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.

We found the service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. The service worked well across teams and services to support people. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service routinely monitored people’s care and treatment to continuously improve it. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

At our last assessment we rated this key question good. At this assessment the rating remained 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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patient’s needs were assessed promptly and comprehensively to ensure they received safe, effective and person-centred care. Staff completed holistic assessments on admission to the ward which was repeated after 48 hours. The assessment considered patients’ physical, mental health, social, cultural and communication needs. Assessments were used to inform care planning and ongoing treatment. We reviewed 20 patient records which demonstrated staff completed a comprehensive health assessment of patients in a timely manner at, or soon after, admission.

Patients were reviewed by suitably qualified clinicians, and specialist teams were involved promptly where required. Staff used recognised assessment tools and clinical pathways to identify risks and support decision-making. Risk assessments, including those for falls, pressure damage, nutrition, hydration and deterioration, were completed and reviewed throughout patients’ admission.

Staff assessed and met patients’ needs for nutrition and hydration using a nationally recognised tool. We reviewed 20 patient records and found each patient had undergone a nutritional assessment. Where there was a risk of malnutrition there were plans to mitigate the risk and re-assess the patient.

Patients with complex needs had access to multidisciplinary assessment and input from specialist services, including frailty, therapy, learning disability, mental health and critical care teams. Staff worked collaboratively to ensure assessments reflected patients’ individual circumstances and supported continuity of care. 

Where staff suspected a patient had cognitive impairment or a learning disability, specialist staff were available to assess patients. For example, the learning disability nurse carried out assessments using a national screening tool which identified patients’ specific needs.

Staff demonstrated a good understanding of patients’ needs and treatment goals. Care records showed assessments were generally completed in a timely way and informed the delivery of care and discharge planning. However, the quality and detail of some assessments varied, and leaders had identified opportunities to improve consistency through audit, training and clinical oversight.

Patients’ mental capacity and ability to participate in decisions about their care were considered appropriately. Where required, capacity assessments and best-interest decisions were completed.

Staff described how they involved patients and, where appropriate, their families and carers in assessment and decision-making processes. Interpreters were available to support people whose first language was not English or who had additional communication needs. However, we did not see evidence of communication aids being used for patients who were non-verbal. Patients told us they felt listened to and that staff took time to understand their concerns and preferences.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. 

People received care and treatment that was generally delivered in line with current legislation, national guidance and evidence-based practice. The service used National Institute for Health and Care Excellence (NICE) guidelines to ensure care was evidence-based. Patient records demonstrated assessments, risk assessments, care planning and treatment interventions were based on recognised best practice and tailored to individual needs. Multidisciplinary teams worked collaboratively to deliver care, and staff had access to relevant policies, guidance and specialist support. 

Since our previous inspection in March 2025, the trust had taken action to address concerns relating to compliance with recognised standards and clinical guidance, resulting in improvements across several areas including NEWS2 and VTE assessments. Leaders had undertaken targeted work to improve compliance and understanding, supported by audit, monitoring and oversight processes. Although compliance with the timeliness of patient observations and VTE assessment remained variable, we saw evidence that patients showing signs of deterioration were appropriately recognised, escalated and managed. VTE assessments had been completed in most records reviewed and appropriate preventative treatment had been prescribed where required. Leaders recognised the need to continue improving compliance and carried out regular audits to monitor performance.

Staff used recognised screening tools to identify risks associated with malnutrition and dehydration. Malnutrition Universal Screening Tool (MUST) assessments were completed on admission and staff understood when referrals to dietetic services were required. Comprehensive guidance and care plans were available to support nutritional needs, including the management of enteral and parenteral nutrition and the safe care of patients requiring feeding tubes.

The service was supported by a skilled and appropriately qualified workforce. Staff received role-specific training, including specialist training in areas such as chest drain and non-invasive ventilation management. Newly appointed staff described comprehensive induction programmes and supernumerary periods that supported their transition into practice. 

Managers identified learning needs and supported staff development through training opportunities, supervision and appraisals. Appraisal compliance was high, with 91% of staff having received an appraisal within the previous 12 months. Staff also had access to regular team meetings and daily safety huddles where learning from incidents, service updates and training requirements were discussed.

The service had established systems to support continuous improvement, including clinical audit programmes, incident reviews and governance meetings. Findings were used to identify learning, address gaps in practice and monitor compliance with expected standards.

However, arrangements relating to sepsis management required further strengthening. While staff recognised the importance of identifying and responding to patient deterioration, the service did not have a dedicated sepsis policy and staff awareness of sepsis screening tools, escalation processes and clinical pathways was inconsistent. Some staff were able to clearly describe the actions they would take if sepsis was suspected, while others demonstrated less certainty regarding escalation requirements. Although we did not identify any evidence of patient harm arising from these issues, the absence of a formal policy and variation in staff knowledge reduced assurance that patients with suspected sepsis would consistently receive a timely and standardised response.

