NHSP annual standards data report for the period 1 April 2019 to 31 March 2020
Published 12 January 2023
Applies to England
© Crown copyright 2023
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This data report presents data against each of the 5 screening standards for screening activity related to the NHS newborn hearing screening programme (NHSP) in England for babies born between 1 April 2019 to 31 March 2020.
The data source used for this report is the NHSP national IT system, SMaRT4Hearing (S4H), which is used to collect screening and audiology data across England. Data is presented by the responsible local NHSP screening site, set using the GP practice assigned to each individual baby’s record.
The national IT system enables management of babies through the screening and audiological assessment process. It interfaces with the Patient Demographic Service (PDS) birth registration process to create a record for each baby born in England. This enables providers to manage babies through their patient journey (the entire process of screening and audiological follow-up). It does not receive information on babies who move into England although information for these babies can be added manually.
Data from the national IT system is transferred daily to a reporting system used to extract data for this report.
The NHS newborn hearing screening programme aims to identify permanent moderate, severe and profound deafness and hearing impairment in newborn babies.
Newborn hearing screening is provided locally by a skilled workforce of hearing screening teams, working in maternity units, outpatient services or in the baby’s home. The teams are led by local managers and liaise closely with audiology and paediatric teams to provide a high quality, safe and effective service for the local population.
The NHSP pathway begins with the identification of babies eligible for screening and includes undertaking the relevant screening tests. It ends for babies who pass the screen or for those with screen-positive results, up to and including the point of referral to audiology and attendance for audiological assessment.
There are two models of newborn hearing screening, which are reflected in this report:
- Hospital-based screening service (well babies) Screening is undertaken by NHSP trained staff. If the initial screening process cannot be completed as an inpatient, an outpatient/home visit appointment will be arranged so that the screen can be completed within 4 weeks of (corrected) age. Most babies will be screened by 10 days of age. If no clear response is obtained on the screen, the baby is referred to audiology diagnostic services and is seen within 4 weeks of screen completion.
- Community-based screening service (well babies) Screening is undertaken by NHSP trained health visitors or other NHSP trained screeners. The first screening will take place at the primary health visitor birth visit or in a clinic setting after 10 days of age. Any subsequent screening required is completed by 5 weeks of (corrected) age. If no clear response is obtained on completion of the screen, the baby is referred to audiology diagnostic services and is seen within 4 weeks of screen completion.
Neonatal intensive care unit (NICU) babies
Screening will be carried out by NHSP trained screeners. The baby will be well and aged not under 34 weeks’ gestation. The Provider will ensure the entire screening process is completed while the baby is still in hospital but as close to discharge as possible. If the screening process is not completed in hospital, an outpatient/home visit appointment will be arranged to complete the screen.
A multistage screening protocol is used. There are two versions of the protocol:
- ‘Neonatal intensive care unit (NICU) protocol’: for babies who have been in a NICU setting for more than or equal to 48 hours continuously
- ‘Well baby protocol’: for all other babies.
The screening protocol has two types of test which are carried out by the newborn hearing screener:
- automated otoacoustic emission (AOAE)
- automated auditory brainstem response (AABR)
The results of the test are affected by many factors including age of the baby, screener technique, and the environment in which the test is performed. The performance of the newborn screening programme can be improved by better screener technique and optimal test conditions, leading to fewer additional tests and referrals to audiology.
This report presents data for the screening site status at the time the report was produced (insert date). Where changes to the model or site structure have been made prior to this date, all historic data is migrated to the new structure.
NHSP standards provide a defined set of measures that providers must meet to make sure services are safe and effective.
1. NHSP Standards
There are 5 national standards included in this report, which are:
- NHSP-S01: coverage (see NHSP-S01)
- NHSP-S02: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1) - hospital model (see NHSP-S02)
- NHSP-S02: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1) - community model (see NHSP-S02)
- NHSP-S03: test: referral rate to diagnostic audiological assessment - hospital model (see NHSP-S03)
- NHSP-S03: test: referral rate to diagnostic audiological assessment - community model (see NHSP-S03)
- NHSP-S04: referral: time from screening outcome to offered appointment for diagnostic audiological assessment (see NHSP-S04)
- NHSP-S05: diagnosis/intervention: time from screening outcome to attendance at an audiological assessment appointment (see NHSP-S05)
Standards data are published annually. Standards that are also key performance indicators (KPI) are published quarterly (see KPI collections).
