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Six million A&E visits a year, and the children's chart that lets a parent's worry raise the alarm

Qurexa Editorial Team2 November 20269 min read 0 0
Six million A&E visits a year, and the children's chart that lets a parent's worry raise the alarm

What happened

From this winter, every A&E department in England will use the same system for spotting a child who is getting worse. NHS England announced on 2 November 2026 that the National Paediatric Early Warning System - usually shortened to PEWS - is being rolled out across emergency departments, with the rollout due to finish over the winter. PEWS is a scoring chart. Staff measure and record a child's vital signs: blood pressure, heart rate, breathing rate, oxygen levels and how awake and responsive they are. Those readings add up to a score, and a higher score is a signal that the child may need attention sooner. What makes it different from a general observation chart is that it is built for children. There are separate charts for different age groups, because a normal heart rate for a baby is not a normal heart rate for a 14-year-old. A reading that would worry you in a teenager can be perfectly ordinary in a newborn, and the other way round. Two other things matter about how it works: - The score does not overrule the staff. A nurse or doctor who is worried about a child can escalate that child's care even when the score is low. - Parents and carers are part of it. NHS England says staff are asked to take in concerns from children, parents and carers, and those concerns can prompt action on their own. Duncan Burton, England's chief nursing officer, said of the system: "Just as importantly, it makes sure the concerns of children, parents and carers are heard and can prompt action." The chart itself is not new. It has been in use on children's inpatient wards since November 2023, and more than 90 hospitals in England now use it there. NHS England says those hospitals have had consistently lower rates of cardiac arrests among their patients. This announcement extends it from the wards to the front door of the hospital, with guidance and training for A&E teams brought in alongside.

Why this matters

More than six million children go to an emergency department in England every year - a very large number of short, rushed encounters, often late at night, often with a frightened child and a tired parent. A&E is also the hardest place to notice a child going downhill. Children can look reasonably well and then deteriorate quickly, far faster than most adults. A busy department with a full waiting room is exactly where that change is easiest to miss, and where patients are handed between staff most often. Until now, different hospitals used different charts, or none. Professor Damian Roland, a consultant in paediatric emergency medicine, said the new system links triage to the observations that follow it and standardises escalation across the country. In plain terms: the first check at the door and every check after it now feed into one agreed picture, and everyone agrees on what that picture means. There is a second reason this is in the news now. It sits alongside Martha's Rule, which has recently been extended to emergency departments and waiting rooms. Martha's Rule lets patients, families or staff ask for an urgent second review when they believe someone is getting worse and their worries are not being acted on. It is named after Martha Mills, who was 13 when she died of sepsis in 2021 after her family's concerns were not escalated. PEWS and Martha's Rule do different jobs. PEWS is the routine net meant to catch most children. Martha's Rule is the cord you pull when the net has missed someone. Having both means a worry has two ways to travel upwards, not one.

What the evidence actually says

It is worth being straight about what is proven here and what is not. What is reasonably solid. PEWS came out of a three-year pilot across 15 sites, built with the Royal College of Paediatrics and Child Health and the Royal College of Nursing - the two bodies whose members actually use it. It has run on children's wards for three years, so this is a tested tool moving to a new setting rather than an untried idea. And NHS England reports lower cardiac arrest rates in the hospitals using the inpatient version. What is not yet proven. NHS England has not published the figures behind that cardiac arrest claim; "consistently lower" is the phrase used, and the numbers are not in the announcement. Nor does a drop in hospitals that adopted PEWS early mean PEWS caused it - hospitals that volunteer first for a safety programme are often ones already investing in safety. That is a well-known trap in reading health data. There is also no published independent evaluation of the A&E version yet. It is new. And one honest caveat, which came from the professionals themselves. Professor Lynn Woolsey, chief nursing officer at the Royal College of Nursing, called the system a vital tool for nursing staff - but said it will be crucial to make sure there are enough nursing staff to use it properly. Dr Mike McKean, vice-president for policy at the RCPCH, welcomed the timing ahead of winter and stressed the training and resources that need to come with it. That is the real test. A scoring chart only helps if someone has time to fill it in, and someone has time to answer when it flags. The chart is the cheap part.

