency care than it was designed to treat.

Leaders recognised the risk of this continued high level of demand was having on patients’ long term health outcomes. The understanding of this risk was shared across the hospital. The service had plans to extend the department to improve the space and ensure more patients were seen promptly in appropriate areas.

There was a member of the team whose job it was to chase the speciality teams to try and ensure they saw their patients as quickly as possible and move them to their wards as soon as space became available. However, it was not always possible for teams to see their patients within 30 minutes or to find space on their wards. We saw 1 patient who waited for over 5 hours to be reviewed, and we saw patients who were clinically stable but had waited for over 24 hours for a bed space to become free.

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

Staff understood they did not need to obtain consent if a patient needed emergency treatment to save their life and they were unconscious. They understood they needed to explain the reasons treatment was given once the person regained consciousness. For patients who were conscious staff understood the importance of ensuring people fully consented to treatment before it was delivered. We saw evidence of consent in patients records.

Where necessary decisions about care and treatment were made within the requirements of the Mental Health Act (1983), the Mental Capacity Act (2005), the Children Act 1989, and Children Act 2004. This included consulting others as part of best interest decision-making and ensuring that people with legal authority were involved in making any relevant decisions.

Gillick competence and Fraser guidelines were used to assess the ability of young people to consent to treatment and sexual health advice and treatment. Gillick competence is concerned with determining a child’s (person aged under 16 years) capacity to consent through assessment of their intelligence, competence and understanding to fully appreciate what's involved in their treatment. Fraser guidelines were used specifically to decide if a child could consent to sexual health advice and treatment.

If a patient was identified as requiring an interpreter, this was arranged to ensure they had all of the information necessary to give informed consent.