Data is extracted from the reporting system and reports for each screening provider are produced.
Two thresholds, the acceptable threshold and achievable threshold are specified for each standard. For screening the acceptable threshold is defined as the lowest level of performance which screening services are expected to attain. The achievable threshold is defined as the level at which the screening service is likely to be running optimally.
Charts in this report display the internal NHSP site code. The table in Appendix 1 shows the names of the organisations associated with each code.
2. NHSP-S01: Coverage
This standard is needed to provide assurance that screening is offered to parents of all eligible babies and that each baby (for whom the offer is accepted) has a completed screening outcome. The standard shows the proportion of babies eligible for newborn hearing screening for whom the screening process is complete by 4 weeks corrected age (hospital programmes – well babies, neonatal intensive care unit (NICU) babies) or by 5 weeks corrected age (community programmes – well babies).
During the COVID-19 pandemic NHSP encouraged services to continue screening where safe to do so in line with national standards and the NHSP technical guidance. However, in some areas screening was delayed due to COVID-19 and we have seen lower coverage as a result. This particularly affected community model services where Health Visitors suspended home visits.
NHSP-S01 is a standard where a higher percentage is better to maximise the number of eligible babies who were offered and accepted screening. The acceptable threshold for this standard in this period was more than or equal to 98.0% and the achievable threshold was more than or equal to 99.5%.
Figure 1: performance of each NHSP site by PHE region. The acceptable and achievable thresholds and England performance are shown.
As shown in Figure 1, the overall England performance of 97.8% (98.8% in the previous year) did not meet either the acceptable or the achievable thresholds, this is due to the impact of the Covid-19 pandemic.
The following service had the highest outcome:
- Cambridgeshire (Peterborough) (99.9%)
The following service had the lowest outcome:
- Dorset (93.4%)
54 out of 109 screening providers met the acceptable threshold of ≥ 98.0% (97 in the previous screening year).
5 out of 109 screening providers also reached the achievable threshold of ≥ 99.5% (23 in the previous screening year).
3. NHSP-S02: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1) - hospital model
This standard provides assurance that the test is correctly identifying babies who require further screening tests. The test outcome can be influenced if test conditions and screener technique are optimised. It shows the proportion of well babies in services who do not show a clear response in both ears at the first screening test AOAE1.
NHSP-S02 is a standard where a lower percentage is better to minimise the number of babies needing further tests. The acceptable threshold for this standard in this period was less than or equal to 27.0% and the achievable threshold was less than or equal to 22.0%.
Figure 2: performance of each NHSP site providing a hospital model by PHE region. The acceptable and achievable thresholds and England performance are shown.
As shown in Figure 2, the overall England performance for sites using a hospital model was 22.1% (22.9% in the previous screening year) met both the acceptable and achievable thresholds.
The following service had the highest rate of babies who did not show a clear response in both ears at AOAE1:
- Kings Lynn (38.3%)
The following service(s) had the lowest rate:
- Wiltshire (Bath) (5.8%)
88 out of 104 screening providers met the acceptable threshold of less than or equal to 27.0% (79 in the previous screening year).
42 out of 104 screening providers also reached the achievable threshold of less than or equal to 22.0% (34 in the previous screening year).
4. NHSP-S02: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1) - community model
To provide assurance that the test is correctly identifying babies who require further screening tests. The test outcome can be influenced if test conditions and screener technique are optimised. It shows the proportion of well babies in services who do not show a clear response in both ears at the first screening test AOAE1.
NHSP-S02 is a standard where a lower percentage is better to minimise the number of babies needing further tests. The acceptable threshold for this standard in this period was less than or equal to 15.0% and the achievable threshold was less than or equal to 13.5%.
Figure 3: performance of each NHSP site using a community model by PHE region. The acceptable and achievable thresholds and England performance are shown.
