We focused our inspection on the Maternity Unit within the South Warwickshire NHS Foundation Trust Hospital. We visited the antenatal clinic and antenatal assessment unit (AAU), the delivery ward, and the combined antenatal and postnatal ward called Swan Ward. We did not inspect the Special Care Baby Unit at this time.

We spoke with eight women in the antenatal clinic, five women on the postnatal ward and two relatives. We also spoke with two doctors, the Head of Midwifery, the clinical governance midwife, the practice development midwife, the manager of the Electro-Bio Medical Engineering (EBME) department, six midwives, three support workers and a receptionist.

We found that people were involved in their care and encouraged to express their wishes and were treated with respect. One woman we spoke with told us, “I have had a lot of opportunity to ask about my surgery. Everything has been explained to me. I know exactly what is going to happen.” Another told us, “I could ask any questions I wanted, I never feel rushed when I come here, even though it is sometimes very busy.”

People commented positively on the care they received and we found that care and treatment plans were completed appropriately. Comments included, “You couldn’t ask for a more caring hospital. They have arranged parking for me this week as I have to come in daily.” Another person told us, “All the nurses are brilliant. It has been a wonderful experience. Everything had been explained to me beforehand as I was booked for surgery, so I knew what to expect.” We found evidence of good information and support provided to women throughout their pregnancy, delivery and postnatal period.

We found that there was enough suitable equipment available and there were good systems in place to ensure regular monitoring and maintenance of equipment.

There were sufficient numbers of staff employed with the appropriate skills and qualifications to perform their roles. We found that staff had received ongoing training necessary to enable them to carry out their role effectively.

We found that staff received regular supervision and training with opportunities to develop their career. There were systems in place to ensure that mandatory training and other essential training took place. One staff member told us, “We get good management support here. Management have a visible presence.”

The inspection team included an 'expert by experience' – a person who has experience of using services (either first hand or as a carer) and who can provide the patient

perspective. We visited a number of wards and departments including the children’s ward, the 23 hour ward, accident and emergency departments, the discharge lounge and pharmacy.

During the two days we were at Warwick hospital we spoke with patients and received many positive comments about the care and treatment provided by the hospital. One patient said, “I cannot complain about the care on this ward. Staff have been very helpful.” Another patient said, “Everyone comes in and makes you feel good and comfortable; the staff nurse was lovely.” A relative told us, “I have been kept informed and involved with my husband's care and treatment all the time.”

Patients and relatives told us that their consent had been sought prior to any treatment being given to them. Some patients told us however that information about their treatment was not always given to them as quickly as they would have liked.

Patients and relatives spoken with thought that the hospital was kept clean. We were told, "The cleaning is very good I have no concerns" and “The ward is very clean, it is done every afternoon.”

Patients said that they felt safe and there were usually enough staff on the wards.

Patients and relatives told us they would report any concerns they might have about their care to hospital staff.

We found that the trust was taking any complaints they received about the hospital seriously and took prompt action to improve the service when things went wrong.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Our overall rating of services stayed the same. We rated them as requires improvement because:

• Risks to patients were not consistently monitored and completed. The hospital did not always complete patient risk assessments. Also fresh eye’ cardiotocography trace reviews, safer surgery checklists and swab counts were not always completed in line with national recommendations and trust policies.

• Systems and processes did not ensure that medicines were stored, prescribed and administered correctly. However, the hospital took action to rectify issues during our inspection.
• Patient’s information including electronic records was not always stored securely in all departments, increasing the risk of breaches of confidentiality.
• The hospital did not always adhere to infection prevention and control practices, such as hand hygiene. Systems were not always effective to ensure that equipment was maintained appropriately.
• The hospital did not always have enough staff in all departments, to meet the demands on the service and there was variable compliance with mandatory training. There was no specialist palliative care consultant based at the hospital, which did not meet national guidelines. However, a specialist consultant was being recruited to the post.

However:

• Staff received training and appraisals of their development to support safe care and treatment. There was good culture of incident reporting and track record on safety. For example, no never events reported since 2016.
• Patients’ feedback was positive about the care and services. Staff were proud to work at the hospital and this was demonstrated in consistently good performance in the NHS staff survey results.
• Patients could access care and treatment at the hospital in a timely way. The emergency department performance was above the England average for the time taken for patients to be seen in the department and the percentage of patients waiting between four and 12 hours from the decision to admit until being admitted. However, data showed that the trusts performance was declining against these targets.
• Patients care was planned and delivered in line with evidence-based guidance, standards and best practice. Individual patients’ requirements including, physical and mental health needs were met.