• Modifications to existing sepsis CQUIN effectively mandates use of NEWS2 in all acute care
  • Trusts who do not adopt system by the fourth quarter of 2018-19 face losing income
  • Decision by NHS England will help reduce variation in detecting deteriorating patients

NHS hospitals must roll out a new “early warning score” across all their wards following a change to a key national target – or they risk losing income.

Using a national CQUIN (Commissioning for Quality and Innovation) target, NHS England has moved to incentivise all hospitals to use the updated national early warning score (NEWS2), which helps ward staff identify deteriorating patients, HSJ has learned.

The national commissioner modified an existing CQUIN used to identify sepsis patients last month, with the effect being that trusts will not be paid unless they are using NEWS2 as a warning score system. It will mean trusts having to adopt NEWS2 as the standard warning score system on all acute wards.

An annex to the CQUIN, which in total is worth 2.5 per cent of the cost of the commissioned services, published on 10 May, states: “During 2018-19, acute and emergency units should be transitioning to use the national early warning score (NEWS2) to support screening of patients.

“By Q4 of 2018-19, payment will only be made if over 90 per cent of screened cases have utilised NEWS2 (where it is appropriate to use NEWS2).”

NHS England endorsed the new early warning score, an updated and improved version, for use in all acute and ambulance settings in December, with hospitals expected to adopt it this year.

A previous version (NEWS) was adopted by around 70 per cent of providers but in some hospitals the tools have been altered or developed differently with varying thresholds meaning there was a lack of consistency between some locations.

Making NEWS2 mandatory has been welcomed as a step towards reducing variation and creating a standard approach to identifying patients at risk of deterioration – issues the Care Quality Commission has highlighted as a key risk to patient care.

Dr Matt Inada-Kim, consultant physician at Hampshire Hospitals Foundation Trust and National Clinical Advisor on Sepsis and Deterioration for NHS England told HSJ it was “refreshing to have a pathway that actually works in the real world”, adding: “The key is ensuring a senior clinical decision maker sees sick patients early, and applies their experience and judgement. By aligning sepsis care with deterioration (as should always have been the case), the highest acuity patients from a multitude of different causes are prioritised.”

He said: “We can never really know what is wrong with patients when they initially present, our pathways must work for all causes, or potential harms from blinkered approaches will ensue.”

The sepsis CQUIN has a number of parts and the section linked to the adoption of NEWS2 is the equivalent of just 0.0625 per cent of the relevant payment, but across a year of acute and emergency inpatient activity, its value could be substantial.

NEWS2, first developed by the Royal College of Physicians in 2012, is often used as a chart at the end of a patient’s bed where nurses record vital observations such as respiratory rate and oxygen saturation levels. When aggregated as a total score the tool can flag early on whether a patient is at risk of deteriorating so that action can be taken and lives potentially saved.

Celia Ingham-Clark, medical director for clinical effectiveness at NHS England, told HSJ: “It is now imperative that all trusts use the NEWS2 scoring system which will help reduce variation across the NHS in how fast deteriorating patients are spotted and treated, and so have updated the guidance accordingly.”