As shown in Figure 3, the overall England performance for sites providing a community model was rounded up to 12.9% (14.6% in the previous screening year) and met both the acceptable and achievable thresholds.
The following service had the highest rate of babies who did not show a clear response in both ears at AOAE1:
- Torbay and Teignbridge (16.0%)
The following service had the lowest rate:
- Plymouth (10.9%)
4 out of 5 screening providers met the acceptable threshold of ≤ 15.0% (3 in the previous screening year).
3 out of 5 screening providers also reached the achievable threshold of ≤ 13.5% (no change from the previous screening year).
5. NHSP-S03: test: referral rate to diagnostic audiological assessment - hospital model
This standard provides assurance that babies with a screening outcome that indicates an immediate referral are appropriately referred for audiological assessment. It shows the proportion of babies in services who require immediate referral for audiological assessment.
NHSP-S03 is a standard where a lower percentage is better to minimise the number of babies referred to audiology. The acceptable threshold for this standard in this period was less than or equal to 3.0% and the achievable threshold was less than or equal to 2.0%.
Figure 4: performance of each NHSP site providing a hospital model by PHE region. The acceptable and achievable thresholds and England performance are shown.
As shown in Figure 4, the overall England performance of 2.4% (no change from the previous screening year) met the acceptable threshold but did not meet the achievable threshold.
The following service(s) had the highest rate of babies referred for audiological assessment:
- North of Tyne (7.0%)
The following service(s) had the lowest rate:
- Wiltshire (Bath) (0.7%)
84 out of 104 screening providers met the acceptable threshold of less than or equal to 3.0% (83 in the previous screening year)
54 out of 104 screening providers also reached the achievable threshold of less than or equal to 2.0% (55 in the previous screening year)
6. NHSP-S03: test: referral rate to diagnostic audiological assessment - community model
This standard provides assurance that babies with a screening outcome that indicates an immediate referral are appropriately referred for audiological assessment. It shows the proportion of babies in services who require immediate referral for audiological assessment.
NHSP-S03 is a standard where a lower percentage is better to minimise the number of babies referred to audiology. The acceptable threshold for this standard in this period was less than or equal to 1.6% and the achievable threshold was less than or equal to 1.3%.
Figure 5: performance of each NHSP site providing a community model by PHE region. The acceptable and achievable thresholds and England performance are shown.
As shown in Figure 5, the overall England performance for sites providing a community model was 1.7% (1.5% in the previous screening year) and did not meet either the acceptable or the achievable thresholds.
The following service had the highest rate of babies referred for audiological assessment:
- Dorset (2.3%)
The following service(s) had the lowest rate:
- Cornwall and Isles of Scilly (1.3%)
3 out of 5 screening providers met the acceptable threshold of less than or equal to 1.6% (2 in the previous screening year).
2 out of 5 screening providers also reached the achievable threshold of les than or equal to 1.3% (no change from the previous screening year).
7. NHSP-S04: referral: time from screening outcome to offered appointment for diagnostic audiological assessment
This standard provides assurance that babies who require immediate referral for audiological assessment are offered a first appointment in audiology that enables attendance in the specified timescales in line with NHSP-S05. It shows the proportion of babies requiring immediate referral for audiological assessment who are offered a first appointment in audiology that is in the specified timescale.
In line with NHSE guidance, many audiology departments closed during COVID-19. This resulted in a delay in appointments for babies referred from the screen in most sites.
NHSP-S04 is a standard where a higher percentage is better to maximise the number of eligible babies who were offered and accepted screening. The acceptable threshold for this standard in this period was more than or equal to 97.0% and the achievable threshold was more than or equal to 99.0%.
Figure 6: performance of each NHSP by PHE region. The acceptable and achievable thresholds and England performance are shown.
As shown in Figure 6, the overall England performance of 93.1% (97.4% in the previous screening year) did not meet either the acceptable or the achievable thresholds, this is partly due to the impact of the Covid-19 pandemic.
