Warwick Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

The service had a very clear shared vision, strategy and culture. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. The service fostered a positive culture where patients felt they could speak up and their voice would be heard. The service valued diversity in their workforce. The service had clear responsibilities, roles, systems of accountability and good governance. The service understood their duty to collaborate and work in partnership, so services work seamlessly for patients. The service focused on continuous learning, innovation and improvement across the organisation and local system.

At our last assessment we rated this key question good. At this assessment the rating has remained as good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders had developed a clear vision and strategy that was well understood across the service. The trust's strategic priorities, known as the '5 Big Moves', focused on being a flexible employer, supporting care closer to home, reducing environmental impact, embedding prevention and developing collaborative models of care. Medical services had aligned divisional objectives that reflected these priorities and considered the needs of local communities, including health inequalities, inclusion and population demographics. The vision and strategy were visible throughout the service and were understood by staff at all levels.

Staff described a strong sense of shared purpose and understood how their roles contributed to delivering the trust's objectives. Staff told us leaders communicated the vision effectively and sought their views when developing and implementing service improvements. Staff felt valued and empowered to contribute ideas and were able to describe how their work supported the delivery of high-quality, person-centred care.

The service worked collaboratively with staff and system partners to develop objectives that reflected the needs of local people. We saw examples of strategic priorities being translated into practice. For example, the trust's commitment to a 'home first' approach had resulted in the development of innovative services that enabled patients to receive care closer to home. These included virtual wards, medical day care units and community-based services that reduced unnecessary admissions and supported earlier discharge while maintaining access to specialist care. The service had further expanded access through the provision of medical day care services within the local area bringing hospital-level care closer to communities.

Staff spoke positively about the culture within the service and described it as inclusive, supportive and collaborative. Staff told us they were proud to work for the organisation and felt respected by colleagues and leaders. Across all staff groups, there was a strong sense of teamwork and shared responsibility for delivering high-quality care. During the inspection, we observed positive and respectful interactions between staff, patients, visitors and colleagues of all grades.

Staff described a culture where support was readily available during challenging situations. Nursing staff told us colleagues, senior leaders, medical staff and specialist teams worked together to provide both practical and emotional support when needed. Staff consistently described feeling safe to seek help, raise concerns and learn from experiences.

There was an emphasis on learning, reflection and continuous improvement. The service used immediate and structured debriefs following challenging events to support staff wellbeing, encourage reflective practice and identify opportunities for learning. Staff described a positive learning culture where learning from incidents was used to improve services rather than attribute blame.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the experience, capacity and capability to deliver the service and manage risks effectively. Medical services sat within the emergency care division and were led through a triumvirate structure comprising operational, nursing and medical leadership. Staff told us this supported effective decision-making and ensured clinical, operational and quality priorities were considered when developing and delivering services.

Leaders at all levels were visible, approachable and supportive. Staff consistently told us senior and local leaders were regularly present in clinical areas and could be approached with concerns, questions or ideas. During our inspection, we observed positive interactions between leaders and staff across a range of services. Local leaders supported clinical areas during periods of high demand and modelled inclusive and collaborative behaviours.

Clinical leaders were respected by multidisciplinary teams and worked collaboratively to improve services. Medical and nursing staff described positive working relationships and told us they were involved in decision-making and service development. Resident doctors told us senior medical staff were accessible, supportive and visible within clinical areas.

Leaders demonstrated a good understanding of the quality, performance and risks within their services. During our previous inspection, we identified areas where leadership oversight and improvement activity had not always been sufficiently effective. At this inspection, leaders were able to clearly describe service performance, risks and the actions taken to address identified concerns. We saw evidence of sustained improvement in areas previously highlighted, demonstrating increased oversight and accountability.

Leaders maintained a visible presence within clinical areas and sought assurance about the quality of care being delivered. Ward leaders and matrons regularly engaged with patients, relatives and staff to understand their experiences and identify opportunities for improvement. Patients told us ward leaders were visible and accessible.

Leaders understood the needs of the local population and considered health inequalities when planning and delivering services. They worked with system partners to understand barriers to care and support improvements in access and outcomes for local communities.

The service supported the development of future leaders through a range of education, training and leadership programmes. Staff described opportunities to develop leadership and management skills and felt supported to progress their careers. Development programmes were available for staff at different stages of their careers, including aspiring ward leaders, specialist nurses and deputy ward managers. Leaders also promoted opportunities to support a diverse and inclusive leadership workforce.

