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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

People were involved in decisions about their care. The service mostly provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it.

The service worked to reduce health and care inequalities through training and feedback.

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.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in their needs.

The department had access to designated specialty leads, for example, for geriatrics, frailty, and trauma. The service was further supported by in-reach services to support person-centred care, for example, for cardiology, pain, and dementia.

The admiral (dementia) nurses provided individualised support for patients in the ED 5 days a week. The type of support offered was based on the persons likes and dislikes and aimed at promoting a sense of calm, and could include, for example, giving a hand massage. Admiral nurses had a resource box that could be used for patients in the ED when the nurses were not available to support the patient themselves. The box contained a range of items that were designed to provide calming and stimulating activities, the items were typically made from a variety of textures and had small, securely attached objects to engage the patient’s senses.

The learning disability lead for acute care provided support for staff in the ED to help increase their confidence and ability to support patients with a learning disability and autism by providing training and advice. There was an activity box in the ED that contained items designed to reduce anxiety or sensory overload for people with a learning disability or autism.

The PED did not have funding for a play specialist. However, staff could sometimes request support from the play specialist from the children’s ward, typically this would be to help support a child with additional needs or challenging behaviour. Challenging behaviours are sometimes a way for a person with learning disability and or a communication difficulty to demonstrate their needs are not being met.

Staff could access a telephone or face to face interpreter for people whose first language was not English, including people who used British Sign Language. There was a staff information board that contained details of staff who could speak more than 1 language so they could be used to translate if necessary. Staff told us there was also an electronic tablet that could be used for translation purposes.

Nurses in the PED had received training in sudden and unexpected death of a child to prepare them to care for families with empathy and compassion, and to equip them to clearly communicate with parents and carers about the processes and procedures that would subsequently need to take place so the cause of death could be investigated.

Each Wednesday a therapy dog visited the PED and ED. Patients could pet the dog to help reduce their anxiety.

Staff ensured patients with a long length of stay in the department had an appropriate mattress (not a trolley) and regular skin integrity checks.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff ensured advanced care plans for children and young people were stored on the electronic patient information system so they did not need to complete a new one at every visit.

The mental health pathway for children and young people was challenged. Referrals to the children and young people's mental health service (CAMHS) for children in crisis could be taken between 8am and 8pm, 7 days a week. However, staff told us If children and young people were not referred before 6.00pm there was no provision for assessment until the following day. This meant children would be required to stay in the PED or be admitted to the children’s ward for an overnight stay while they waited for a psychiatric assessment by CAMHS.

There was a referral pathway to the ward for patients waiting for assessment from the CAMHS team however they did not always have bed space to admit the child to. If a child was deemed as low risk of harm to themselves or others while they were waiting for a CAMHS assessment, and they had a responsible adult with them, they may be asked to wait in the waiting room overnight if there were no available cubicles in the PED. Children and young people assessed as higher risk would wait for their CAMHS assessment in a cubicle so regular or constant observations could be performed. In addition to the external CAMHS team the PED employed a mental health support worker to help support young people in crisis; however, they were only available between 8am and 4pm 5 days a week.

Patients could request a visit from the trust Chaplin. There was a multifaith room that could be used by patients and other people visiting the hospital for prayers or quiet reflection.

The service supplied appropriate, accurate and up-to-date information. However, some information was only available in English.

There were lots of information leaflets for patients on a range of different subjects for example, management of wrist injury, burns, alcohol, and pneumothorax. The trust had a work stream to explore how they could improve patient’s access to leaflets and other information in a range of languages. They were looking into the use of quick response (QR) codes so information could be accessed online in a range of languages.

There were easy read leaflets, but these were only available in English.

Staff effectively tailored information for diverse audiences (adults, children, relatives and carers) by using clear, age-appropriate language, avoiding jargon, allowing time for questions, and by using reassurance to build trust and reduce anxiety. They worked to ensure everyone understood care and treatment plans.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The trust’s website provided clear information about how to make an online, written, or verbal complaint and how quickly people could expect a response. Complaints were regularly reviewed by senior leaders to ensure they were being appropriately investigated and responded to.

Feedback was gathered through patient surveys and concerns were responded to. We saw ‘you said, we did’ posters in the patient area. The posters gave details of suggestions that people had made to improve the service and what had been done by the department to implement the suggestions. For example, people said the chairs in the waiting room were uncomfortable. The response included information about the progress that had been made to find and purchase more comfortable seating.

There were television screens in the waiting areas that provided information about the wait times to see doctors. There was an infographic in the MIU that showed the pathways through the minor injury department. The infographic had been introduced following feedback from patients who said they did not understand what their treatment would look like in the MIU.

The service worked exceptionally hard to ensure people could access the care, support and treatment they needed when they needed it, or reduce the length of time they had to wait. However, despite their best efforts, reducing patients length of stay in the department, and making sure patients were being cared for in an inappropriate area was beyond the control of staff.

Staff worked with their system partners and wider sector partners to gather information to help them understand how the department was performing, especially at times of increased pressure like winter, to enable them to consider effective ways of working that would improve their ability to meet demand. For example, they took part in the Society for Acute Medicine Benchmarking Audit 2024 which enabled them to prepare for the management of patients presenting with respiratory illness as well as adding to a national understanding of if the management of that cohort of patients was meeting national recommendations.

The trust had a frailty service, virtual wards, a same day emergency care (SDEC) unit and other initiatives that helped keep people out of the ED and therefore reduced demand on the service. However, demand on the department exceeded the resources available. To ensure that patients with the highest clinical acuity received the right care at the right time a risk stratification process was used. This enabled patients at the lowest risk to be stepped down into the waiting room while the sicker patients received treatment in the fit to sit area, majors or in the resuscitation room.

