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The NHS is rolling out the National Paediatric Early Warning System in A&E departments across England, extending a system already used on children’s wards. It combines age-adjusted observations with concerns from families and staff, which can prompt an urgent review even if a child’s score is low. The rollout is not expected to remove waiting times, and staffing and implementation details remain important.
The NHS is rolling out the National Paediatric Early Warning System (PEWS) in A&E departments across England to help staff identify babies, children and teenagers whose health is deteriorating. The system uses age-adjusted observations and allows concerns from parents, carers, children or clinicians to prompt an immediate review, including when a child’s score is low.
PEWS brings measurements such as heart rate, breathing rate, oxygen levels, blood pressure and consciousness together in a standardised score. Age-specific charts account for the fact that expected vital signs differ between babies, younger children and teenagers. The score is intended to support staff in identifying who may need urgent assessment or treatment; it does not replace clinical judgement.
More than 90 hospitals in England already use PEWS on children’s wards. The current rollout extends the national system to emergency departments for the first time, according to the source report. NHS England says data from hospitals using the inpatient system show consistently lower rates of cardiac arrests among patients; the report does not give figures or establish that the system alone caused that difference.
A key feature is that a low score does not rule out escalation. The source report says concerns raised by families, children or healthcare professionals can trigger an immediate review of care. The rollout is taking place ahead of winter, when emergency departments face increased pressure, and applies in a service where more than six million children attend A&E in England each year, according to the report.
How PEWS Could Change A&E Reviews
Children’s health can change while they are waiting for assessment, and the new approach gives staff a shared framework for recording observations and spotting deterioration. A standardised score may help teams identify warning signs earlier and make decisions more consistently across emergency departments.
For families, the stated escalation route matters because a parent’s knowledge of a child’s normal behaviour can add information not captured by a single set of measurements. The policy gives their concerns a role in requesting a review, rather than treating the numerical score as the only trigger for action. It does not, however, promise shorter waits or guarantee a particular outcome.
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From Children’s Wards to Emergency Departments
PEWS has been used in children’s wards at more than 90 hospitals, but this announcement extends the national system into A&E. The change is being introduced ahead of winter, a period when emergency departments can face higher demand, though the source report does not set out a hospital-by-hospital timetable.
The rollout is also described alongside plans to extend Martha’s Rule to hospital emergency departments in England. The rule is named after 13-year-old Martha Mills, who died from sepsis in 2021 after her family’s concerns about her worsening condition were not acted upon. Under the scheme described in the report, patients and families can request a rapid review if they believe someone is deteriorating and their concerns are not being addressed; A&E departments are expected to provide a dedicated phone number for requests.
The announcement comes amid scrutiny of children’s emergency care, including concerns about overcrowding and delays. The report says the NHS is developing new standards for the service and has identified ending corridor care for young patients as a priority. The Royal College of Paediatrics and Child Health and the Royal College of Nursing helped develop PEWS.
“The system would help medical teams recognise warning signs and make faster decisions in busy emergency departments.”
— Duncan Burton, chief nursing officer for England
Rollout Details and Staffing Needs
The source report does not specify when each A&E department will begin using PEWS, how implementation will be monitored, or how much additional staff training and support will be provided. It also gives no underlying figures for the reported association between inpatient PEWS use and lower cardiac-arrest rates, so the size of the difference and the role of other factors are unclear.
It is also not clear from the report how quickly a requested review must take place in A&E, how the dedicated Martha’s Rule phone number will operate at each hospital, or what response families can expect if emergency departments are under heavy pressure. The system is designed to support recognition and escalation; it does not remove waits or guarantee that every deterioration will be detected before harm occurs.
Hospitals Put the System Into Practice
The next step is for A&E departments across England to introduce the national charts and escalation process. The report gives no detailed schedule, so families may need to check locally how PEWS and the planned Martha’s Rule arrangements will be available at their hospital.
For now, the advice described in the report is to tell a nurse or doctor promptly if a child’s symptoms or behaviour change while waiting, explain what seems unusual, and ask for a reassessment if concerned. Families who feel their concerns are not being addressed can ask staff how to request an urgent review. The broader impact will depend on how consistently hospitals put the system into practice, including whether they have the staffing and training needed to respond.
Key Questions
What is the new NHS warning system?
The National Paediatric Early Warning System combines observations such as breathing, heart rate and alertness into an age-adjusted score to help staff recognise when a child may be deteriorating.
Does a low PEWS score mean my child cannot get an urgent review?
No. The source report says concerns from parents, carers, children or healthcare professionals can prompt an immediate escalation of care even when the score is low.
Will PEWS make A&E waits shorter?
The system is intended to help staff recognise deterioration and support decisions. The report says it will not remove A&E waiting times.
What is Martha’s Rule?
As described in the report, Martha’s Rule gives patients and families a way to request a rapid review when they believe someone’s condition is worsening and their concerns are not being addressed. Plans are described to extend it to hospital emergency departments in England.
What should I do if my child seems worse while waiting?
Tell a nurse or doctor promptly, describe what has changed, and ask for your child to be reassessed if you remain concerned. If you feel your concerns are not being addressed, ask how to request an urgent review under the hospital’s arrangements.
Source: madeformums.com