Staff told us leaders invested in their development and encouraged them to expand their skills and responsibilities. We met staff who had progressed into advanced clinical practice roles and were contributing to the development of innovative models of care, including virtual wards and frailty services.

Leaders took action to address behaviours that could negatively affect staff wellbeing, team working or patient care. Staff described a culture where concerns were addressed promptly and supportively. Leaders gave examples of resolving workplace issues through early intervention, open communication and mediation, helping to maintain positive working relationships within teams.
 

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where patients felt they could speak up and their voice would be heard.

Staff and leaders acted with openness, honesty and transparency. Staff understood their responsibilities under the duty of candour and told us they were supported to be open with patients and families when things went wrong. We reviewed 3 incident investigations and found duty of candour had been applied appropriately, including providing explanations and apologies where required. Staff told us managers responded to mistakes in a supportive way that focused on learning and improvement. Teams were provided with opportunities to discuss incidents and share learning.

Staff felt able to raise concerns and speak up without fear of detriment. Staff told us they would be comfortable raising concerns with their managers and were confident concerns would be listened to and acted upon. Staff were aware of the different routes available to raise concerns, including anonymously if they preferred. Leaders told us concerns were managed sensitively and confidentially.

There was a positive culture of speaking up across the service. Staff consistently told us their views were valued and that leaders encouraged open and honest feedback. The trust had a freedom to speak up team which promoted a fair and open culture and provided additional support to staff when required. Staff also had opportunities to share ideas and concerns directly with senior leaders and executive team members.

Leaders actively encouraged staff to contribute to service improvement. Staff described examples where feedback had resulted in positive changes. For example, concerns about ward coordination led to the introduction of an additional ward coordinator role to support the effective running of a ward. Junior doctors also described how feedback through staff forums contributed to a review of overnight medical cover and the allocation of an additional registrar to the overnight on-call rota. These examples demonstrated that leaders listened to staff and responded to concerns and suggestions for improvement.

Patients, relatives and carers were also encouraged to share feedback about their experiences. Staff and managers had access to feedback from patients using the service and used this information to identify learning and support improvements to care.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders demonstrated a commitment to promoting equality, diversity and inclusion and regularly reviewed workforce data to identify opportunities for improvement. Leaders used information from the Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) to understand staff experiences and inform improvement plans. Trust data for 2025/26 showed performance was better than benchmark levels in most WRES and WDES indicators, and action plans were in place to address areas requiring further improvement. The outcomes reflected the experiences of staff we spoke with, including staff from Black, Asian and minority ethnic backgrounds who told us they had access to training, development opportunities and leadership programmes.

Leaders took action to address disparities in staff experiences and opportunities. The trust had adopted inclusive recruitment practices, including bias awareness training and inclusive recruitment resources for recruiting managers. Data showed disabled applicants were appointed at a similar or slightly higher rate than non-disabled applicants following shortlisting. Leaders had also identified reducing inequalities in experiences of bullying, harassment, discrimination, career progression and disciplinary processes as priorities and were implementing targeted improvement work in these areas.

The trust had systems and processes in place to promote a fair and inclusive culture. An anti-discrimination toolkit provided staff with guidance on expected behaviours and how to challenge discrimination. Equality impact assessments were completed when developing policies and initiatives, and a range of staff networks provided opportunities for staff from different backgrounds to share experiences and influence organisational decision-making.

Leaders took steps to prevent and address discrimination, bullying and harassment. Staff had access to support through the trust's equality, diversity and inclusion team, and anti-discrimination champions were available to provide advice and promote inclusive behaviours. Staff and leaders also participated in active bystander training to improve confidence in recognising and challenging inappropriate behaviour.

Leaders supported disabled staff and those with long-term health conditions through reasonable adjustments and targeted support. Staff survey results showed positive levels of engagement, career development and job satisfaction among disabled staff compared with national benchmarks. The trust had further strengthened its approach through revised policies, workplace passports, neurodiversity initiatives and staff networks. Leaders recognised that further work was needed to improve staff confidence that reasonable adjustments would be implemented consistently and had included this within future improvement plans.

