NHS England Rolls Out Child Early Warning Checklist in A&E

NHS England is extending a standardized early warning checklist for sick children to every emergency department in England, after testing the tool in more than 90 hospitals, according to the BBC. The system, called the National Paediatric Early Warning System, or PEWS, assigns a numerical score to a child's vital signs — blood pressure, heart rate and oxygen levels — so staff can flag deterioration before it becomes a medical emergency, the BBC reported.

The rollout is timed to reach all A&E departments in England before winter, when emergency department demand is typically at its highest, according to the BBC.

What does the National Paediatric Early Warning System measure?

PEWS requires staff to check, log and grade a set of vital signs at regular intervals, the BBC reported. A high overall score signals a child needs more urgent attention. The tool also includes an escalation trigger that does not depend on the numerical score alone: if a staff member, parent, carer or the child raises a concern, that alone is enough to force an immediate review of care, according to the BBC. NHS England has already run a comparable scoring system for adults — including patients with sepsis — in emergency and general wards, the BBC said, and the age-appropriate versions of PEWS cover patients from infancy through the teenage years.

Why is NHS England introducing PEWS now?

Health Secretary Yvette Cooper has pledged to end what she called "corridor care" for children, the BBC reported. Cooper raised the issue on the BBC's Sunday with Laura Kuenssberg program, citing the case of two-year-old Finlay Roberts, who died in 2024 after spending hours in a hospital corridor before being discharged. "No child should be treated in a corridor. No patient should be treated in a corridor," Cooper said, apologizing to Finlay's parents on behalf of the NHS, according to the BBC.

Whittington Health NHS Trust, where Finlay waited for treatment, extended condolences to the family and told the BBC it "continued to experience periods of exceptional demand across emergency care" and that "at times, some patients may receive care in temporary clinical areas, including corridors."

What happened to Finlay Roberts and Martha Mills?

Finlay Roberts died in 2024 following his wait at Whittington Health NHS Trust, the BBC reported. Separately, Martha Mills died at age 13 in 2021 at King's College Hospital in London after developing sepsis — blood poisoning — following a bike accident, according to the BBC. A coroner ruled that her family's concerns about her worsening condition were not acted on and that she probably would have survived had she been moved to intensive care sooner, the BBC reported.

Martha's parents, Merope and Paul Mills, subsequently proposed a rule bearing her name aimed at changing the culture that contributed to her death, according to the BBC.

How does Martha's Rule fit into the new system?

NHS England has said it will extend Martha's Rule to every hospital emergency department in England, the BBC reported. The rule gives patients, families and carers a direct route to request a rapid clinical review if they believe a patient is deteriorating and their concerns are not being addressed. Under the expanded rule, A&E units will carry a dedicated phone number that can trigger that urgent review, according to the BBC. The rule already operates in NHS settings beyond emergency departments and is being paired with the new children's scoring tool as part of the same winter push, the BBC reported.

What happens next for emergency departments?

Duncan Burton, chief nursing officer for England, called the children's early warning system "an important next step in improving care for children and young people across England for this winter — and beyond," according to the BBC.

"In fast-paced emergency departments, staff need to spot quickly when a child's condition is deteriorating. This standardised approach will help them recognise the warning signs, communicate concerns, and make timely decisions," Burton said, per the BBC.

The more than 90 hospitals that have already used similar scoring systems on children's wards give NHS England a working base to expand from, the BBC reported, though the broadcaster's reporting did not specify a hospital-by-hospital completion date beyond the stated target of having the system active in A&E units "for this winter." The expansion runs alongside the wider rollout of Martha's Rule, meaning emergency departments will carry both a standardized vital-signs score for children and a direct escalation line for families who believe those numbers are not telling the full story.

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