The challenge

Across the UK, there is a clear and growing focus on improving safety in maternity and neonatal care, with national programmes led by NHS England placing increasing emphasis on early recognition of deterioration, effective escalation, and strengthening the voice of families.  

The Solution

The Maternal Early Warning Score (MEWS) is an observation chart designed to help the clinical approach to recording vital signs in antenatal and postnatal patients and when to escalate a response.  

Its use and implementation vary across the country, which has led NHS England to roll out a new standardised version of the tool.    

The national MEWS, available in paper and digital form, is being deployed in some trusts as part of their new electronic patient record systems. 

In Cornwall, where electronic patient record system eCare is going live this summer, staff have worked collaboratively to bring forward implementation by rolling out the new MEWS chart on paper – and widening its implementation across clinical and community settings beyond inpatient maternity. It’s the first case of NHS Trust-wide paper-based rollout of MEWS, beyond obstetric settings, in the South West. 

Meanwhile, another patient safety tool is helping recognise newborn deterioration early. The National Early Warning Trigger and Track (NEWTT2) framework charts vital signs and sets out clear escalation pathways to empower staff at every level to raise concerns about newborns and make sure action is taken in the right timeframe. 

The NEWTT2 tool has been recently updated to recognise the concern of parents and the vital role of families’ observations alongside the wider care team. 

Our work in partnership

Through 2025/26, Health Innovation South West has been providing implementation support to NHS Trusts in the South West to embed the new standardised MEWS and NEWTT2 as part of the PIER (Prevention, Identification, Escalation, Response) framework.   

The use of both MEWS and NEWTT2 is being ensured by the Maternal and Neonatal Safety Improvement Programme led by NHS England. 

Our impact so far

At Royal Cornwall Hospitals NHS Trust (RCHT), inpatient, maternity, adult, emergency and community settings across RCHT now have access to the new national MEWS on paper.  

The paper rollout is ensuring deteriorating pregnant and postpartum women across these settings are managed in a consistent way, ahead of the move from analogue to digital patient records. 

An audit carried out following implementation showed 100% appropriate escalation and response to maternal deterioration within required timeframes.  

Our small recent survey of RCHT staff, mostly midwives and maternity support workers, suggests the national MEWS is helping to improve early recognition and structured monitoring.  

Meanwhile, the introduction of NEWTT2 at RCHT is helping to keep babies safer during the postnatal period.  

The result is safer care for babies, and less separation between newborns and their parents at a critical time.

Fergal O’ Malley, Advanced Neonatal Nurse Practitioner at Royal Cornwall Hospitals NHS Trust and Clinical Associate in Perinatal Patient Safety at Health Innovation South West  

Our PIER event, held in our Event and Innovation Space this spring, built on this momentum, creating a space for 37 colleagues from five NHS trusts in the South West to share learning and explore challenges, to support the consistent adoption of national MEWS and NEWTT2 tools across the region.  

What’s next?

Health Innovation South West is continuing to engage with local stakeholders to support digital readiness and NHS trust go-lives across the region.  

RCHT intends to change to a digital version of MEWS when eCare is live. Having staff across the hospital already trained in the new MEWS tool will ease the change, having laid out the groundwork for adoption of a digital version.   

When we move to digital, it’s just learning [MEWS] in its digital form, rather than learning the new MEWS scores and escalation pathways. The awareness [of MEWS as a tool] will be there because we have already implemented the tool.

Jane Pascoe, Intrapartum Maternity Matron at Royal Cornwall Hospitals NHS Trust 

More widely, we’ll be supporting scoping conversations on implementation of the Maternity Care Bundle, relating to element 2 (MEWS).