We scored the service as 3. The evidence showed a good standard. 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.

Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Staff we spoke to felt teams were supportive of each other. We observed positive working relationships between staff on wards, demonstrating a mutual respect for each other’s role to meet patient’s needs. For example, we observed staff including doctors, physiotherapists and occupational therapists working closely with ward staff to provide treatment and support to patients. 

Staff held regular and effective multidisciplinary meetings. Staff shared information about patients at effective handover meetings within the team. Ward rounds were multi-disciplinary, and all staff contributed to the patient discussions across all wards we visited. Patients on virtual wards were reviewed daily by the multi-disciplinary teams overseeing their care in hospital and the community.

Specialist roles and teams including clinical nurse specialists worked across the service to support ward staff in managing patients with specialist and complex needs. For example, patients with respiratory conditions or those requiring frailty support were supported by clinical nurse specialists. Alcohol and drug practitioners worked closely with ward staff and community services to support safe admission and transition to the community. They attend local strategy meetings and drug related death forums to support improve pathways for patients.

The critical care outreach team provided multi-disciplinary training sessions to support different roles in the effective management of deteriorating patients. They were also visible in clinical areas to support staff and patients requiring a higher level of support. For example, patients on non-invasive ventilation.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. For example, nursing staff had access to the High Intensity User (HIU) Team who specifically co-ordinated the care and supported effective multi-agency communication for people with complex needs who were regular hospital attenders.

We scored the service as 3. The evidence showed a good standard. 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 and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives. Patients’ needs were assessed at admission where their needs were considered. For example, assessments considered patients social circumstances, nutrition and mental health needs. 

Patients were provided with a menu to choose from which was labelled to indicate nutritional details. For example, there were options for healthier eating, higher protein and gluten free. A range of snacks were also offered to meet individual needs. The service was trailing de-caffeinated drinks to reduce the risk of bladder irritation.

Patients’ emotional wellbeing was supported. For example, there were mental wellbeing champions on wards, trained to support both staff and patients. Furthermore, there was information displayed about how to deal with stress and challenging emotions.

National health priorities were supported through access to support. For example, alcohol and drug specialist staff were available and visible on wards to assess and support patients with alcohol and drug dependency whilst in hospital and to refer them for support upon discharge. Tobacco dependency support service was available for patients to seek support to stop smoking during and after their hospital stay. Clinical nurse specialists were available for patients with specific conditions who provided extensive advice and support to patients to improve their health and wellbeing. For example, there was support provided to patients in managing respiratory conditions and diabetes. Patients were referred to their therapy team and dietitians for support in improving their health and wellbeing.

The service provided information to patients and visitors to encourage healthier lives. There were multiple information boards on all wards we visited providing information and signposting to community support. For example, there was advice and guidance around loneliness, menopause information, discharge advice, tips to increase physical activity, alcohol and drug awareness and smoking cessation. Furthermore, specialist information was displayed linked to cancer care, respiratory support and end of life care.

Carer support information was displayed. This provided carers with advice, information and signposting to community support. This supported carers to focus on their own wellbeing whilst supporting their relative or loved one. Furthermore, highly visible signs encouraged visitors to wash their hands to reduce the risk of them developing an infection.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The trust participated in a range of national clinical audits to monitor the quality and effectiveness of care, including the National Respiratory Audit Programme, National Audit of Dementia, National Audit of Care at the End of Life and National Audit of Inpatient Falls. Performance was generally positive. Leaders reviewed audit outcomes and benchmarked performance against national standards to identify areas of good practice and opportunities for improvement. 

For example, the service participated in the chronic obstructive pulmonary disease audit. The 2026 report showed the service performed above the national averages in the percentage of patients reviewed by a respiratory specialist within 24 hours of admission (79.7%), the numbers prescribed oxygen (98.2%), a recorded spirometry result (65.7%) and those identified as current smokers and referred for smoking cessation (94.6%). The respiratory team continued to develop the service to drive improvement. For example, they visited patients upon admission to ensure their needs were met, implemented a virtual ward and same day emergency care service to support patient centred and timely care.

The service participated in the national audit of dementia. Compliance with initial delirium assessments was 92%, matching the national average. Dementia patients received pain assessments in 95.9% of audited cases, demonstrating strong recognition of pain and symptom monitoring. However, care planning within 24 hours of admission was completed in 40% of cases, significantly below the national value of 89%, indicating opportunities to strengthen early care planning and personalised care arrangements. The trust had a dementia and delirium team and admiral nurse service who worked together with ward staff to improve patient care and experience and continue to drive outcomes for patients living with dementia.

