Posted on November 1, 2023

Building on our leadership of national projects to support the management of deterioration including New Early Warning Score (NEWS2) and ED Safety Checklist, we have delivered free RESTORE2 training to thousands of care staff across the region.

Originally created by Hampshire, Southampton and Isle of Wight CCG, RESTORE2 is an escalation tool for use in care settings to enable early recognition of deterioration. Training in RESTORE2 supports more effective communication, efficient workflow and improves patient safety at the handovers of care between care staff, primary care and the urgent care system.  Calculating a NEWS2 is an important part of the RESTORE2 tool.

Prior to the use of NEWS2 across healthcare systems there was no standardised response to deterioration or common language used at handovers of care for acutely unwell patients.

Supported by Health Innovation West of England, NEWS was adopted across all elements of the region’s healthcare system. NEWS2 was subsequently rolled out nationally through our Network’s Patient Safety Collaboratives in 2018-20.

To build on this work and cement the importance of managing deterioration in care homes, we provided a programme of free RESTORE2 training for care providers from December 2019 to October 2023. Whilst initially delivered face-to-face, learning moved online in spring 2020 due to the COVID pandemic and this then remained virtual.

“We also have a better relationship with our GP now we use RESTORE2. We can now speak a common language with the clinicians; we are now able to clearly communicate our observations and concerns when we ask for a GP home visit, and the GP better appreciates the complexity of needs of residents living in the home.” Ella Redler, Care Home Team Leader, Brandon Trust

Watch our short video on RESTORE2 training:

The challenge

Prior to the use of NEWS2, health care settings did not use the same common language or set of measurements at the handovers of care, or where different parts of the health and social care systems met.  This resulted in a lack of consistency in identification and response to acute illness. Equally there was no standardised training or process for the management of deterioration in care settings.

NEWS2 is a simple scoring system, based on the six physiological measurements that make up the routine vital signs of an adult patient. By monitoring scores over time, NEWS2 can demonstrate a positive response to treatment, or more importantly, allow early detection of patient deterioration. Early recognition and management of deterioration leads to improved outcomes for patients. Whilst NEWS2 was rolled out across healthcare services it was vital that a similar approach was adopted in care settings where many of the most vulnerable patients are supported. The COVID pandemic brought an increased emphasis on the value of managing deterioration in care settings.

Calculating NEWS2 is an important part of the RESTORE2 tool alongside building the confidence of care staff to communicate concerns about patients with primary care and urgent care systems through the development of a common language. The RESTORE2 Mini tool is suitable for use in domiciliary care and acts as an important development opportunity for non-registered care staff.

“Soft signs” training is particularly valuable where individuals have difficulties in communicating when they are feeling unwell or in pain including in care homes for people with learning disabilities or dementia.

Our approach

In March 2015, the West of England Patient Safety Collaborative became the first region to implement NEWS. National adoption and spread of NEWS2 took place from 2018-2020.

During this time, Health Innovation West of England also created Primary Care, ED and Community Collaboratives to enable sectors to meet and share best practice on improving patient safety through the effective management of deterioration.  Identifying that many of the most vulnerable patients reside in care homes, or receive domiciliary care, we launched care homes training in late 2019.

Prior to and during the pandemic – and in line with the British Geriatrics Society paper offering key recommendations to help care home staff support residents through the pandemic – Health Innovation West of England recognised the importance of supporting care staff in managing deterioration through the observation and escalation of ‘softs signs’.

Initially training was offered face-to-face but the pandemic required a pivot to virtual learning which presented an opportunity for greater attendance and representation at sessions. Health Innovation West of England offered a choice of workshops tailored to the different needs of care staff: RESTORE2 Mini, RESTORE2 and Train the Trainer.

We also developed supporting materials including posters, videos and case studies.

Impact to date

“I cannot say how much I would recommend investing in this training. Staff will feel upskilled, more competent and I truly believe our use of RESTORE2 saved lives. I absolutely, 100% believe in RESTORE2 for all staff, residential and nursing.” Jacqui Croxford, Care Home Manager, Darbyshire Care

To illustrate how RESTORE2 has improved patient outcomes and care staff confidence in communicating at the handovers of care a series of ‘in our words’ case studies have been collated. These illustrate the positive personal impact training has had on care staff, their patients and teams.

By the end of the programme in October 2023, we had trained 84% of nursing homes in RESTORE2 or RESTORE2mini across the West of England region, well exceeding our target of 60%.

We have trained 3,217 care staff with 553 West of England care providers participating.

Building on our RESTORE2 training, free videos were produced by Health Innovation West of England and partners to help staff working in care homes spot and respond to the soft signs of deterioration. The videos have now been viewed more than 1.8 million times (as of March 2024) and were shortlisted for a 2021 HSJ Patient Safety Award.

Our South West Learning Disabilities Collaborative continues to advocate use of NEWS2 and soft-signs tools including RESTORE2 to support early identification of physical deterioration in patients who may be less able to communicate feeling unwell. In February 2021 Health Innovation West of England staff delivered a ‘Super Trainer’ RESTORE2 model to 167 experienced trainers, who by the end of May 2021 had trained over 7,000 paid and unpaid carers. Training continues to be delivered across the country.

Our programme to support the use of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment), evolved from insights gained through our NEWS2 project, inappropriate end-of-life ED attendance and conveyance, alongside our wider work on Structured Mortality Reviews. RESTORE2 training in the West of England showcases ReSPECT and the importance of care planning for emergencies and end-of-life care.

“As a GP I can clearly see how RESTORE2 would benefit patients through the earlier identification of deterioration and treatment commencing earlier. When I am triaging home visits, having a NEWS2 score and soft signs available allows me to ensure that a visit is prioritised within an appropriate timescale.” Chris Turner, GP, Swindon Community Health Services

Next steps

Our RESTORE2 training programme finished in October 2023. By offering a train-the-trainer approach as part of our training package, we have been able to promote the sustainability of this model. This was increasingly a focus in the last few months of the programme and 364 care colleagues were trained using the train-the-trainer model.

The ongoing impact of our adoption of NEWS2 and related collaboratives continues to be felt today in the work of Health Innovation West of England and our Patient Safety Collaborative.

Find out more

Find out more about the resources available to care home staff or email

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