The West of England Patient Safety Collaborative was the first area to implement NEWS2 as a common language across a region. NEWS2 is the latest version of the National Early Warning Score, developed by The Royal College of Physicians (RCP). Find out more about NEWS2 on the RCP website.

Currently, all acute trusts, out-of-hours GP services, mental health trusts, community service providers and clinical commissioning groups (CCGs) have all signed up to support the adoption and spread of NEWS2, and communicating this score at the interfaces of care across the system.

The use of early warning scores is being recommended in primary and community care settings.  The National Confidential Enquiry into Patient Outcome and Death report in November 2015 (‘Just Say Sepsis!’) argued that an early warning score should be used in both primary and secondary care wherever sepsis is suspected.  Early warning scores are increasingly becoming part of the lexicon for communication about physiology between all health care providers, enhancing and focusing the handover of technical information about patients, especially those at risk of deterioration.

NEWS in practice

We now have a number of examples of patient stories from across the region where NEWS has been used to assess and trigger responses across patient pathways and ultimately improving outcomes for those patients.

One of these examples was a patient in North Somerset who visited his GP with cellulitis but felt very poorly.  The GP used NEWS to assess that the patient was acutely unwell and needed rapid treatment. NEWS was used to track the patient’s condition from primary care, into the ambulance and into the Emergency Department and clearly showed he was deteriorating.  This patient had sepsis but thanks to the early detection of his condition in primary care, it was treated within five hours of seeing his GP and he made a quick and full recovery.

We have produced a short film which tells this NEWS2 story.

NEWS in acute settings

In order to achieve our aims we adopted a breakthrough collaborative model.  Health Innovation West of England supported all acute trusts in the region to adopt NEWS, supported by a NEWS Implementation Toolkit. All acute trusts are now using the updated NEWS2, as recommended by the Royal College of Physicians. View our regional NEWS Implementation Toolkit here (PDF). 

A free NEWS2 NHS toolkit is available.

NEWS in emergency departments

We supported the national adoption and spread of the Emergency Department (ED) Safety Checklist, piloted at University Hospitals Bristol NHS Foundation Trust. The checklist includes the requirement to take hourly observations and calculate NEWS2 scores to track patient acuity in ED. We have developed a free toolkit for implementing the ED Safety Checklist.

Read our ED Safety Checklist case study.

NEWS in community settings

We have teamed up with community providers to support the identification of the deteriorating patient.  We continue working closely with each system to help raise the profile of NEWS2 across the different settings. Read our examples of NEWS being used in practice.

We have established the West of England Learning Disabilities Collaborative, made up of professionals, experts by experience, families and carers. By applying our learning from the region-wide rollout of NEWS, we aim to reduce premature mortality and improve health outcomes for people with learning disabilities.

The British Geriatrics Society (BGS) released a paper COVID-19: Managing the COVID-19 pandemic in care homes which offered 13 key recommendations to help all care home staff to support residents through the pandemic. This guidance recommends care home staff should be trained to spot the early warning signs of residents becoming unwell, where possible using the RESTORE2 tool or soft signs using RESTORE2 mini.

We have developed free resources and training packages support care home staff.

The BGS guidance also recommends that care home staff work with residents’ GPs to review Advance Care Plans as a matter of urgency with residents.

NEWS in primary care

We offer an information sheet explaining what NEWS is and why it’s a relevant tool for primary care.

We have produced free supporting information in postcard and business card size:

If you are an EMIS user you have access to a NEWS template. This video explains how to set it up.

We also have a template available in SystemOne, please email our patient safety team for more information.

Tying all of this work together, we have run various collaborative cross-sector learning set events with hundreds of attendees from healthcare providers across the region and beyond.

NEWS in mental health settings

All NHS mental health care providers in the West of England use NEWS to help identify physical deterioration in service users.

We worked with a medical student from the University of Bristol who was on an elective QI placement with North Bristol NHS Trust, to evaluate use of NEWS in Avon and Wiltshire Mental Health Partnership NHS Trust’s eating disorders unit.


Clinical Medicine Journal: NEWS2 in out-of-hospital settings, the ambulance and the emergency department

Clinical Medicine Journal: NEWS2, patient safety and hypercapnic respiratory failure

Emergency Medicine Journal: National Early Warning Scores (NEWS2) and component physiology in COVID-19 positive hospitalised patients in the West of England

BMJ Emergency Medicine Journal: Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out

Resuscitation: Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review

BMJ Open: Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England. 

British Journal of General Practice: Implementation of the National Early Warning Score in patients with suspicion of sepsis: evaluation of a system-wide quality improvement project

British Journal of General Practice: Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care

BMJ Emergency Medicine Journal: NEWS used without clinical judgement is of limited value (A response to the Finnikin paper ‘Are referrals to hospital from out-of-hours primary care associated with National Early Warning Scores?’

Age and Ageing: Using the recommended summary plan for emergency care and treatment (ReSPECT) in care homes: a qualitative interview study


Nursing Standard: Adapting the NEWS early warning tool to assess patients in the community.

Healthcare Manager: Early warnings save lives. 


If you would like to get involved or want more information, please contact our patient safety team.

Previous events

NEWS implementation toolkit

National Early Warning Score (NEWS) implementation toolkit

Created for all staff working across commissioning, clinical, hospital and ambulance service settings to support the successful implementation of the NEWS.

View the NEWS toolkit
Care home resident and employee

Support, resources and training for care providers

We offer free training and resources for care providers - whether you’re in a nursing or residential home or providing domiciliary care.

Read more
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.

Read more
Emergency Department Safety Checklist

Emergency department safety checklist

Created to standardise the delivery of basic care in emergency departments, improving safety for patients and resilience during periods of crowding.

Discover the checklist