NEWS2 and RESTORE2 Explained: A Guide for Care Homes

NEWS2, the National Early Warning Score 2, is a Royal College of Physicians tool that scores six routine observations to show how unwell an adult is and how fast they need a response. A total of 5 or more, or 3 in any one observation, calls for urgent clinical review. A total of 7 or more is an emergency. RESTORE2 adapts it for care homes.

Here's how NEWS2 works, what RESTORE2 adds, and what escalating deterioration looks like on a care home shift.

What NEWS2 is

The Royal College of Physicians (RCP) first produced the National Early Warning Score in 2012 and published the updated version, NEWS2, in December 2017. In 2018 NHS England and NHS Improvement adopted it as the early warning system for acutely ill adults in hospitals in England, including spotting deterioration from sepsis, and set an ambition for all acute and ambulance settings to use it by March 2019. As of October 2026 the RCP still lists the December 2017 edition as current.

NEWS2 gives points to observations staff already take: the further from normal, the more points. The RCP is clear on two things:

• NEWS2 is an aid to clinical assessment, not a substitute for clinical judgement. Concern about how someone is should always override the score.
• It shouldn't be used for children under 16 or for pregnant women. NHS England has separate tools for both in hospital: a national paediatric early warning system (PEWS) chart released in 2023, and a national maternity early warning score (MEWS).

The six NEWS2 parameters

• Respiration rate.
• Oxygen saturation: measured with a pulse oximeter. There are two scales. Scale 2 is for people with a particular type of breathing failure whose target is 88 to 92%, and it's only used when a qualified clinician says so.
• Systolic blood pressure (the top number).
• Pulse rate.
• Level of consciousness or new confusion: recorded using ACVPU: alert, new confusion, responds to voice, responds to pain, or unresponsive. New confusion scores 3 on its own.
• Temperature.

Each parameter scores 0 to 3, and 2 extra points are added if the person needs supplemental oxygen. The total is the NEWS2 score.

NEWS2 score thresholds and the response

The RCP links each score to how often observations should be taken and how urgent the response should be. These are written for hospitals:

• 0: observations at least every 12 hours.
• 1 to 4 (low): a registered nurse assesses and decides whether to increase monitoring or escalate. Observations every 4 to 6 hours.
• 3 in any single parameter: urgent review by a clinician skilled in acute illness. Observations at least hourly.
• 5 or 6 (medium): the key threshold for urgent review by a clinician skilled in acute illness. Observations at least hourly.
• 7 or more (high): emergency assessment by a team with critical care skills. Continuous monitoring.

NICE's sepsis guideline for people aged 16 or over in England (NG253, published November 2025) uses the same bands in acute hospitals, acute mental health settings and ambulances: 7 or more is high risk, 5 or 6 moderate, 1 to 4 low. For community settings, NICE grades sepsis risk differently, using the person's history, examination and set criteria rather than NEWS2.

What RESTORE2 adds for care homes

RESTORE2 stands for Recognise Early Soft signs, Take Observations, Respond, Escalate. It was developed by West Hampshire Clinical Commissioning Group with the Wessex Academic Health Science Network. It's now trademarked to NHS Hampshire and Isle of Wight Integrated Care Board, which describes it as a physical deterioration and escalation tool for care and nursing homes that makes NEWS2 accessible to them. It's free for health and care settings to use, provided no changes are made, and staff need training before using it.

RESTORE2 has three parts:

1. Recognise soft signs that someone may be becoming unwell.
2. Take a full set of observations and work out the NEWS2 score.
3. Escalate using an escalation guide matched to the score, and pass the information on using SBARD.

It also includes a "what's normal for this resident" record, agreed with a health professional, so staff can tell a real change from the person's usual pattern. In the version we reviewed, each score band links to a care home action, from senior staff review and repeat observations, through GP review, to calling 999 at 7 or more. Local versions vary, so use the one your area provides.