The trust worked to develop a workforce that reflected the population it served. Representation of staff from Black, Asian and minority ethnic backgrounds had increased over recent years, including within senior leadership and board-level positions. Leaders monitored workforce diversity and took action to promote equality of opportunity across recruitment, development and progression.

Staff told us leaders provided opportunities to share feedback and contribute to service development. Staff from a range of backgrounds described feeling valued and respected within their teams. The trust promoted cultural awareness and celebrated diversity through staff-led initiatives, awareness events and recognition activities. During our inspection, we saw examples of teams celebrating the diverse backgrounds of their workforce and creating inclusive environments where staff felt able to be themselves.

Staff described a culture where diversity was valued and recognised as a strength. Some staff told us they had been encouraged to share their knowledge, skills and experiences to support learning within their teams, helping to foster inclusion and broaden understanding across the workforce.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Leaders had established effective governance arrangements to support the delivery of safe, high-quality and sustainable care. There were clear structures, processes and systems of accountability, and governance arrangements generally supported effective communication from board to ward. Service leaders understood how local governance processes linked to trust-wide committees and escalation routes, ensuring risks, concerns and performance issues were escalated appropriately. 

A comprehensive programme of meetings operated across ward, specialty, directorate and divisional levels, providing regular opportunities to review quality, performance, workforce and operational issues. Daily safety huddles supported the timely sharing of safety information, learning and practice improvements, while ward and governance meetings ensured feedback from incidents, complaints and audits was discussed and acted upon.

Leaders had good oversight of quality and safety performance and used a range of information to monitor services and drive improvement. Divisional governance meetings reviewed performance, risks and quality indicators, and leaders contributed to national audits and implemented improvement programmes in response to findings. For example, following concerns identified through mortality data relating to sepsis and acute kidney injury, the service undertook detailed audits and improvement work to better understand the causes and improve patient outcomes. In addition to a routine audit programme, leaders commissioned responsive audits and external reviews in areas identified through incidents, complaints and national audit findings, including the use of restraint and application of the Mental Capacity Act. Audit results were reviewed through established governance processes and used to support learning and service improvement.

There was a proactive approach to risk management. Risks were recorded, reviewed and monitored through divisional governance structures and were aligned with concerns identified by staff and managers. Service leaders could describe their highest-rated risks and the actions being taken to mitigate them. 

Weekly significant event meetings provided oversight of incidents involving moderate or greater harm, enabling leaders to identify immediate safety actions, monitor investigations and ensure learning was shared. There were clear escalation processes into wider trust governance structures. Mortality review processes were well established, with all deaths subject to independent scrutiny through the Medical Examiner service. Concerns regarding the quality of care were escalated to clinical leaders, and specialty mortality and morbidity meetings helped ensure learning was identified and embedded into practice.

Managers had access to a range of information to support effective decision-making, including performance, workforce and quality metrics. Information was presented through dashboards, reports and governance meetings, enabling leaders to identify trends, monitor progress and respond to emerging pressures. Staff used electronic systems to support clinical decision-making, continuity of care and information governance, and there was sufficient access to information technology and equipment. Although patient records remained a mixture of paper and electronic systems, which could sometimes make information harder to access, the service was progressing towards a full electronic patient record system. Leaders anticipated this would strengthen oversight and improve access to information across services. 

The service also demonstrated resilience and sustainability through effective emergency preparedness arrangements. Staff implemented trust-wide emergency planning processes and, during a period of extreme heat at the time of inspection, had introduced measures to identify and mitigate risks to patients and staff. 

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for patients. They share information and learning with partners and collaborate for improvement.

Staff worked effectively with a wide range of health, social care and community partners to support joined-up care and improve outcomes for patients. Strong multidisciplinary and cross-organisational relationships supported timely access to services, safe discharge planning and continuity of care across the patient pathway.

Leaders recognised the value of partnership working and had established collaborative arrangements with local NHS trusts, community services, commissioners and voluntary sector organisations. Staff described positive working relationships with community teams, general practitioners, social workers, district nurses and integrated care system partners. We saw examples where community nursing support was arranged prior to discharge to help ensure patients received appropriate follow-up care and support in the community.

Pathways into community-based services were well established. For example, the frailty team worked closely with the community response team and ambulance service to support seamless admission avoidance, discharge planning and ongoing care for frail patients. Alcohol and drug support workers maintained strong links with local substance misuse services and attended regional forums to ensure patients could access appropriate support following discharge and that care pathways remained aligned with local provision.

