Hospital emergency departments across England are implementing the National Paediatric Early Warning System (PEWS) to enhance the identification and care of children experiencing clinical deterioration. The system requires staff to monitor, record and assess vital signs including blood pressure, heart rate and oxygen saturation, with higher overall scores indicating a need for more urgent attention. Any concerns raised by staff, parents, carers or patients themselves will prompt immediate escalation of care.
The initiative was developed collaboratively by NHS England, the Royal College of Paediatrics and Child Health and the Royal College of Nursing. More than 90 hospitals across England have already been utilizing alert systems in children’s wards, featuring assessments tailored to different age groups from infants through teenagers. The expansion to emergency departments represents a significant broadening of this existing early warning infrastructure.
The rollout follows high-profile cases highlighting gaps in emergency care for children. A coroner raised concerns about insufficient monitoring in the case of two-year-old Finlay Roberts, who died in 2024 after extended periods waiting in a hospital corridor before discharge. Health Secretary Yvette Cooper has committed to eliminating corridor care for sick children, citing unacceptable waits for available hospital beds.
The initiative also incorporates Martha’s Rule, which grants patients, families and carers the right to request urgent care reviews when they believe a patient’s condition is worsening and concerns are not being addressed. The rule is named after Martha Mills, who died aged 13 in 2021 from sepsis following a bicycle accident; a coroner determined that her family’s concerns about her deteriorating condition were inadequately heeded and that earlier intensive care transfer would likely have prevented her death. Emergency departments will feature dedicated telephone numbers enabling families to trigger these urgent reviews.
Duncan Burton, England’s chief nursing officer, characterized the system as a critical advancement for child care during high-pressure winter months and beyond, noting that rapid identification of warning signs and timely decision-making are essential in fast-paced emergency settings.
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