The NHS is rolling out a new early warning system for doctors and nurses treating children to quickly identify deterioration, escalate care, and act on parental concerns.
The system allows doctors to track possible deterioration in a child’s condition on a chart, measuring things like blood pressure, heart rate, oxygen levels and levels of consciousness, with different scores representing the level of concern.
While many hospitals already have similar systems in place, this change will provide a single, national standardised process for patients, families, and staff to have a clear way of ensuring issues are detected and escalated quickly.
If a parent or carer raises a concern that their child is getting ill or sicker than the score shows, this will immediately escalate the child’s care regardless of other clinical observations.
Working in partnership with the Royal College of Paediatric and Child Health and the Royal College of Nursing, NHS England has been developing the Paediatric Early Warning System for over three years with pilots running across 15 sites.
The NHS will be rolling out a leaflet and video content for parents, letting them know how to communicate concerns to healthcare staff and encouraging them to escalate if needed. As the programme develops, the NHS will implement any guidance from Martha’s Rule within the early warning system.
A similar process for adults, the National Early Warning System, already exists but now children will also benefit in hospital settings, with plans to expand to mental health, ambulance, and community services in due course. Unlike adults the system has four separate charts, each covering a different age range, including 0-11 months, 1-4 years, 5-12 years, and those aged 13 and over.
Nicola Ennis, NHS South Yorkshire's Children and Young People Alliance Programme Lead, said: "In South Yorkshire we have been working in partnership for many years to ensure we are getting it right for children and young people who present unwell at hospital. We aim for equity, quality and a standardised approach to care. The roll out of the paediatric early warning system provides additional support to clinicians to identify a sick child at the earliest stage of presentation to ensure the provision of the best care for our children and young people in hospital settings."
Professor Sir Stephen Powis, NHS national medical director, said: “The rollout of the National Paediatric Early Warning System has been years in the making and I know NHS staff and patients alike will welcome the introduction of this standardised system across hospital settings, allowing dedicated clinicians to observe, track and identify deterioration in children’s conditions to get them the help they need faster and more easily.
“We know that nobody can spot the signs of a child getting sicker better than their parents, which is why we have ensured that the concerns of families and carers are right at the heart of this new system with immediate escalation in a child’s care if they raise concerns and plans to incorporate the right to a second opinion as the system develops further.”
Dame Ruth May, Chief Nursing Officer for England, said: “The national roll-out of PEWS is an important step in improving care for children and young people. This standardised method of tracking deterioration will improve working methods and safety, supporting doctors and nurses to do the very best for the children and young people in their care.
“It is vital that parents, children and young people are listened to when making clinical decisions. PEWS ensures that escalation of care takes place in response to medical observations, listening to the voices of children and young people, and parent/carer concern. With this initial roll-out taking place in hospitals, we are working towards extending this to other settings including accident and emergency departments, ambulances and the community in the future.”
Professor Simon Kenny, NHS national clinical director for children and young people, said: “With different tools for tracking the condition of babies, children and teenagers, this system will enable NHS teams to use straightforward, standard scoring systems to track a child’s vital signs, with evidence from pilot sites demonstrating clear benefits for patients and staff alike.
“This new process is the result of extensive work by NHS England, the Royal College of Paediatric Child Health and the Royal College of Nursing and will be invaluable for both NHS staff and patients, helping to create a ‘common language’ as part of the process in tracking any signs of deterioration and triggering escalation if needed.”
Health Minister, Maria Caulfield, said: “This single, national, early warning system, specific to children, will save lives by helping to spot a deterioration in a child’s condition quickly.
“We know from the tragic case of Martha Mills that it’s vital to give parents a voice when it comes to the care of their child and so it will be reassuring to families that as part of this system, parents will be heard.
“Aligning this early warning system with any future guidance will ensure both medical and parental concerns are swiftly escalated.”
