The prevention, identification, escalation and response
to physical deterioration in all care settings for adult patients.

The National Patient Safety Improvement Programme (NatPatSIP’s) deteriorating patient work stream supports the adoption of NEWS2 in acute and ambulance care, RESTORE2 for care settings and the use of pulse oximeters with COVID-19 patients at home.


Resources for responding to COVID-19

The primary focus of responding to physical deterioration in relation to Covid-19 is support for the National Implementation of the NHS Covid Oximetry@Home and Covid Virtual Ward Models.

View our Patient Safety resources for COVID-19 >


Responding to non Covid-19 identification of deterioration in children

The focus is on improvement in deterioration management in the care of children.

The Innovation Agency are supporting the delivery of the NHS System-wide Paediatric Observations Tracking (SPOT) programme. This builds on our existing work around the National Early Warning Score (NEWS2), standardising the approach to acute deterioration in adults.

At present, there is no single nationally validated system for recognising and responding to deterioration for children and young people in England. Our ambition in supporting the SPOT programme is to reduce deterioration associated harm in children and young people.

The Patient Safety & Care Improvement Team are supporting the pilot sites across the North West Coast in implementing the new Paediatric Early Warning Score (PEWS).  Our coaching academy team offers a range of quality improvement, human factors and coaching guidance to enable these acute settings to adopt the new Paediatric Early Warning Score.  We will aspire to share the learning across the regional networks as this work progresses. 

Information and resources to support this piece of work can be found here;

For more information please contact Verity Mather Project Manager, Patient Safety & Care Improvement Team



Managing Deterioration in non-acute settings

The focus will be to establish consistent methods for deterioration management and supporting systems for monitoring and escalating the care of the acutely unwell.



NEWS2 is an approach to standardising the assessment of, and response to, acute illness. It consists of a scoring system based on a number of simple criteria which helps improve the detection of clinical deterioration in patients.

Locally, all acute hospitals and the ambulance trust in the North West Coast have adopted NEWS2.

The aim is for NEWS2 to become the ‘common language’ for communicating patient deterioration across the whole system and its use is now being explored in out-of-hospital settings as well, again with the support of the Patient Safety Collaborative.



RESTORE2 is a physical deterioration and escalation tool for care and nursing homes.

It is designed to support homes and health professionals to:

  • Recognise when a resident may be deteriorating or at risk of physical deterioration;
  • Act appropriately according to the resident’s care plan to protect and manage the resident;
  • Obtain a complete set of physical observations to inform escalation and conversations with health professionals;
  • Speak with the most appropriate health professional in a timely way to get the right support;
  • Provide a concise escalation history to health professionals to support their professional decision-making.

The Patient Safety Collaborative for the North West Coast is rolling out RESTORE2 across all residential, nursing and specialist care settings in the region. Care organisations are able to take part in online RESTORE2 training sessions and receive resources such as handbooks and observation charts free of charge.

Find out more 


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