Sudden deterioration: an action plan
A sudden deterioration action plan records what is normal, what has changed and who to call, so urgent help is clear when someone becomes unwell.
How this guide was prepared
Purpose: urgent guidance · Level: detailed
Checked by: Does Your Duck Quack. Sources are linked below; seek professional advice for individual circumstances.
The short answer
What to do first
A sudden deterioration action plan records what is normal, what has changed and who to call, so urgent help is clear when someone becomes unwell.
Start here: With the person’s agreement, record how they normally communicate, move, eat and drink, breathe, manage personal care and respond to familiar people. Include what support is usual and how they show pain or distress.
Do not wait: Call 999 for severe breathlessness, chest pain, unresponsiveness, signs of stroke or suspected sepsis. Do not wait to complete a checklist. For an urgent but not immediately life-threatening change, use the route agreed with the GP or care team, or the urgent-care service for the person’s nation.
Visual guides
See the decision at a glance
- 1. Call for emergency helpCall 999 for severe breathlessness, chest pain, unresponsiveness, stroke signs or suspected sepsis.
- 2. Compare with usualNotice changes in confusion, breathing, eating, drinking, mobility, pain or skin colour.
- 3. Follow the planUse the GP or care team’s written daytime and out-of-hours contact order.
- 4. Describe the changeSay what changed, when it began, immediate risks and what has already happened.
- Health essentialsKeep the current medicines list, allergies and key diagnoses together.
- Usual baselineRecord usual communication, movement, eating, drinking and daily support.
- Contacts and needsSave team numbers, communication needs and safe access information.
Scope of this guide
This guide helps you understand the options and questions to ask. It is not personal medical, legal or financial advice. Check the official sources for your nation and seek qualified help for high-stakes decisions.
Call 999 for a life-threatening emergency. For an urgent problem that is not clearly life-threatening, use the official NHS urgent-care route for the UK nation you are in. Have the address, symptoms, onset time, medicines and allergies ready.
Who this guide is for
Family members, friends and care workers who notice a sudden change in an older person and need an agreed, calm route to help.
A change can be obvious, such as severe breathlessness, or quieter: new confusion, eating much less, a fall, unusual sleepiness or becoming unable to do a familiar task. A written plan agreed with the person and their GP or care team helps supporters describe the change and contact the right service. It is a prompt for seeking clinical help, not a tool for diagnosing or waiting to see whether a serious problem passes.
What to do now
1. Describe the person’s usual day
With the person’s agreement, record how they normally communicate, move, eat and drink, breathe, manage personal care and respond to familiar people. Include what support is usual and how they show pain or distress.
2. Write down the changes that matter
Note what changed, when it began, whether it is getting worse and what happened just before it. Include confusion, falls, breathlessness, reduced intake, urine changes, skin colour, pain, drowsiness or a new inability to stand.
3. Agree who to contact and in what order
Ask the GP, community nurse or specialist team to write down the daytime contact, out-of-hours route and the circumstances for using each one. Put 999 first for an emergency such as severe breathlessness, chest pain, unresponsiveness, stroke signs or suspected sepsis.
4. Prepare a brief handover
Keep the current medicine list, allergies, key diagnoses, contact details and any communication or access needs together. When calling, state the person’s usual baseline, the change, when it started, immediate risks and what has already been tried.
5. Review the plan with the person
Check the plan after a hospital visit, new diagnosis, medicine change or change in care support. Share it only with people the person has chosen, and store it where an authorised helper can find it.
Warning signs and checks
- Usual baseline recorded
- Exact onset noted
- Medicines and allergies current
- Address and access details ready
- Escalation route agreed
- No delay to gather perfect information
- Usual communication, movement, intake and support described
- Changes and their start time recorded
- GP, team and out-of-hours contacts written down
- 999 emergency signs clearly stated
- Medicines, allergies and communication needs available
- Person has agreed who may see the plan
- Review date and responsible person recorded
Common questions
What counts as a sudden deterioration?
It is a noticeable change from that person’s usual health or ability. It may involve new confusion, unusual drowsiness, breathing, eating or drinking less, a fall, new pain, a change in skin colour or difficulty moving. A change can be important even when there is no fever.
What should I tell the GP or 111?
Start with the person’s name, location and usual baseline, then state the change, when it started and whether it is worsening. Mention breathing, alertness, pain, food and fluid intake, falls, medicines and any relevant conditions. Say what support is present and whether the person is alone.
Can relatives use RESTORE2 to decide whether to call?
RESTORE2 is a structured soft-signs and observations tool used within some health and care services. It requires suitable training and does not replace clinical assessment. A relative can still report a soft sign, such as someone being unusually withdrawn or eating less, without calculating a score.
Should we wait and see if the person improves?
Do not wait when the change is severe, sudden or getting worse, or when the plan says to seek help. A person may show illness through confusion, a fall or reduced eating rather than describing symptoms clearly. If unsure, contact the GP or urgent-care route promptly and explain the change from normal.
Differences across the UK
Urgent community response and clinical escalation differ locally; 999 applies throughout the UK. The urgent-care route depends on where the person lives: use NHS 111 in England and Wales, NHS 24 on 111 in Scotland, and the local GP or out-of-hours arrangements in Northern Ireland; call 999 for an emergency throughout the UK. Local teams may use different deterioration pathways and forms. RESTORE2 is used in some English care settings and is not a universal family checklist. Ask the person’s own NHS or HSC team which contacts and locally recognised tools apply.
Call 999 for severe breathlessness, chest pain, unresponsiveness, signs of stroke or suspected sepsis. Do not wait to complete a checklist. For an urgent but not immediately life-threatening change, use the route agreed with the GP or care team, or the urgent-care service for the person’s nation.
Primary sources
The publisher checked this guide against the 9 official sources below. This is an editorial source check, not approval by a clinician, lawyer or benefits adviser.
- NHS: When to call 999
- NHS England: FRAIL strategy
- NHS England: Enhanced health in care homes framework and soft signs
- NHS England: Learning disability health improvement and deterioration tools
- NHS: Stroke signs and emergency help
- NHS: Sepsis
- NHS inform: Accessing and using NHS services in Scotland
- NHS 111 Wales: Calling 111
- NHS: When to use 111
Related guides
Editorial note: By Does Your Duck Quack.