Hospital emergency departments across England are rolling out a new early warning system designed to help staff quickly identify sick children whose conditions are worsening dangerously. The National Paediatric Early Warning System (PEWS) asks staff to check, log and grade vital signs including blood pressure, heart rate and oxygen levels, with high scores triggering more urgent attention. According to BBC News, the initiative follows Health Secretary Yvette Cooper's commitment to eliminate "corridor care" for sick children caused by prolonged waits for hospital beds.
The system will also ensure that concerns raised by staff, parents, carers or the children themselves trigger an immediate escalation of care. The move comes as the NHS prepares for winter, when pressure on emergency services reaches its peak.
Why this matters now
The case of two-year-old Finlay Roberts brought the dangers of corridor care into sharp focus. Finlay died in 2024 after spending hours waiting for treatment in a crowded hospital corridor before being discharged. On the BBC's Sunday with Laura Kuenssberg, Cooper addressed the tragedy directly, apologising to Finlay's parents on behalf of the NHS and stating:
No child should be treated in a corridor. No patient should be treated in a corridor.
Whittington Health NHS Trust, where Finlay received care, extended its condolences to the family and acknowledged that it continues to experience periods of exceptional demand across emergency care, during which some patients may receive treatment in temporary clinical areas, including corridors.
The broader problem extends beyond individual cases. Data shows that nearly 3,000 patients daily in England receive corridor care, facing long waits in unsafe and undignified conditions. This systemic issue has prompted urgent action across multiple fronts.
How the early warning system works
The PEWS framework builds on an existing model already proven effective in adult care. A similar early warning system to identify acutely ill adults, including those with sepsis, has been in use across emergency and general NHS hospital wards for some time. More than 90 hospitals across England have already been using alert systems in children's wards, with different age-appropriate assessments tailored for babies through to teenagers.
Duncan Burton, chief nursing officer for England, described the expansion as an
important next step in improving care for children and young people across England for this winter - and beyond.He emphasised that
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 when every moment matters.
The system is a collaboration between NHS England, the Royal College of Paediatrics and Child Health and the Royal College of Nursing. The national PEWS project began in 2018 as part of a longer-term effort to standardise paediatric care across the NHS.
Martha's Rule: empowering families to speak up
Alongside the early warning system, the NHS is expanding 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 believe a patient's condition is deteriorating and their concerns are not being addressed.
The rule is named after Martha Mills, who died aged 13 in 2021 after developing sepsis in hospital following a bike accident at King's College Hospital in London. A coroner ruled that her family's concerns about her worsening condition were not listened to and that she would probably have survived had she been moved to intensive care earlier. Martha's parents, Merope and Paul, developed the concept of the rule in an effort to change the culture that contributed to her death.
A&E units will have a dedicated phone number that can be called to trigger an urgent review of a patient's care. In an eight-month pilot across seven emergency departments, 69 calls were made to dedicated Martha's Rule numbers, demonstrating both the feasibility and uptake of the system.
What happens next
Martha's Rule is being rolled out in phases across England's A&E departments. The phased expansion is expected to be complete by March 2028, with implementation beginning in waiting rooms and expanding through emergency departments. Additionally, NHS trusts are required to complete Martha's Rule implementation across acute inpatient services during 2026/27, with a contract deadline of 31 March 2027.
These measures represent a significant shift in how the NHS responds to deteriorating patients, placing greater emphasis on early detection and family advocacy. Together, the early warning system for children and the expanded Martha's Rule framework aim to prevent tragedies like those of Finlay Roberts and Martha Mills by ensuring that warning signs are recognised quickly and concerns are acted upon immediately.