RESTORE2mini is a shorter version built on soft signs and SBARD, for settings without the equipment or skills to take observations. In January 2023 the Health Innovation Network reported that an NHS England-commissioned programme had engaged nearly 11,000 care homes in managing deterioration, and over 7,000 had adopted a deterioration management tool.

Soft signs of deterioration

Soft signs are the things carers notice before the numbers move. The RESTORE2 tool lists signs such as:

• worsening breathlessness, chestiness or fast breathing
• going off food or drink
• changes in passing urine, or new smelly urine
• diarrhoea, vomiting or signs of dehydration
• being "off their legs" or less mobile than usual
• new or increasing pain
• new or increased confusion, or less alert than normal
• more tired, withdrawn, anxious or agitated, or "not themselves"
• cold hands and feet, changes in skin colour, mottling or a rash
• shivering, fever, or feeling very hot, cold or clammy
• any concern from the resident, their family or carers

Signs of a stroke, or central chest pain, mean calling 999 straight away.

SBARD: escalating clearly

When you call the GP, NHS 111 or 999, SBARD gives the conversation a shape:

• Situation: who you are, who you're calling about and what's worrying you.
• Background: relevant history, conditions and medicines.
• Assessment: the observations, the NEWS2 score and the soft signs you've seen.
• Recommendation: what you think needs to happen.
• Decision: what's been agreed, by whom, and when you'll review.

Write the decision down: what was seen, what was scored and who said what. Record keeping training helps staff write notes that stand up later.

Making it work in your service

• Record a baseline on admission and review it when someone's health changes.
• Check the kit: thermometer, blood pressure monitor and pulse oximeter, working and to hand.
• Agree escalation routes with your GP practice and local services, and keep the numbers visible.
• Hand over soft signs between shifts, not just tasks.
• Build observation skills. In mental health services, physical healthcare in mental illness training covers taking and interpreting observations.
• Plan for the worst case: staff who may face a collapse need basic life support.

RESTORE2 was developed in England. Outside England, check which deterioration tools your local health board or trust uses.

How Kasorb can help

Our sepsis awareness training helps staff recognise the early signs of sepsis, understand who is most at risk, and escalate quickly. It covers what sepsis is, early signs and symptoms and septic shock, common sources of infection, diagnosis, treatment, the roles of staff, the person and the organisation, recovery, and documentation. Your trainer tests understanding through case studies and questions.

It runs on site or live online in half a day, at one flat rate for the group, and certificates are emailed the next day. It's awareness training that supports staff to escalate in line with your own procedures, and it isn't a regulated qualification.

FAQs

What is a normal NEWS2 score?

A score of 0 means all six observations are in the normal range. Some people with long-term conditions score above 0 when they're well, so RESTORE2 asks you to record what's normal for each resident, agreed with a health professional. A change from that person's usual score matters most.

What NEWS2 score needs urgent action?

In the Royal College of Physicians' scheme, a total of 5 or more, or a score of 3 in any single observation, needs urgent review by a clinician. A total of 7 or more is an emergency. In a care home, follow your local escalation tool, which may set out actions at lower scores too.

What are soft signs of deterioration?

Changes that suggest someone is becoming unwell before their observations change much: going off food or drink, new or increased confusion, being less mobile or 'off their legs', passing less urine, new pain, unusual sleepiness, or just not being themselves. A concern from family or carers counts too.

What is the difference between NEWS2 and RESTORE2?

NEWS2 is the scoring system: six observations, each scored, added up into one number. RESTORE2 is a care home tool built around it. It adds soft signs, a record of what's normal for the resident, an escalation guide matched to the score, and SBARD for passing the information on clearly.

Can NEWS2 be used for children?

No. The Royal College of Physicians says NEWS2 shouldn't be used for children under 16 or for pregnant women. NHS England has developed separate early warning tools for children and for maternity care in hospitals. If you support young people, follow the advice of their health professionals.