England is introducing a new early warning system in hospital emergency departments to help staff identify sick children who are deteriorating rapidly. The National Paediatric Early Warning System (PEWS) requires medical personnel to check, log, and grade vital signs such as blood pressure, heart rate, and oxygen levels.
The initiative aims to save lives ahead of the winter season, when pressure on the National Health Service (NHS) typically peaks. Health Secretary Yvette Cooper has pledged to stop “corridor care” for sick children, citing long waits for hospital beds as a critical issue.
Learning from Tragic Deaths
The push for standardized monitoring follows high-profile cases where children died after waiting in hospital corridors. Cooper recently discussed the case of two-year-old Finlay Roberts, who died in 2024 after spending hours in a crowded corridor before being discharged. Cooper apologized to Finlay’s parents on behalf of the NHS, stating that no child should be treated in a corridor.
Whittington Health NHS Trust, where Finlay waited for treatment, extended condolences to the family. The trust noted it continues to experience periods of exceptional demand across emergency care, which sometimes results in patients receiving care in temporary clinical areas, including corridors.
Another key driver for the new protocols is the case of Martha Mills, who died aged 13 in 2021 at King’s College Hospital in London. A coroner ruled that her family’s concerns about her worsening condition were not listened to, and she would likely have survived had she been moved to intensive care earlier. Martha developed blood poisoning, or sepsis, following a bike accident.
Escalation and Martha’s Rule
Under the new PEWS guidelines, a high overall score from vital sign checks means a child needs more urgent attention. Crucially, concerns raised by staff, parents, carers, or the child themselves will trigger an immediate escalation of care.
This aligns with the expansion of “Martha’s Rule” to all hospital emergency departments in England. The rule gives patients, families, and carers the right to request a rapid review if they are worried that a patient’s condition is getting worse and their concerns are not being addressed. A&E units will have a dedicated phone number that can be called to trigger this urgent review.
Duncan Burton, chief nursing officer for England, described the new system as an “important next step in improving care for children and young people across England for this winter – and beyond.” He emphasized that in fast-paced emergency departments, staff need to spot quickly when a child’s condition is deteriorating. He added that this standardized approach will help them recognize warning signs, communicate concerns, and make timely decisions when every moment matters.
The early warning system for children is a collaboration between 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 using alert systems in children’s wards, with different age-appropriate assessments available for babies through to teenagers. A similar early warning system to identify acutely ill adults, including those with sepsis, is already in use in emergency and general NHS hospital wards.
Source: BBC