The following services had the highest outcome:
- Essex (Chelmsford) (100.0%)
- Herefordshire (100.0%)
- Norfolk and Norwich (100.0%)
- Plymouth (100.0%)
- Scunthorpe (100.0%)
- Wirral (100.0%)
- West Suffolk (100.0%)
The following service had the lowest outcome (66.5%):
- St Helens and Knowsley
20 out of 109 screening providers met the acceptable threshold of more than or equal to 97.0% (72 in the previous screening year)
9 out of 109 screening providers also reached the achievable threshold of more than or equal to 99.0% (33 in the previous screening year)
8. NHSP-S05: diagnosis/intervention: time from screening outcome to attendance at an audiological assessment appointment
This standard provides assurance that opportunities for intervention for babies who require an immediate referral for audiological assessment are maximised by attending audiology in the required timescale. It shows the proportion of babies requiring immediate referral who are brought for an audiological assessment appointment in the required timescale.
In line with NHSE guidance, many audiology departments closed during COVID-19. This resulted in a delay in the assessment of babies referred from the screen in most sites.
NHSP-S05 is a standard where a higher percentage is better to maximise the number of eligible babies who attended timely audiology follow-up.
Figure 7: performance of each NHSP by PHE region. The acceptable and achievable thresholds and England performance are shown.
As shown in Figure 7, the overall England performance of 83.7% (90.2% in the previous screening year) did not meet either the acceptable or the achievable thresholds, this is partly due to the impact of the Covid-19 pandemic.
The following service had the highest outcome:
- Wiltshire (Bath) (96.8%)
The following service had the lowest outcome:
- St Helens and Knowsley (50.0%)
21 out of 109 screening providers met the acceptable threshold of more than or equal to 90.0% (59 in the previous screening year)
3 out of 109 screening providers also reached the achievable threshold of more than or equal to 95.0% (21 in the previous screening year)
9. Appendix 1: Organisation table
| Code | Organisation | PHE Region | NHS England Region |
|---|---|---|---|
| AIR | Airedale | North | North East and Yorkshire |
| AVO | Avon | South | South West |
| HAV | Barking and Havering | London | London |
| BAR | Barnsley | North | North East and Yorkshire |
| BED | Bedfordshire and Luton | Midlands and East | East of England |
| BSS | Birmingham | Midlands and East | Midlands |
| BLF | Blackpool and Fylde | North | North West |
| BOL | Bolton | North | North West |
| BRA | Bradford | North | North East and Yorkshire |
| BRI | Brighton, Hove and Mid Sussex | South | South East |
| BUC | Buckinghamshire | South | South East |
| CAL | Calderdale and Huddersfield | North | North East and Yorkshire |
| CMA | Cambridgeshire (Addenbrookes) | Midlands and East | East of England |
| CMH | Cambridgeshire (Hinchingbrooke) | Midlands and East | East of England |
| CMP | Cambridgeshire (Peterborough) | Midlands and East | East of England |
| CES | Central and East Suffolk | Midlands and East | East of England |
| CHS | Chester | North | North West |
| COR | Cornwall and Isles of Scilly | South | South West |
| THR | County Durham and Tees Valley | North | North East and Yorkshire |
| COV | Coventry and Rugby | Midlands and East | Midlands |
| CRE | Crewe | North | North West |
| DON | Doncaster and Bassetlaw | North | North East and Yorkshire |
| DST | Dorset | South | South West |
| DUD | Dudley | Midlands and East | Midlands |
| EKH | East Kent | South | South East |
| ELA | East Lancs (Blackburn, Burnley and Darwen) | North | North West |
| ERH | East Riding and Hull | North | North East and Yorkshire |
| STE | East Staffordshire | Midlands and East | Midlands |
| EAH | East Sussex | South | South East |
| BAS | Essex (Basildon) | Midlands and East | East of England |
| ESX | Essex (Chelmsford) | Midlands and East | East of England |
| COL | Essex (Colchester) | Midlands and East | East of England |
| HAR | Essex (Harlow) | Midlands and East | East of England |
