NHS England to introduce child early warning scores in A&E departments this winter

NHS England is bringing a standardised early warning score for sick children into emergency departments, starting this winter.

The National Paediatric Early Warning System, known as PEWS, already exists for inpatients. More than 90 hospitals in England use it on children's wards. NHS England says this is the first time it will be used in A&E.

How the scoring works

Staff check, record and grade a child's vital signs: blood pressure, heart rate, breathing rate, oxygen levels and consciousness. A high overall score flags a child who needs more urgent attention.

The charts are age-specific, with separate assessments for babies, children and teenagers. NHS England says this version was designed for the speed of an emergency department.

More than six million children attend A&E in England every year. NHS England calls the rollout the largest standardised scoring system of its kind in the world. That is the agency's own description.

A similar tool for adults, the National Early Warning System, is already used in NHS hospitals, including to identify acutely ill patients with sepsis.

Parents' concerns count, whatever the score

NHS England says PEWS is not meant to replace clinical judgment. Concerns from staff, parents, carers or the child can trigger an immediate escalation of care even when the score is low.

That sits alongside Martha's Rule, which the NHS has already said it will extend to all emergency departments in England. The rule lets patients, families and carers request a rapid review if they fear a patient is getting worse and nobody is listening. A&E units will have a dedicated phone number to trigger that review.

The rule is named for Martha Mills, who died aged 13 in 2021 from sepsis after a bike accident. A coroner ruled that her family's concerns about her worsening condition were not listened to and that she would probably have survived if moved to intensive care sooner. Her parents, Merope and Paul, proposed the rule.

Duncan Burton, England's chief nursing officer, said staff "need to spot quickly when a child's condition is deteriorating." He said the standard approach will help them "recognise the warning signs, communicate concerns, and make timely decisions when every moment matters."

Dr Mike McKean, vice-president for policy at the Royal College of Paediatrics and Child Health, which worked on the system, said he was "delighted" to see it rolled out ahead of winter, which he called "always a busy and challenging time."

The corridor problem

The rollout follows a promise from Health Secretary Yvette Cooper to stop corridor care for sick children because of long waits for hospital beds.

On the BBC's Sunday with Laura Kuenssberg, Cooper discussed the case of two-year-old Finlay Roberts. He died in 2024 after spending hours in a hospital corridor before being discharged. She apologised to his parents on behalf of the NHS. "No child should be treated in a corridor. No patient should be treated in a corridor," she said.

Whittington Health NHS Trust, where Finlay waited, offered its condolences. It said it continues to face periods of exceptional demand across emergency care and that at times some patients may receive care in temporary clinical areas, including corridors.

Separately, NHS England is drawing up urgent new standards for treating children in A&E. Eliminating corridor care for youngsters is a stated priority. Those standards are not yet published.

Cooper said children's health "needs to be a much greater focus for the whole NHS." She said that when a parent says something isn't right, "they will be listened to, their concerns will be acted on and lives will be saved."

Limits of a points-based score

A score only works if a child is seen, assessed and then moved somewhere. PEWS flags the deterioration. It does not add a bed or clear a corridor, and the Whittington's own statement shows corridor care persists under peak demand.

Researchers elsewhere are questioning how far fixed scoring can go. At Georgia Tech and Children's Healthcare of Atlanta, a three-year project called ACCORD is building an AI warning tool for hospitalised children.

Kai Wang, an assistant professor at Georgia Tech and co-principal investigator, described today's approach as "a pretty basic rubric that sums up all the data points and then decides whether they are high-risk or low-risk." He said that from a data science view "it's not optimal." ACCORD's model would analyse dozens of data streams, including labs and clinical observations.

That is a US research project in development, not a comment on the NHS system. Its clinical lead, Dr Mark Mai, makes the case for early detection: children can look fine, then "fall off a cliff," and those needing emergency intensive care transfer die at a higher rate than those brought up in a controlled way.

What comes next

PEWS is due in emergency departments from this winter. NHS England has not published a date for when the new children's A&E standards will be finalised, or when corridor care for children is meant to end. Those standards will be the test of whether the promise Cooper made turns into a measurable rule.