Paediatric Early Warning System (PEWSystem) - developing a standardised tool for England

We are collaborating with NHS England and the Royal College of Nursing to develop a single nationally validated Paediatric Early Warning system, (PEWS) for England.

The call for a universal PEWS has escalated in recent years by clinicians, coroners, regulators and families. PEWS can effectively recognise and respond to the acutely deteriorating child or young person.

The absence of a single standardised PEWS presents a challenge for clinical staff as they move across sites and may use different observation charts, scoring systems and escalation processes. A single standardised tool will remove this challenge.
Last modified
23 March 2023


Previous work to improve the recognition and response to deterioration in children and young people has rightly focused on improving the whole system response rather than the single component of measurement of observations.

While there is no single nationally-validated system in England for children and young people, we do not believe this has negatively impacted on the care they receive in hospitals across England. It does however, present a challenge for the NHS to truly operate as a national system and affects most of our staff who move across sites.

Many acute hospitals have developed their own programmes to improve the recognition and response to deterioration. These have included Early Warning Scores (EWS), initiatives and technology for improving the accuracy of taking and recording observations, and the timely escalation of care.

Development across different geographies and clinical settings has created inconsistencies across England. This is unlike other countries, including the devolved nations of Scotland and Northern Ireland, where single EWS systems for children are in place.

In June 2018, NHS England & NHS Improvement, the RCPCH and the Royal College of Nursing (RCN) came together to establish a joint National PEWS Programme Board for England. In 2020, the NHS SPOT (System-wide Paediatric Observations Tracking) Programme was launched, led by the NHS England Children and Young People’s Transformation Programme team.

Our ambition is to develop a consistent approach and common language to promptly recognise and respond to the acutely ill or deteriorating infant, child or young person. A paper was published in October 2020 on details of a pre-implementation survey conducted by the programme team for a standardised approach to paediatric early warning systems. In January 2021, the case for change was published in Archives of Disease in Childhood.

Current and ongoing work

  • Development of national programme board to bring together the right health partners
  • A clear vision and direction of travel to implementation
  • Development of a case for standardisation 
  • Clinical development of the content of a national PEWS chart 
  • Development of the design and human factors of a national PEWS chart
  • Pilot, evaluation and roll-out of a national PEWS chart and system, as part of the NHS SPOT Programme
  • Education and training support

Timeline for development

  • Development of the programme scope and key principles from August 2018 to October 2019
  • Clinical development, including design and human factors, of the PEWS chart content from September 2019 to Spring 2021
  • Piloting and evaluation of PEWS from December 2021 to Spring 2023
  • National roll-out from April 2023 onwards


Safe System Framework for Children at Risk of Deterioration

Situation Awareness for Everyone (S.A.F.E) Toolkit

Re-ACT- the Respond to Ailing Children Tool

Standards for Assessing, Measuring and Monitoring Vital Signs in Infants, Children and Young People

Subbe C, Bannerd-Smith J, Bunch J, Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems. Resuscitation. 2019;141:1-12

Wheway J, Stilwell PA, Cook A, et al, A preimplementation survey for a standardised approach to paediatric early warning systems. Archives of Disease in Childhood Published Online First: 13 October 2020. doi: 10.1136/archdischild-2020-319100

How you can get involved

The RCPCH, RCN and NHS England and Improvement (NHSEI) held an online event on Tuesday 15 December 2020 to update and engage with healthcare professionals within the NHS on the NHS SPOT Programme. The webinar was co-chaired by Prof Simon Kenny (National Clinical Director for Children and Young People at NHSEI) and Dr John Alexander (Officer for Clinical Standards and Quality Improvement at RCPCH).


  • Welcome and introductions – Prof. Simon Kenny, National Clinical Director for Children and Young People, NHSE
  • A view from affected families – Elizabeth Stanley, Parent and Carer
  • Scope of the SPOT Programme and inpatient PEWS – Dr Damian Roland, Consultant and Honorary Associate Professor in Paediatric Emergency Medicine, Leicester Hospitals and University
  • SPOT from an RCN perspective – Prof Dave Clarke, Associate Dean for Health, Social Care and Partnerships, University of the West of England, Bristol
  • Adopting regional change: Learning for the National PEWS – Dr Kate Pryde, Consultant Paediatrician & Clinical Lead for Improvement University Hospital Southampton & Allison Ahvee Senior Sister Poole Hospital
  • Round up and close – Dr John Alexander, Officer for Clinical Standards and Quality Improvement, RCPCH

You can find a recording of the event and details of future virtual engagement events can be found on the SPOT Programme’s FutureNHS Collaboration platform. 

More information is also available on the FutureNHS Collaboration platform of the NHSEI Children and Young People’s Transformation Team.

If you do not have a user account on the FutureNHS Collaboration platform, you will be redirected to a log-in page where you can register with an NHS email address.

For any queries or if you would like to get involved in this work, please contact