Spotting and acting on the signs of deterioration in a patient or care home resident is vital to ensuring patient safety. As of April 2022, the national Managing Deterioration Safety Improvement Programme has been largely refocused on patient safety in care homes. Read about the free training, support and resources we offer to care homes

Alongside the aims of the managing deterioration programme, we have been working to improve the management of deterioration during, and as we emerge from, the COVID-19 pandemic. Read more about our COVID-19 related work.

Key ambitions

  • Support testing of the national Paediatric Early Warning System (nPEWS) across a cohort of hospitals to be completed by the end of September 2022.
  • Adoption of deterioration management tools (RESTORE2/RESTORE2mini or equivalent) in at least 85% of care homes (including those homes caring for people with learning disability, autism, and mental ill-health) by the end of March 2023.

Our work

We are continuing to support a number of projects focused on managing deterioration across the West of England including:

Support for care homes

We offer free RESTORE2 and Train-the-Trainer training for care homes. Over 2,490 care staff  across our region have now been trained. Read more about our support for care homes.

Read our RESTORE2 case study which explores the impact of our training and resources.

South West Learning Disabilities Collaborative

On average, males with a learning disability die 22 years younger than males from the general population, and females 26 years younger than females from the general population (2021 LEDER Report). Many of these deaths continue to be from avoidable causes, such as pneumonia and sepsis. The West of England Learning Disabilities Collaborative was established in early 2019 to address this disparity.

In 2022/23 our collaborative was relaunched to cover the entire South West region.  Find out more about the South West Learning Disabilities Collaborative.

Read our West of England Learning Disability Collaborative case study, which explores the collaborative’s impact prior to March 2022.

Get in touch

For more information on any of our past or current managing deterioration work, please contact our patient safety team.

You can also stay up to date with our news and events by signing-up to receive our newsletter.

Completed projects

Please find a brief listing of some of our key completed managing deterioration projects:

Recommended Summary Plan for Emergency Care and Treatment – ReSPECT

ReSPECT is about creating a personalised recommendation for someone’s clinical care in emergency situations where they are not able to make decisions or express their wishes. Our focus on ReSPECT evolved from our work on Structured Mortality Reviews and the national Learning from Deaths programme which highlighted the need for appropriate care planning as patients approach the end of their life. Read more about ReSPECT.

Read our ReSPECT case study, which explores the project’s impact.

Paediatric Early Warning Score (PEWS)

PEWS can effectively recognise and respond to an acutely deteriorating child or young person. While almost all hospitals use a form of PEWS, currently there is no single nationally-validated system in England.  A standardised PEWS tool used in every inpatient setting could help eliminate variation and remove the challenge for clinical staff as they move between sites using different observation charts, scoring systems and escalation processes. Read more about PEWS.

COVID Oximetry @home and COVID virtual wards

By May 2021 over 2000 people with COVID had been enrolled in COVID Oximetry @home and COVID virtual ward services across the West of England. Read more about how we rolled out these services across our region, alongside reviewing a case study exploring the patient’s journey.

The national COVID Oximetry @home and virtual wards project won the Patient Safety Award at the 2021 HSJ Awards. The programme has helped over 40,000 people most at risk from COVID-19 to be safely supported at home, through remote self-monitoring of their oxygen saturation levels. Find out more about our response to COVID-19.

Safer Care through NEWS2 (National Early Warning Score)

We have developed a programme to encourage and support the use of a single early warning score – the National Early Warning Score (NEWS2) – across the region and at each of the interfaces of care across the healthcare system. Use of NEWS2 throughout acute and community settings enables deterioration to be recognised, tracked and appropriately responded to at all stages of a patient’s journey, including at points of handover of care. Find out more about NEWS2.

Watch our short film telling the story of a patient in North Somerset, who made a quick and full recovery from sepsis as a result of NEWS.

Emergency Department (ED) Checklist

Our Emergency Department Collaborative was set up in August 2016 to encourage greater collaboration between each of the six acute trust emergency departments (EDs) across the West of England, as well as the South Western Ambulance Service. The Emergency Department Safety Checklist aimed to standardise and improve the delivery of basic care in EDs, to improve resilience in EDs during periods of crowding, to improve the safety and clinical outcomes for patients accessing the emergency care system. Find out more about the ED Checklist.

Structured Mortality Reviews

A precursor to ReSPECT, Health Innovation West of England (in collaboration with eight acute trusts) was one of the early implementers of the structured review and developed a best practice framework as a template to support the trusts in this project.

Human Factors

Our Human Factors programme developed the non-technical skills of support staff to enhance safer ways of working – these include teamwork, communication, leadership and an awareness of human factors when designing systems and processes. Find out more about our Human Factors project.


We hosted two learning events on the topic of falls. Find out more about our 2017 event “Reducing harm from falls” and our 2016 falls event.

Primary Care Collaborative

We worked with our member Clinical Commissioning Groups and practices across the region as part of our primary care collaborative. Read more about the Primary Care Collaborative. 


Our Frailty Community of Practice launched in summer 2017. Find out more about our work on frailty.


Child with a doctor

Improving patient safety

Our award-winning support for improving patient safety is central to our work in transforming health services and systems.

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Keeping people safe during and after COVID-19

Take a look at our training events and resources for care home and NHS colleagues during the COVID-19 pandemic and beyond.

Read more