Under the NHS Plan there are 2 targets that trusts must work to achieve. Firstly that 78% of patients should not wait for more than 4 hours in the emergency department from arrival to admission, transfer or discharge. Secondly, 10% of patients should not wait for more than 12 hours in the emergency department from arrival to admission, transfer or discharge. In 2024 the department’s 4-hour performance varied between 62.4% and 75.0%. This was mostly below (worse than) regional (65-70%) and national (68-74%) averages. There was significant improvement in 2025, in the 3 months prior to our inspection the 4-hour performance ranged from 75.4% to 79.3%. However, the national data included the performance of all EDs in the country. In comparison with other type 1 EDs in England the trust’s 4-hour performance had been in the top 20 since April 2025.

Activity in the MIU was consistently within four hours (100%). The 12-hour decision to admit waits remained substantially lower (better than) comparator levels, ranging from 0.0% to 5.6%, compared with 20.7% regionally and 13.1% nationally, with the highest volumes recorded in December 2024 (136 patients) and January 2025 (122 patients).

In the 12 months before our inspection approximately 4.4% of patients waited over 12 hours to be seen, against an England average of around 10%. Of this cohort of patients most (47%) were waiting for a bed on a medical ward. A further 17% were waiting for a bed on a surgical ward and 31% were discharged back into the community. To reduce the risks associated with a long length of stay in the emergency department patients waiting over 12 hours had additional safety checks and rounding to ensure they were not coming to harm.

The NHS plan stipulates a maximum handover time of 45 minutes for patients arriving by ambulance. Ambulance arrivals between August and November 2025 were stable at approximately 40-60 per day, and handover delays in both the 30-60 minute (1-10%) and over 60-minute (0-8%) categories remained consistently lower (better than) than regional (14-29%) and national (5-17%) averages. According to the trust’s local ambulance trust the ED consistently had the best ambulance handover times in their region (West Midlands). During the month of our inspection the ED only had 1.5% of their ambulance delays over 60 minutes, this was less than a third of the delays of the next best performing trust. The ambulance trust also said the ED is the only one in the region consistently meeting the 45 minute standard. This is despite intelligent conveyancing which can place additional demand on the department.

Staff worked hard to make sure patients did not have to stay in the ED longer than they needed to. Managers and senior hospital leaders met regularly throughout the day to look at how flow could be created within the hospital to ensure adults and children who needed to be admitted to a ward could be. The trust had developed electronic oversight dashboards to help them see where patients were located and where they were in their hospital journey. It also helped them identify trends in admissions which enabled them to forecast demand. For example, at one of the meetings we attended leaders predicted continued high demand on the service from respiratory illness, so they requested rota resilience to ensure more staff would be available to manage demand.

To reduce (improve) the amount of time patients spent in the department there was a designated progress chaser. The progress chaser made sure patient’s paperwork was completed and blood test results, and other diagnostic test results, came back in a timely way so they could be reviewed by a doctor.

Staff and leaders were innovative in how they listened to information about people who were most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide tailored care, support and treatment.

The trust took part in the National Emergency Department Survey in February 2024 to get information about people’s experience of receiving care in the department. Feedback was collected from 380 people. The feedback was predominantly better than scores from across the emergency care sector. Scores we given out of 10 for each metric in the survey. The ED scored 8.38 for overall patient satisfaction (the highest score for any type 1 ED in England), the MIU scored 9.18. The ED scored 9.66 for patients being told what would happen next, the MIU scored 9.62. In the ED people scored 9.23 (MIU 9.53) for being treated with dignity and respect, and 9.16 (MIU 9.53) for being given privacy during examinations, 8.92 (MIU 9.59) for feeling safe in the department and 8.73 (MIU 9.21) for being told why tests were being carried out and 8.64 (MIU 9.1) for staff giving an explanation of test results in a way people could understand. An area of concern was limited information about the lengths of waits to be seen. The ED scored 3.05 for this metric, the MIU scored higher at 6.41. Patients in the ED also feedback there were limited opportunities to get food and drinks 7.12 (MIU 5.06). The department used this feedback to improve peoples experience of using the ED and PED. Patients were given information about waiting times when they booked in at reception and by the triage nurse. We saw water coolers in waiting areas along with vending machines. Patients told us they had been offered hot and cold drinks and food when they had a long wait in the department, including in the waiting room.

The admiral nursing team kept a database of failed discharges so they could identify emerging themes and provide targeted training to staff to reduce the number of unsuccessful discharges for patients with dementia.

Doctors went out onto ambulances to assess patients who had been on them for over 20 minutes. This was to ensure patients who arrived by ambulance received safe care and treatment when the department was too full for patients to be brought in straight away.

The services designed to keep people out of the PED and ED were not open 24 hours a day. When these services were closed the demand on the PED and the ED increased. For example, the Paediatric Assessment Unit (PAU) was open from 10am to 10pm. The PAU was for children needing urgent assessment, observation, and treatment for acute illnesses or injuries, designed to prevent overcrowding in the PED and ensure children got care in the right place, at the right time. Staff told us the PAU opening hours significantly impacted on the flow of patients in the PED because when the PAU was closed these children and young people were treated in the PED.

People were supported to plan for their future.

When people were asked to consent to invasive treatment procedures, patients were given information about all the risks involved in having the treatment and what not having the treatment was likely to mean for them.

Some patients had advanced care plans that included not wanting to be resuscitated. We saw staff check these plans to make sure they were up to date and contained all the information required for staff to act accordingly with the patient’s wishes. When patients had not made an advanced care plan staff asked patients about their wishes and helped them to devise a plan when required.