We have been working to improve the management of deterioration during the COVID-19 pandemic (including through the roll-out of COVID Oximetry @home and COVID virtual wards), read more about our COVID-19 related work.

Spotting and acting on the signs of deterioration in a patient or care home resident is vital to ensuring patient safety. The objective of the national Managing Deterioration Safety Improvement Programme (known as ManDetSIP) is to create and embed the conditions for staff across the healthcare system to improve the safety and outcomes of patients by managing deterioration, and provide a high quality healthcare experience across England.


The national ManDetSIP aims to:

  • Support the spread and adoption of the COVID-19 Oximetry @home remote monitoring model across England by March 2021.
  • Support the spread and adoption of the acute Paediatric Early Warning Score (PEWS) and system-wide paediatric observations tracker for children across all appropriate care settings in England by March 2024.
  • Support an increase the spread and adoption of deterioration management tools (e.g. NEWS2, RESTORE2, RESTORE2mini, SBARD etc.), reliable personalised care and support planning (PCSP), and approaches encompassing end of life care principles, to support Learning Disabilities, Mental Health and Dementia care management in relation to deterioration in at least 80% of all appropriate non-acute settings across health and social care by March 2024.

A visual illustration of our ManDetSIP work programme is available here.

Current managing deterioration projects


In the West of England, from March 2020, we rapidly converted our face-to-face RESTORE2 and RESTORE2mini training for care homes into a virtual offering, enabling us to continue to reach providers in the region at pace and scale.

Over 2,375 care home staff have now been trained.  Read more about our support package, including free training, for care homes.

COVID Oximetry @home and COVID virtual wards

By May 2021 over 2000 people with COVID had been enrolled in COVID Oximetry @home and COVID virtual ward services across the West of England. Read more about how we worked rapidly and collaboratively to roll out these services across our region, alongside reviewing a case study exploring the patient’s journey.

The national COVID Oximetry @home and virtual wards project won the Patient Safety Award at the 2021 HSJ Awards. The programme was delivered in partnership with NHS England and NHS Improvement, NHS Digital and NHSX, and helped over 40,000 people most at risk from COVID-19 to be safely supported at home, through remote self-monitoring of their oxygen saturation levels.

Find out more about our response to COVID-19.

Recommended Summary Plan for Emergency Care and Treatment – ReSPECT

ReSPECT is about creating a personalised recommendation for someone’s clinical care in emergency situations where they are not able to make decisions or express their wishes. Our focus on ReSPECT evolved from our work on Structured Mortality Reviews and the national Learning from Deaths programme which highlighted the need for appropriate care planning as patients approach the end of their life. Read more about ReSPECT.

The West of England Learning Disabilities Collaborative

Responding to the findings of the Learning Disabilities Mortality Review is a priority for the West of England. The disparity between the age of death for people with learning disabilities (age 4 years and over) and the general population (all ages) in 2019 was 22 years for males and 27 years for females. Many of these deaths continue to be from avoidable causes, such as pneumonia and sepsis. The West of England Learning Disabilities Collaborative was established in early 2019 to address this, by focusing on three priority areas. The collaborative was shortlisted for a 2021 HSJ Patient Safety Award. Find out more about the West of England Learning Disabilities Collaborative.

Safer Care through NEWS2 (National Early Warning Score)

We have developed a programme to encourage and support the use of a single early warning score – the National Early Warning Score (NEWS2) – across the region and at each of the interfaces of care across the healthcare system. Use of NEWS2 throughout acute and community settings enables deterioration to be recognised, tracked and appropriately responded to at all stages of a patient’s journey, including at points of handover of care. Find out more about NEWS2.

Watch our short film telling the story of a patient in North Somerset, who made a quick and full recovery from sepsis as a result of NEWS being communicated at every handover of care.

Get in touch

For more information on our managing deterioration work, please contact our patient safety team.

You can also stay up to date with our news and events by signing-up to receive a monthly West of England AHSN newsletter.

Completed projects

Please find a brief listing of some of our key completed projects focusing on managing deterioration and patient safety:

Emergency Department (ED) Checklist

Our Emergency Department Collaborative was set up in August 2016 to encourage greater collaboration between each of the six acute trust emergency departments (EDs) across the West of England, as well as the South Western Ambulance Service. The Emergency Department Safety Checklist aimed to standardise and improve the delivery of basic care in EDs, to improve resilience in EDs during periods of crowding, to improve the safety and clinical outcomes for patients accessing the emergency care system. Find out more about the ED Checklist.

Structured Mortality Reviews

A precursor to ReSPECT, the West of England AHSN (in collaboration with eight acute trusts) was one of the early implementers of the structured review and developed a best practice framework as a template to support the trusts in this project. Find out more about Structured Mortality Reviews. 

Human Factors

Our Human Factors programme developed the non-technical skills of support staff to enhance safer ways of working – these include teamwork, communication, leadership and an awareness of human factors when designing systems and processes. Find out more about our Human Factors project.


We hosted two learning events on the topic of falls. Find out more about our 2017 event “Reducing harm from falls” and our 2016 falls event.

Primary Care Collaborative

We worked with our member Clinical Commissioning Groups and practices across the region as part of our primary care collaborative. Read more about the Primary Care Collaborative. 


Our Frailty Community of Practice launched in summer 2017. Find out more about our work on frailty.


A photo of a mother lying on a sofa with her baby on her chest.

Maternity and Neonatal Safety Improvement Programme

Find out about our work across the West of England to improve maternal and neonatal patient safety.

Read more

Mental Health Safety Improvement Programme

Our Mental Health Safety Improvement Programme aims to improve patient safety for people accessing mental health services and treatment.

Read more

Adoption and Spread Safety Improvement Programme

The Adoption and Spread Safety Improvement Programme seeks to identify and spread effective interventions and practice.

Read more

Medicines Safety Improvement Programme

Find out about our work to improve Medicines Safety.

Read more

Keeping people safe during and after COVID-19

Take a look at our training events and resources for care home and NHS colleagues during the COVID-19 pandemic and beyond.

Read more