The trust also demonstrated a commitment to collaborative working for patients with complex needs. The team worked alongside public health colleagues, community services and the West Midlands Ambulance Service to better understand local population needs, reduce health inequalities and develop personalised care plans for patients who frequently attended emergency services. Staff also worked collectively to reduce stigma and improve support for people experiencing homelessness, mental health concerns, learning disabilities and substance misuse.

Partnership working extended beyond traditional health services. The trust had collaborated with the local Fire and Rescue Service to develop a hospital-to-home initiative, whereby patients were supported home following discharge and received a safe and well check to help identify any immediate environmental or safety concerns. This helped promote independence and reduce risks following discharge.

Leaders and staff engaged with external stakeholders to support service development. Directorate leaders worked with commissioners and Healthwatch, and patients and staff were able to provide feedback directly to senior leaders and commissioners. An independent patient forum contributed to environmental and food audits, and the trust was developing further patient engagement and co-production work in partnership with a local university.

The trust also participated in a bi-monthly mental health partnership group involving internal and external organisations. This enabled partners to develop a shared understanding of the challenges experienced by people with mental health needs and supported collaborative initiatives, including staff training and service improvements.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Leaders fostered a culture of continuous learning, improvement and innovation across the medical care service. Staff were encouraged and supported to identify opportunities to improve care, lead quality improvement initiatives and develop new ways of working. The trust had introduced a ‘Dragon’s Den’ programme, which gave staff the opportunity to present improvement ideas and secure funding to implement them. This had encouraged staff engagement, ownership and innovation. For example, the respiratory virtual ward was developed and implemented following a quality improvement programme and contributed to the expansion of admission avoidance initiatives across the service.

The service worked collaboratively with system partners to develop and improve pathways of care. Leaders and staff shared learning across the local health and care system and participated in regional forums, including virtual ward conferences, to support service development. Staff described how joined up working with community, safeguarding and specialist teams had helped improve frailty pathways, reduce unnecessary admissions and support people to receive care closer to home. The High Intensity User Service demonstrated a proactive and person-centred approach to improvement, using personalised care plans, multidisciplinary working and virtual ward follow-up to provide continuity of care and better support people with complex needs.

The service used quality improvement methods effectively and routinely learned from audits, incidents, complaints and outcome data. Staff participated in national audits relevant to the service and used the findings to improve care and clinical practice. Audit findings informed targeted improvement initiatives, including the development of clinical tools, staff education and pathway redesign. In addition to participating in national programmes, the service undertook local audits and accreditation activities, which provided assurance and helped identify opportunities to enhance care. Staff understood quality improvement methodologies and were given time and support to participate in improvement work.

The service demonstrated a commitment to innovation to improve patient safety and experience. For example, staff introduced a safer walking scheme for patients who lacked capacity, had cognitive impairment and were subject to Deprivation of Liberty Safeguards authorisations. The scheme enabled patients to move more freely around clinical areas while maintaining appropriate safeguards through wearable technology that alerted staff if a patient approached an exit point. Staff told us the initiative promoted independence, reduced agitation and reduced reliance on one-to-one supervision. The service also worked with safeguarding, dementia and delirium teams to improve practice relating to the Mental Capacity Act, best-interest decision-making and the use of restraint.

Leaders demonstrated a strong commitment to evaluating and embedding improvements. The Dementia and Delirium Outreach Team (DDOT) was a well-developed example of how learning, innovation and multidisciplinary working had improved outcomes for patients. The team used audit findings, staff feedback and outcome measures to continuously develop the service. Staff confidence in caring for people living with dementia and delirium had improved, supported by specialist training and increased workforce capacity. The team had led improvements in dementia diagnosis, discharge planning, Mental Capacity Act and Deprivation of Liberty Safeguards practice, and reducing restrictive interventions. These improvements were associated with measurable benefits for patients, including a reduction in the average length of stay for people with dementia and delirium, improved patient flow and more effective use of resources.

The service also supported research and innovation activities. Staff had opportunities to participate in research and worked with external partners to explore new approaches to supporting people with complex cognitive and medical needs. Leaders had clear plans for further improvement, including the development of electronic patient records, expansion of community pathways and continued investment in virtual ward models.