Hospital emergency departments across England are introducing a new early warning system to help NHS staff identify children whose condition is dangerously worsening, following the death of a two-year-old who spent hours waiting in a corridor.
The National Paediatric Early Warning System (PEWS) is being rolled out ahead of winter, when pressure on the NHS is at its highest. Under the initiative, concerns raised by staff, parents, carers or children themselves will trigger an immediate escalation of care.
How the system works
Medics will check and grade vital signs including blood pressure, heart rate and oxygen levels to give each child an overall score, with a higher score indicating a need for more urgent attention. The system is designed to help identify sick children whose condition is deteriorating.
The move comes after two-year-old Finlay Roberts died in 2024 after waiting hours in a hospital corridor with a tummy ache. Medics failed to identify that he was suffering from a twisted bowel. The toddler spent nine hours in A&E, which his family said was mainly spent in the corridor. He was sent home in the early hours of the next day, and just hours later his mother found him not breathing next to her.
Apology and pledge over corridor care
A coroner raised concerns about a lack of basic observations carried out by busy staff. Health Secretary Yvette Cooper apologised to Finlay's parents on behalf of the NHS, saying: "No child should be treated in a corridor. No patient should be treated in a corridor." She later pledged to stop corridor care for sick children and urged NHS England's chief executive to draw up new standards for children's care in A&E.
Finlay's father, David Roberts, said: "Being on the chair for hours and hours in the corridor, it's not exactly what killed him, but it's just perfectly emblematic of a broken system, not breaking - fundamentally broken. If kids who are in that degree of need, if they're just sitting on their parent in the corridor... this is a broken system."
Corridor care and Martha's Rule expansion
Corridor care became widespread in the NHS after the Covid-19 pandemic and sees patients treated in non-clinical spaces such as corridors, offices and walk-in cupboards. It became increasingly common in 2024 after a decade of rising A&E and 999 waits. The practice was quietly rolled out across the NHS in England in 2022 to get ambulances queuing outside A&Es back on the road quicker.
In September, a review revealed overcrowded A&Es may be causing more than 1,000 deaths a week. The study of more than 19,000 adult patients found that for every 10% increase in emergency department occupancy, the chance of dying in the following 28 days rose by 1%.
A similar early warning system for acutely ill adults, including those with sepsis, is already used in emergency and general NHS hospital wards. More than 90 hospitals across England have also been using the alert system on children's wards, with different age-appropriate assessments for babies through to teenagers.
The NHS has said Martha's Rule will be expanded to all hospital emergency departments in England. It gives patients, families and carers the right to request a rapid review if they believe a patient's condition is getting worse and their concerns are not being acted on. The policy is named after Martha Mills, who died aged 13 at King's College Hospital in Southeast London in 2021 after developing sepsis following a bike accident. A coroner ruled that the family's concerns were not listened to and Martha would probably have survived had she been moved to intensive care earlier.
Martha's Rule will allow patients, loved ones and staff at A&E units across England to call a dedicated phone number and trigger an urgent review if a patient's health is deteriorating and they feel their concerns are not being listened to.
