Managing Deterioration

The Managing Deterioration Safety Improvement Programme (ManDetSIP) aims to reduce deterioration-associated harm by improving the prevention, identification, escalation and response to physical deterioration, through better system co-ordination and as part of safe and reliable pathways of care.

Contact Karen Verrill for more information on this programme.

Our Partners

The programme focuses on managing deterioration at a system-wide level and we work with a number of partners from a range of sectors including health and social care, private, community and voluntary sectors and academic institutions, these include:

Key Ambitions of the Managing Deterioration Programme

  • To support the spread and adoption of the acute Paediatric Early Warning Score (PEWS) and a system-wide paediatric observations tracker for children across all appropriate care settings in England.
  • To support an increase in the adoption and spread of deterioration management tools (e.g. NEWS2, RESTORE2, RESTORE2 mini, SBARD etc.), reliable personalised care and support planning, and approaches encompassing end-of-life care principles in non hospital settings.
  • To support learning disabilities, mental health and dementia in relation to deterioration in non hospital settings.

During the pandemic, we have also worked with the Respiratory Network and other partners to support the implementation of COVID Oximetry @home and COVID virtual ward models across the NENC region.

Is my resident unwell? Communication Tool

The ‘Is my resident unwell?’ communication tool has been developed by the AHSN NENC Well Connected Care Homes programme. The communication tool was developed to assist staff in recognising signs and in recording a set of observations; it is now in use in care homes in the North East and North Cumbria.  A downloadable version of the ‘Is your resident unwell?’ communication tool is available below as well as a poster to be displayed in participating care homes.

‘Is my resident unwell?’ tool



Key Activities

Identifying and Responding to non-COVID-19 deterioration in Children – acute Paediatric Early Warning Score (PEWS)

Currently, there is no single, national validated system for identifying deterioration in children in England.

This work will support the introduction and adoption of a national Paediatric Early Warning Score (PEWS) in acute settings and a system-wide paediatric observations tracker for children across all appropriate care settings.

This project aims to identify and respond to deterioration in adults in care homes. It aligns with the Enhanced Health in Care Homes Framework and those being cared for in other non Hospital Settings.

There are significant numbers of people being cared for in care homes and other non hospital settings. Spotting and acting on the early signs of deterioration in a care home resident or person being cared for at home is vital to ensuring patient safety. Our work focuses on supporting and promoting the use of standardised deterioration tools to monitor and escalate concerns relating to care home residents and others being cared for in the community. There are a number of tools and resources available to help identify and respond to physical deterioration with many being structured around the PIER Framework (Prevention; Identification; Escalation; Response).


Enhancing and maintaining health and wellbeing to ensure best health. Care workers, carers and health care practitioners are often able to intuitively recognise very early signs that a person is becoming unwell e.g they may go off their food or cease to do their normal activities. If these early signs (often called ‘soft signs’) are recognised and acted upon, it may prevent physical deterioration.


This relates to identifying when someone becomes unwell and responding accordingly. May include monitoring physical observations eg blood pressure, pulse etc to arrive at a NEWS2 score which will determine the most appropriate course of action.


Where a person is becoming unwell, there should be a system or process for care staff/carers to communicate their concerns effectively. This needs to be to the right person so that the unwell person can access the right care.


There should be an appropriate and timely response. In some cases, this may be admission to hospital but there may be circumstances where this is not appropriate and/or may be against the person’s wishes e.g. if they are approaching end of life care.

This work involves supporting an increase in the spread and adoption of reliable personalised care and support planning (PCSP), and approaches encompassing end of life care principles.