Leaders routinely monitored the quality and effectiveness of care through a programme of Patient Care Indicator (PCI) and specialist clinical audits. Audit findings were reviewed through ward and divisional governance processes, enabling leaders to identify areas of good practice and target improvement activity where performance fell below expected standards.

Audit outcome data provided by the service following our inspection from July 2025 to June 2026 showed overall PCI compliance across medical wards was consistently good throughout the reporting period. Medical wards achieved overall compliance rates of 93.2% in July to September 2025, 91.9% from October to December 2025, 91.6% from January to March 2026 and 90.7% from April to June 2026. Several wards demonstrated sustained high performance, including Beaumont ward, the acute medical unit (98.1%), Victoria (98.5%), and Charlecote ward (95.3%). 

Audit results showed positive performance across a number of fundamental care standards, including skin integrity assessments, falls risk assessments, nutritional screening, pain assessments, continence assessments and escalation of deteriorating patients, with many audit indicators achieving compliance rates close to or at 100%. Staff generally completed risk assessments promptly and demonstrated effective monitoring of patients' care needs.

Some variation remained across wards in relation to Mental Capacity Act 2005 (MCA) and best-interest documentation, cannula management, intentional rounding, lying and standing blood pressure monitoring, and nutritional monitoring. Lower overall PCI compliance was observed on a small number of wards, including Mary, Castle, and Nicholas, particularly, and action was taken through matrons' oversight and ward improvement plans to support improvement. Leaders had oversight of areas requiring improvement.

A bed rail audit carried out in February 2026 demonstrated compliance for completion of bed rail assessments across medical wards was 99%, and 93% of patients had bed rail use that matched the documented assessment. Most wards achieved full compliance, although a small number of discrepancies were identified and monitored through local governance arrangements.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were supported to make informed decisions about their care and treatment in line with legislation and national guidance. Staff sought consent before providing care and treatment and patients told us they were involved in decisions about their care. We observed staff explaining what they were doing in a way patients could understand and allowing time for questions. We observed staff seeking verbal consent to carry our patient observations.

Staff were provided with mandatory training in the MCA and Deprivation of Liberty Safeguards (DoLS). However, not all staff had completed it at the time of our inspection. Training compliance levels exceeded the trust target for nurses and allied health professionals but remained below target for medical staff (MCA 56.9%; DoLS 55.6%). Leaders told us training had been paused while content was updated following legislative changes.

Staff understood the principles of the MCA and applied them when providing care. During our previous inspection in January 2025, we found issues around the use of restrictive practices and the MCA. During this inspection, we found some improvements had been made. We found most staff had an improved understanding of the MCA. Patients' capacity to make specific decisions was considered and documented where appropriate. Records demonstrated staff assessed capacity when there were concerns about a patient's ability to make decisions and took steps to maximise patients' involvement in decision-making. 

Staff used the least restrictive approach when caring for patients. Restrictive interventions were only used when necessary to prevent harm and were proportionate to the risks identified. Staff demonstrated an understanding of patients' rights and the need to balance safety with maintaining independence and dignity. This demonstrated significant learning had been made in staff understanding and practice since our previous inspection in 2025.

Where patients lacked capacity, decisions were made in their best interests. However, the quality and detail of documentation varied between records, particularly in relation to best-interest decision-making and the rationale for some decisions. Staff did not always recognise the importance of being specific about actions to be taken in a patient’s best interest and how they would be depriving a patient of their liberty and why. Leaders were aware of this and had implemented monitoring and training to improve consistency.

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) documentation were generally completed appropriately. Records demonstrated that treatment escalation plans were discussed with patients wherever possible and reviewed as patients' clinical needs changed. Where patients lacked capacity, decisions were made in line with legal requirements. However, there was limited evidence documented these decisions were discussed with those important to the patient. We observed posters displayed on some wards to explain what DNACPR meant and who to ask for further information. The service provided staff with guidance in completing these documents effectively using ward education boards to display guidance and best practice examples.

Staff understood the importance of gaining valid consent and respecting patients' rights. Patients were provided with information in a way that supported informed decision-making, including access to interpreters, and accessible information where required. Staff adapted their approach to meet the needs of patients with cognitive impairment, learning disabilities or communication difficulties.

Patients' consent and capacity assessments were documented in care records. We found documentation was generally completed appropriately and demonstrated that consent had been sought for examinations, treatment and care interventions. For example, we found written consent had been gained for patient on Castle ward who had undergone an endoscopy procedure.

Consent practices were also routinely monitored. Overall consent audit compliance remained consistently high, ranging from 93% to 98% in the 12 months prior to our inspection. Where concerns were identified, these were largely related to documentation quality rather than consent processes themselves, including incomplete recording of risks and benefits, missing staff details, absent signatures, illegible handwriting, poor document scanning and occasional missing consent forms.