NHS leaders say the world’s largest paediatric early warning system is being introduced in emergency departments across England, designed to help staff quickly identify when sick children are dangerously deteriorating, with the rollout coming ahead of the winter pressure period.
The national Paediatric Early Warning System (PEWS) asks staff to check, log and grade vital signs such as blood pressure, heart rate, breathing rate, oxygen levels and consciousness. A high overall score signals that a child needs more urgent attention. Concerns raised by staff, parents, carers or the child themselves can still trigger an immediate escalation of care even if the PEWS score is low, NHS England said.
Duncan Burton, chief nursing officer for England, said standardising the approach would help staff in fast-paced emergency departments recognise warning signs and make timely decisions "when every moment matters."
The system, a collaboration between NHS England, the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Nursing, has been in use for inpatients in more than 90 hospitals. NHS England has said this winter will be the first time it is used in A&E.
More than 6 million children attend A&E in England each year. The PEWS includes age-appropriate charts for babies, children and young people, designed specifically for the rapid decision-making needed in busy emergency departments.
Dr Mike McKean, vice-president for policy at the RCPCH, said: "The emergency department PEWS charts are extremely important tools that will support all paediatricians and wider child health teams to spot deterioration in children in hospital."
Prof Lynn Woolsey of the Royal College of Nursing said early escalation was critical for patient safety, especially for children.
NHS England data suggests hospitals using the inpatient PEWS have consistently lower rates of cardiac arrests among their patients.
Separately, NHS England is drawing up new standards for how children should be treated in A&E, including eliminating corridor care as a priority. Two-year-old Finlay Roberts died in 2024 after spending hours in a hospital corridor. Health Secretary Yvette Cooper apologised to his parents on behalf of the NHS, saying no child should be treated in a corridor.
Analysis
Why This Matters
- The rollout covers all A&E departments in England, potentially affecting millions of children each year
- Standardised early detection could reduce preventable deaths and cardiac arrests in children
- The system comes alongside new standards to eliminate corridor care for children, responding to recent high-profile cases
Background
PEWS is a standardised scoring system for children's vital signs already used in inpatient wards at more than 90 hospitals. Its expansion to emergency departments makes it the largest system of its kind globally. A similar adult early warning system is already in use across NHS hospitals. The initiative follows criticism of corridor care for children, notably the death of two-year-old Finlay Roberts in 2024.
Key Perspectives
NHS England: says the system will help staff spot deterioration quickly and ensure the concerns of children, parents and carers are heard.
Royal College of Paediatrics and Child Health (RCPCH): the charts are extremely important tools that will support paediatricians and wider teams, alongside training and resources.
Royal College of Nursing: early escalation is critical; the emphasis on listening to children and families is especially important, but enough nursing staff and training are needed to use it effectively.
What to Watch
- Whether emergency departments report a reduction in serious deterioration events this winter
- Any updates on the new standards for children's care in A&E, including the corridor care pledge
- Monitoring of staffing levels and training capacity to use the system effectively
Checked
12 claims in this story checked against 2 sources: 12 supported.
Show each claim
- SupportedThe world’s largest paediatric early warning system is being introduced in A&Es across England.UK news | The Guardian: “The world’s largest “early warning system” to spot when sick children are dangerously deteriorating is being introduced in A&E departments across England”
- SupportedThe new scoring system aims to help staff spot children’s deterioration ahead of winter.BBC News: “The initiative is designed to save lives ahead of winter, when pressure on the NHS is at its highest.”
- SupportedDuncan Burton said the system would help staff make timely decisions “when every moment matters.”UK news | The Guardian: “This standardised approach will help them recognise the warning signs, communicate concerns, and make timely decisions when every moment matters.”
- SupportedDr Mike McKean said the emergency department PEWS charts would support child health teams to spot deterioration in children in hospital.UK news | The Guardian: “The emergency department Pews charts are extremely important tools that will support all paediatricians and wider child health teams to spot deterioration in children in hospital.”
- SupportedYvette Cooper apologised to Finlay Roberts’s parents on behalf of the NHS and said no child should be treated in a corridor.BBC News: “Cooper apologised to Finlay's parents on behalf of the NHS, saying: "No child should be treated in a corridor. No patient should be treated in a corridor."”
- SupportedPEWS asks staff to check, log and grade vital signs including blood pressure, heart rate, breathing rate, oxygen levels and consciousness.UK news | The Guardian: “Doctors and nurses can use it to measure, record and assess vital signs, such as blood pressure, heart rate, breathing rates, oxygen levels and consciousness.”
- SupportedA high overall PEWS score signals that a child needs more urgent attention.BBC News: “A high overall score means a child needs more urgent attention.”
- SupportedConcerns raised by staff, parents, carers or the child can trigger immediate escalation even if the PEWS score is low.UK news | The Guardian: “Concerns raised can still trigger an immediate escalation of care, even if a child’s Pews score is low.”
- SupportedMore than 90 hospitals use the inpatient PEWS system.UK news | The Guardian: “More than 90 hospitals across England use the national inpatient Pews system”
- SupportedNHS England has said this winter will be the first time PEWS is used in A&E.UK news | The Guardian: “NHS England has said this winter will be the first time it is used in A&E .”
- SupportedMore than 6 million children attend A&E in England each year.UK news | The Guardian: “More than 6 million children attend A&E in England each year.”
- SupportedNHS England data suggests hospitals using inpatient PEWS have consistently lower cardiac-arrest rates among their patients.UK news | The Guardian: “data suggests they have consistently lower rates of cardiac arrests among their patients, according to NHS England.”