| ESS | Essex (Southend) | Midlands and East | East of England |
| FHT | Frimley Health Trust | South | South East |
| GLO | Gloucestershire | South | South West |
| GOS | Great Ormond Street | ||
| GRI | Grimsby | North | North East and Yorkshire |
| GYM | Gt Yarmouth and Waveney | Midlands and East | East of England |
| HAC | Hackney | London | London |
| HFW | Hammersmith, Fulham and Westminster | London | London |
| HHA | Hampshire Hospital Area | South | South East |
| HEB | Harrow Ealing and Brent | London | London |
| HEF | Herefordshire | Midlands and East | Midlands |
| HEN | Hertfordshire East and North | Midlands and East | East of England |
| HRW | Hertfordshire West | Midlands and East | East of England |
| HIL | Hillingdon | London | London |
| KCH | Kensington, Chelsea and Hounslow | London | London |
| KET | Kettering | Midlands and East | Midlands |
| KLY | Kings Lynn | Midlands and East | East of England |
| LEE | Leeds | North | North East and Yorkshire |
| LEI | Leicester | Midlands and East | Midlands |
| LIS | Lincolnshire | Midlands and East | Midlands |
| LIV | Liverpool | North | North West |
| MAC | Macclesfield | North | North West |
| MAN | Manchester | North | North West |
| MYH | Mid Yorkshire Hospitals | North | North East and Yorkshire |
| MIL | Milton Keynes | Midlands and East | East of England |
| MRB | Morecambe Bay | North | North West |
| NEH | Newham | London | London |
| NOW | Norfolk and Norwich | Midlands and East | East of England |
| NCL | North Central London | London | London |
| NCH | North Cheshire (Warrington) | North | North West |
| NCU | North Cumbria | North | North East and Yorkshire |
| CHE | North Derbyshire (Chesterfield) | Midlands and East | Midlands |
| DVO | North Devon | South | South West |
| NNG | North Nottinghamshire | Midlands and East | Midlands |
| NNN | North of Tyne | North | North East and Yorkshire |
| NWR | North Warwickshire | Midlands and East | Midlands |
| NOA | Northampton | Midlands and East | Midlands |
| NOT | Nottingham | Midlands and East | Midlands |
| OXF | Oxfordshire | South | South East |
| PLH | Plymouth | South | South West |
| PIW | Portsmouth and IOW | South | South East |
| PRE | Preston | North | North West |
| ROC | Rochdale and Oldham | North | North West |
| ROT | Rotherham | North | North East and Yorkshire |
| RBH | Royal Berkshire NHS Foundation Trust | South | South East |
| SCU | Scunthorpe | North | North East and Yorkshire |
| SHE | Sheffield | North | North East and Yorkshire |
| SHR | Shropshire | Midlands and East | Midlands |
| SOM | Somerset | South | South West |
| SDE | South Derbyshire | Midlands and East | Midlands |
| SEL | South East London | London | London |
| SWA | South Warwickshire | Midlands and East | Midlands |
| SWL | South West London | London | London |
| SHA | Southampton | South | South East |
| SFW | Southport and West Lancs | North | North West |
| STH | St Helens and Knowsley | North | North West |
| STO | Stockport | North | North West |
| SUN | Sunderland, South Tyneside and Gateshead | North | North East and Yorkshire |
| SAS | Surrey and Sussex Healthcare | South | South East |
| TGH | Tameside | North | North West |
| TOT | Torbay and Teignbridge | South | South West |
| ELC | Tower Hamlets | London | London |
| NST | University Hospitals of North Midlands | Midlands and East | Midlands |
| WAS | Walsall | Midlands and East | Midlands |
| KEN | West Kent | South | South East |
| WSU | West Suffolk | Midlands and East | East of England |
| WSY | West Surrey | South | South East |
| WSH | Western Sussex Hospital FT | South | South East |
| WXR | Whipps Cross and Redbridge | London | London |
| WIG | Wigan | North | North West |
| BAT | Wiltshire (Bath) | South | South West |
| SBR | Wiltshire (Salisbury) | South | South West |
| WSW | Wiltshire (Swindon) | South | South West |
| WIR | Wirral | North | North West |
| WVA | Wolverhampton | Midlands and East | Midlands |
| WOR | Worcester | Midlands and East | Midlands |
| HAY | York, Harrogate and Scarborough | North | North East and Yorkshire |