Download this case study

Care homes in St Helens, Merseyside, are sharing their successes in adopting a tool which ensures safer care of residents.

A collaboration between NHS St Helens CCG and the Innovation Agency led to the widespread adoption of a tool to manage the care of residents when their condition deteriorates.

A total of 32 homes – 90 per cent of those based in the borough – have been trained in using RESTORE2, Recognise Early Soft Signs, Take Observations, Respond, Escalate.


RESTORE2 is based on recognising early signs of deterioration; the national early warning score, NEWS2; and structured communications using SBARD – situation, background, assessment, recommendation.

NEWS2 comprises six physical observations - pulse, respiration rate, blood pressure, temperature, oxygen saturations and conscious level. The higher the score, the more likely medical treatment may be needed.

Whenever a resident is unwell care home staff can measure their condition with this tool and relay a NEWS2 score which is recognised by clinical staff across all disciplines.

Health Innovation North West Coast is supporting the roll out of RESTORE across the North West Coast as part of the National Patient Safety Improvement Programme.

The challenge

Before the introduction of RESTORE2 there was no consistent or standardised way of identifying and recording deterioration in a resident’s condition. Each care home had their own plan, which could lead to a delayed response and potentially unnecessary admissions to hospital.

Actions taken

Health Innovation North West Coast was offering training and support for using RESTORE2 to care homes throughout the North West Coast. NHS St Helens CCG responded by allocating a dedicated team member to work closely with the Innovation Agency and ensure take-up throughout the borough.

Care home staff attended online training events and the Innovation Agency also provided information leaflets and offered ongoing support, while the CCG helped to ensure maximum takeup, providing reassurance and helping to embed the tool into care home processes.


A total of 32 homes in St Helens have adopted RESTORE2 and have undertaken training - 90 per cent of all care homes in the borough.

Care home staff have embraced the new system and managers report that they feel more confident in communicating with other health services when a resident’s condition deteriorates. This is especially the case for temporary and agency staff.


Duty Manager at Madison Court care home Jeanette Gow said: “Since we started using RESTORE2 we have noticed an improvement in the care provided to our residents, now whenever staff need to speak with a GP, 111 and ambulance staff it’s like they are all speaking the same language. It has helped to speed up the process of getting the correct care when residents are most vulnerable.”

Quality and Safety Nurse at St Helens CCG Nicola Gavin, said: “As the rollout happened during the pandemic, initially some care settings were hesitant and had concerns that this would create an additional workload.

“But with the help of the Innovation Agency we were able to tailor the training to local needs and provide reassurance about ongoing support. I am delighted that almost all of our care homes have adopted RESTORE2 and residents’ care will be improved as a result.”

Next steps

St Helens CCG now monitors the use of RESTORE2 in quality and safety nurse reviews during routine visits to care homes.

Health Innovation North West Coast continues to support the management of deterioration in care homes across the North West Coast. To find out more, contact Programme Manager Rebecca Wardle at:  

Case studies >

Cytoprime: an innovative diagnostic test Read more

The Innovation Agency supported the pilot of an innovative diagnostic test, delivered in community settings, that aims to divert patients away from hard-pressed hospital endoscopy services.

Flu test and treat pathway trial Read more

A new test and treat pathway was trialled at six primary care sites in Wirral, aiming to speed up the diagnosis of patients in the community.

Q Coaching: Developing skills to bring teams on a change journey Read more

A programme to equip participants with structured, practical coaching approaches that can be adapted to specific team needs and put to immediate use.

All the latest from the Health Innovation North West Coast...