PEWS and NEWS2: How the NHS Spots Deterioration Early

PEWS and NEWS2: How the NHS Spots Deterioration Early

Why early warning scores matter

When someone is in hospital, small changes in heart rate, breathing, oxygen levels or blood pressure can show that their condition is getting worse. Spotting those changes early gives teams time to act before things become serious.

Early warning scores turn those everyday observations into a simple number. A rising score flags the need for more frequent checks or a review by a more senior clinician. The score does not replace professional judgement. Instead, it gives teams a shared language so they respond in a consistent way.

NEWS2 for adults

The National Early Warning Score 2 (NEWS2) is the standard system used for adults across NHS hospitals. The Royal College of Physicians introduced the original NEWS in 2012. They released the updated NEWS2 version in 2017.

Staff record six main measurements:

• Respiratory rate
• Oxygen saturation (with a standard scale or a special lower-target scale for people with certain chronic lung conditions)
• Temperature
• Systolic blood pressure
• Heart rate
• Level of consciousness (including new confusion)

Each of these scores between 0 and 3 depending on how far it sits from normal. If the person is receiving supplemental oxygen, staff add an extra 2 points to the total. They then add the numbers together.

Roughly speaking:

• 0–4 is low risk and needs routine monitoring
• 5–6 (or any single measurement scoring 3) needs prompt review by a clinician skilled in acute care
• 7 or above is high risk and triggers an urgent response, often involving outreach or critical care teams

A NEWS2 of 5 or more should also prompt staff to consider sepsis. Teams use the system on wards, in emergency departments and increasingly in ambulances and community settings.

You can read the full NEWS2 guidance from the Royal College of Physicians here: National Early Warning Score (NEWS) 2.

PEWS for babies, children and young people

Children are not small adults. Their normal heart rates, breathing rates and blood pressures change quickly with age, and they can deteriorate faster than adults. For years many hospitals used their own paediatric early warning tools. This created inconsistency when staff moved between sites.

PEWS is not a brand-new system. Hospitals have used it on inpatient wards for a couple of years. In 2023, NHS England, the Royal College of Paediatrics and Child Health and the Royal College of Nursing developed a single national Paediatric Early Warning System (PEWS) for inpatients. More than 90 hospitals are already using it on children’s wards, and data suggests lower rates of cardiac arrest in those settings.

What is new this winter is its introduction into A&E departments across England. With more than six million children attending A&E each year, this creates the world’s largest standardised paediatric early warning system. It is designed for the fast pace of emergency departments while remaining consistent with the ward version.

Age-appropriate charts cover:

• 0–11 months
• 1–4 years
• 5–12 years
• 13 years and over

The score typically draws on heart rate, respiratory rate, extent of respiratory distress (work of breathing), blood pressure, oxygen saturations, oxygen delivery and capillary refill time. Staff also record temperature, consciousness and pain. Escalation bands run from low through medium and high to emergency, with clear guidance on monitoring frequency and who needs to be involved.

A key feature is that parent, carer or child concerns, or a clinician’s intuition that “something is not right”, can trigger immediate escalation even if the numerical score is low.

Key differences between NEWS2 and PEWS

• NEWS2 uses one set of adult thresholds. PEWS uses four age-banded charts because normal ranges shift rapidly in childhood.
• PEWS places stronger explicit weight on parent or carer concern and clinical intuition as independent triggers.
• NEWS2 has a special oxygen scale for adults with certain chronic lung conditions. PEWS scores low oxygen saturations consistently across age groups.
• PEWS includes measures of respiratory effort and capillary refill that are particularly useful in children.

Both systems aim to standardise recognition and communication of deterioration so teams act sooner. Neither replaces professional judgement or the need to listen to the patient or family.

What this means in practice

When a child or adult arrives in hospital or is monitored on a ward, staff take the observations, plot them on the appropriate chart (or enter them digitally) and calculate the score. A rising score or any single red-flag value prompts more frequent checks, a review by a more senior clinician, and, if needed, transfer to higher dependency or intensive care. Staff actively ask parents how their child is compared with earlier observations.

Early results from hospitals already using national PEWS on wards are encouraging. The A&E rollout aims to bring the same consistency to the front door, where waits can be long.

These tools do not diagnose illness or guarantee outcomes. They are safety nets that make subtle signs of deterioration more visible. For families, the message is straightforward: your observations and concerns matter and can trigger action, even when the numbers look reassuring.

Overall, the national PEWS rollout in A&E this winter, building on the established NEWS2 system for adults, marks a significant step towards more consistent, responsive care for patients of all ages across the NHS.

Martha’s Rule and listening to families

Martha’s Rule gives patients, families, carers and staff a clear route to request a rapid review by an independent clinician if they are worried that a patient’s condition is getting worse and their concerns are not being listened to. The rule takes its name from Martha Mills, who died aged 13 in 2021 after developing sepsis in hospital.

The three core components are:

• Staff ask patients (or parents of children) at least daily how they are feeling and whether they feel better or worse.
• Any staff member can request a review from a different team if they are concerned.
• Patients, families and carers can also request a rapid review if they remain worried.

Martha’s Rule is expanding to all A&E departments and waiting rooms. PEWS and Martha’s Rule work together. The score provides the physiological safety net. Martha’s Rule ensures that family and staff concerns are heard even when the numbers look reassuring.

Official NHS England resources on Martha’s Rule:

• Martha’s Rule overview and implementation
• Martha’s Rule core standards
• Information for patients, families and carers
• Implementation in emergency departments

Useful official resources

Here are five key bodies of knowledge on PEWS and NEWS2:

• NHS England – National Paediatric Early Warning System (PEWS)
• NHS England – National PEWS observation and escalation charts (age-banded PDFs)
• Royal College of Paediatrics and Child Health – UK Paediatric Early Warning Systems
• Royal College of Physicians – National Early Warning Score (NEWS) 2
• RCPCH – PEWS updates from the UK nations