Guidance

NHSP: interactions between English and Welsh hearing screening programmes

Updated 10 October 2024

Applies to England

A number of babies are born in England and reside in Wales or are born in Wales and reside in England.

In order to ensure these babies safely follow the appropriate screening pathway a Memorandum of Understanding has been agreed by both screening programmes in England and Wales which permits the appropriate exchange of data and information between the programmes.

1. Defining the eligible population

Wales (NBHSW) Screening results are added into the Welsh Child Health system for babies who either:

• are resident in Wales and have a Welsh GP
• are resident in Wales and are registered with an English GP but the GP uses a Welsh Heath Visitor
• are born in Wales and are screened in Wales (regardless of where normally resident)

England (NHSP) Records are mapped within the national NHSP IT system for babies who either:

• are born in England
• are registered with an English GP

2. Protocol

Wales (NBHSW) Bilateral OAE - Accept a unilateral clear response for well babies. Parents are given the ‘Your Baby’s Hearing Screening Test - clear response in one ear only’ letter. This details their options for follow up. If the parent requests an immediate follow up, a repeat screening test on both ears is performed in an audiology clinic at a later date.

England (NHSP) Bilateral OAE - Require bilateral clear responses before discharging the baby.

3. NICU babies

Wales (NBHSW) Perform AABR only. Require bilateral clear responses at AABR.

England (NHSP) Perform both AOAE and AABR. Require bilateral clear responses at AABR.

It has been agreed that NICU/SCBU babies that have been screened by NBHSW will not be recalled by NHSP England solely for the purpose of AOAE testing.

4. Targeted follow-up

Wales (NBHSW) Offer a targeted follow up at 7 to 9 months for babies who:

• were missed
• have not completed the screen
• have parents who requested audiological surveillance following unilateral fail
• were unscreened and moved into the area
• have Down’s syndrome
• have cleft palate
• have significant cranio-facial abnormality
• have parental or professional concern about their hearing
• have significant FH of early onset hearing loss

England (NHSP) Offer a targeted follow up at 7 to 9 months for babies who are discharged from the screen and who:

• have congenital infection
• have craniofacial anomalies
• have syndrome associated with hearing loss
• NICU baby protocol with bilateral NCR AOAE and bilateral CR AABR

4.1 Data/IT

Wales (NBHSW) Use the All Wales Newborn Hearing System (AWNBHS) to record screening result information. The system automatically receives NHS numbers for all babies born in Wales from PDS.

AWNBHS receives demographic updates from Welsh Child health systems for new births manually added, such as Welsh residents born in England and children under one year old who move into Wales.

England (NHSP) Use the NHSP national IT system, SMaRT4Hearing (S4H). The system automatically receives NHS numbers for all babies born from PDS.

Records for English residents born in a Welsh hospital will be manually added to S4H on discharge by Welsh Screening Administrators.

NHSP and NBHSW have agreed that babies will follow the pathway and protocols of the hospital in which they are being screened. Therefore:

• babies whose mothers are resident in Wales and who are born in England will follow the English care pathway until they are discharged from the English programme
• babies whose mothers are resident in England and who are born in Wales will follow the Welsh care pathway until they are discharged from hospital

A flowchart of the NBHSW screening pathway is available.

5. Data

Both programmes need to exchange information and data (including date and screening result information for each ear) for babies who are transferring between the English and Welsh programmes.

A NHSP site for Wales has been created in S4H (SITE_Wales) as they may be the:

• responsible site
• hearing screening provider
• temporary hearing screening provider (if monitoring a Welsh resident hearing screening results)

Once results have been added to S4H, the shares should be broken.

NBHSW staff can only access the Welsh site in S4H. Welsh programme administrators will add the records to S4H for any English residents born in Wales when they are discharged from hospital as these records are not automatically received from PDS. The information they will add will include:

• primary contact details
• GP (where available)
• risk factors
• whether a translator is required
• whether consent has been given
• screening outcome – should be ‘incomplete - out of screening coverage’
• test results - should only be entered as case notes

Note that the Welsh programme administrators can create the S4H record manually but cannot automatically load results into S4H. They can only add information as a case note, as the screening test results criteria for the 2 programmes are different.

Both the English local managers (LMs) and the Welsh programme managers have access to the contacts database on S4H. This means that they can contact a relevant site or give parents appropriate contact details. They are each responsible for ensuring contact details are updated as necessary.