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 score and 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
10 December 2019


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.

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. We have seen great success in the roll-out of National Early Warning Scores (NEWS2) for adults and are keen to mirror this for children and young people, but recognise they are a very different population group with very different needs.

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 Key PEWS Principles document 
  • Clinical development of the content of a national PEWS chart, available to download below   
  • Development of the design and human factors of a national PEWS chart
  • Pilot, evaluation and roll-out of a national PEWS chart and system 
  • 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 autumn 2020
  • Piloting and evaluation of a PEWS chart from April 2020 to December 2020
  • Ambitions for a national roll-out from April 2021 onwards

 The National PEWS Programme update, containing the development timeline is available to download below.


RCN Development of a Paediatric Early Warning Scoring System

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

How you can get involved

If you would like to get involved in this work, please contact