Reduce deterioration associated harm by improving the planning, identification, escalation and response (PIER) to physical deterioration through better system co-ordination and as part of safe and reliable pathways across health and social care’.

The Patient Safety Collaborative (PSC) commission for the Managing Deterioration Programme is paused from 30th June 2023. Work is continuing centrally and the National Patient Safety Improvement Team are developing an ICS facing toolkit for the prevention and management of deterioration. Though the PSC involvement in the Programme is paused for now, there are opportunities for us at the Health Innovation North West Coast to support locally commissioned work in this area. Please contact us directly to discuss this further: . 


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 supporting the spread and adoption of deterioration management tools (namely Restore2/Mini) to Care Homes across the region.

Find out more 

Past projects and resources


Testing of the national Paediatric Early Warning System (nPEWS)

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

Health Innovation North West Coast have supported the delivery of the NHS (National Health Service) System-wide Paediatric Observations Tracking (SPOT) programme between April 2021 to September 2022. 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.  The ambition in supporting the SPOT programme is to reduce deterioration associated harm in children and young people. 

Between April 2021 to September 2022, the Patient Safety & Care Improvement Team have supported 5 pilot sites across the North West in implementing the new Paediatric Early Warning Score (PEWS).  We have engaged with these acute trusts through regional learning events, 1:1 coaching sessions and our Coaching Academy offer of quality improvement, human factors, and coaching guidance to support adoption.  

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

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 >


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