Qurexa perspective

We deliver prescriptions and support medication routines for households across Lincolnshire, so the part of this story closest to our work is what happens after the hospital visit. A child discharged from A&E often goes home with something new - an inhaler, a course of antibiotics, a changed dose. The first 48 hours are when a worried parent most needs the medicine actually in the house, and most needs to be clear on how to give it. That is unglamorous logistics, and it is exactly what falls over when a family has had a long night. The principle behind PEWS applies at home too: someone records what normal looks like, notices when it changes, and tells somebody. At home that someone is you - and a pharmacist is a free, same-day source of advice on whether what you are seeing is expected. We can help get a prescription to your door, but the clinical question belongs with your pharmacist or GP, and we would rather you asked them twice than guessed once.

Practical advice

If you take a child to A&E this winter, here is what is genuinely useful to know. Say what has changed, not just what is wrong. Staff are reading numbers against what is normal for a child that age. You are the only person in the room who knows what is normal for your child. "She has not had a drink since this morning" or "he is usually bouncing off the walls and he will not lift his head" is clinical information, not fussing. Speak up again if things change while you wait. New symptoms, or your child seeming worse, should be told to a nurse or doctor straight away rather than waiting to be called. Do not assume someone has noticed. Name unusual sleepiness specifically. A child who is unusually floppy, hard to rouse, or behaving very differently from normal is worth describing in exactly those words. Ask for a reassessment. You are allowed to ask for your child to be checked again, and under the new system your concern can prompt escalation even if the last readings looked fine. Ask about Martha's Rule if you are not being heard. If you have raised a worry and it has not been acted on, you can request an urgent review under Martha's Rule. A&E departments have a dedicated phone number for it. You do not need to be confrontational - naming it is enough. For the ordinary winter weeks when A&E is not the answer, NHS 111 is there around the clock, and a pharmacist can deal with a great deal without an appointment. Keeping your child's regular medicines stocked and in date prevents a lot of out-of-hours scrambling.

What to know

The short version: - NHS England announced on 2 November 2026 that the National Paediatric Early Warning System is being rolled out to every A&E department in England, to be completed over this winter. - It is an age-specific scoring chart for children's vital signs: blood pressure, heart rate, breathing rate, oxygen levels and responsiveness. - It has been used on children's inpatient wards since November 2023 and is already in more than 90 hospitals there. - More than six million children attend A&E in England each year. - Staff judgement and parents' concerns can escalate a child's care even when the score is low. - Martha's Rule has recently been extended to emergency departments, giving families a separate route to request an urgent review. - Royal college and nursing leaders welcomed it but said it depends on having enough staff, training and support behind it. - NHS England has not published the detailed figures behind its claim of lower cardiac arrest rates, and there is no independent evaluation of the A&E version yet. Sources: Nursing Times, "System that spots deteriorating children to be rolled out in England", 2 November 2026, https://www.nursingtimes.net/childrens-nursing/early-warning-system-for-children-rolled-out-nationwide-02-11-2026/ ; Royal College of Paediatrics and Child Health, "RCPCH comments on roll out of child alert system in A&Es", 2 November 2026, https://www.rcpch.ac.uk/news-events/news/2026-11/rcpch-comments-roll-out-child-alert-system-aes ; Open Access Government, "New NHS system will help doctors spot seriously ill children faster in A&E", 2 November 2026, https://openaccessgovernment.org/new-nhs-system-will-help-doctors-spot-seriously-ill-children-faster-in-ae/216055 ; MadeForMums, "NHS launches new warning system to spot seriously ill children faster in A&E", 2 November 2026, https://www.madeformums.com/news/new-nhs-ae-warning-system-children-parents/ ; NHS England, "New NHS warning system to spot deterioration in children's health faster", November 2023, https://www.england.nhs.uk/2023/11/new-nhs-warning-system-to-spot-deterioration-in-childrens-health-faster/ This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional. If you are worried that a child is seriously unwell, contact NHS 111, or call 999 in an emergency.

#childrens health#NHS England#A&E#patient safety#PEWS#Martha's Rule

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