National Early Warning Score (NEWS2)

In 2024, we created a new role of Group Clinical Lead, appointing Andre Downer (RMN) to help address the increasing health complexities of an ageing client group. With Andre’s clinical leadership, we have successfully introduced NEWS2 (National Early Warning Score 2) —a clinical monitoring system typically used in hospitals — into our everyday care model. This has genuinely transformed how we respond to health deterioration among people who may be non-verbal or unable to communicate symptoms effectively. Nationally, the use of NEWS2 in Supported Living is currently rare, so we are proud to be taking the lead and using a system which we believe will, and already has, truly benefited those we support.

NEWS2 (National Early Warning Score 2) is a clinical risk assessment tool developed by the Royal College of Physicians. It is widely used across UK healthcare settings to identify patients at risk of clinical deterioration. Here’s a breakdown of what NEWS2 is and how it can be beneficial in Supported Living settings for adults with Learning Disabilities (LD), Autism, and Mental Health needs:

How does NEWS2 work?

NEWS2 is a standardized scoring system used to monitor vital signs and assess whether a person may be becoming unwell. It includes six physiological parameters:

• Respiration rate
• Oxygen saturation
• Systolic blood pressure
• Pulse rate
• Level of consciousness or new confusion
• Temperature

Each parameter is scored from 0 to 3 based on how far it deviates from the normal range. An additional score is added if the person is on supplemental oxygen. The total score guides staff in determining whether clinical intervention is needed and how urgent it is.

People with LD, autism, or mental health needs may not always be able to effectively communicate physical symptoms, or express pain. NEWS2 allows support staff to identify subtle physical changes early by objectively tracking vital signs. Using the also introduced Abbey Pain Scale, which does not require effective vocal communication, non-verbal residents can have their pain successfully assessed. This leads, and has led, to quicker much interventions and can also either prevent unnecessary hospital admissions or escalate medical intervention.

Periodic taking of NEWS2 readings within Strada Care, now routinely done monthly, is integrated in to practice and has given staff the confidence to proactively promote all residents’ health. In some cases, where more frequent monitoring has been identified as needed, NEWS2 monitoring has been increased to weekly and in recent acute situations as frequently as hourly. There have been actual emergencies where NEWS2 was the critical catalyst for acutely unwell residents to access quicker access to GPs, emergency services and even emergency hospital admission.

The majority of residents do recognise that the taking of NEWS2 readings is a genuine and often welcome aspect of their care, though a very few can be resistive to this, or any other physical based examination, even when, as is standard, staff seek consent before taking readings.

CQC and NHS England support the use of NEWS2 in supported living and readings ‘baselines’ for individuals are included it in health action plans, used during annual health checks, and included in hospital passports. In addition, LeDeR (Learning from Death Reviews) has highlighted missed signs of deterioration in people with a Learning Disability. NEWS2 is increasingly promoted in response to reduce health inequalities.

How NEWS2 Can Be Useful in Supported Living Settings

1. Early Detection of Deteriorating Health

People with LD, autism, or mental health needs may not always be able to effectively communicate physical symptoms. NEWS2 allows support staff to identify subtle physical changes early by objectively tracking vital signs. This leads to quicker interventions and prevents unnecessary hospital admissions.

2. Supports Non-Clinical Staff in Decision Making

In supported living, many staff members are not medically trained. NEWS2 provides a clear, structured framework to escalate concerns to clinical teams (like GPs, community nurses, or NHS 111) when thresholds are exceeded, even if the individual cannot verbalize symptoms.

3. Enhancing Communication with Healthcare Professionals

NEWS2 creates a common clinical language. For instance, instead of saying “he looks unwell,” staff can say “he has a NEWS2 score of 5 with an elevated temperature and low oxygen saturation.” This improves triage and responsiveness by NHS services.

4. Promotes a Culture of Health Monitoring

Implementing NEWS2 fosters routine physical health checks as part of everyday care, promoting parity of esteem between mental and physical health. This is crucial for people with LD or autism, who statistically face poorer physical health outcomes and premature mortality.