Newborn and infant physical examination screening standards data report 1 April 2018 to 31 March 2019
Published 16 September 2021
Applies to England
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This is the first published annual data report for the NHS newborn and infant physical examination programme (NIPE) in England.
It presents data against each of the 5 screening standards for the newborn examination in England from 1 April 2018 to 31 March 2019.
This report focuses on the quality of the recorded data in the national NIPE IT system. True performance of services against most of the standards is difficult to determine as data recorded in the NIPE IT system is incomplete for many providers.
NIPE data for England from 1 April 2018 to 31 March 2019 shows that:
567,949
babies were screened in NHS trusts that were using the NIPE IT system
and:
95.3%
of babies were recorded on the IT system as screened within 72 hours of birth
This report identifies the baseline data recorded on the NIPE IT system in the 2018 to 2019 screening year to track data completeness and quality improvement. This will support its use in assessment of service performance against standards in the future.
The data source used for this report is the national NIPE IT system. In 2018 to 2019 this system was NIPE SMART, which was then upgraded and from April 2019 has been known as SMaRT4NIPE (S4N). It is the clinical management system used to collect newborn physical examination screening and outcome data across England.
The data source is referred to as ‘the NIPE IT system’ throughout this report.
1. The screening programme
As part of the NHS NIPE screening programme all newborns are examined, ideally before they are 72 hours of age, to identify congenital cataracts, congenital heart problems, developmental dysplasia of the hip and undescended testes (in boys).
The NIPE pathway begins with the identification of babies eligible for screening and includes undertaking the 4 screening elements (eyes, heart, hips and testes (in boys)) alongside non-screening elements of the wider newborn examination. For babies with screen negative results the screening pathway ends. For babies with screen positive results the screening pathway ends with timely review by specialist services (defined within the standard for each condition). All babies enter the Healthy Child Programme.
National NIPE standards provide a defined set of measures that providers must meet to make sure services are safe and effective. There are 5 national NIPE standards, which are:
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NIPE-S01: coverage
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NIPE-S02: diagnosis/intervention: timeliness of intervention for abnormality of the eye (predominantly congenital cataracts)
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NIPE-S03: diagnosis/intervention: timeliness of intervention for developmental dysplasia of the hip (DDH)
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NIPE-S04: diagnosis/intervention: timeliness of intervention for DDH risk factors
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NIPE-S05: diagnosis/intervention: timeliness of intervention for bilateral undescended testes
Standards data ispublished annually. Standards that are also key performance indicators (KPIs) (NIPE-S01 (NP1) and NIPE-S03 (NP2)) are published quarterly.
2. Summary of data
Please note, reported performance for standards NIPE-S02 to NIPE-S05 is underestimated and should be interpreted with caution. The data is incomplete as many post referral outcomes are not entered on to the NIPE IT system.
2.1 Table 1: national and regional summary[footnote 1]
| Regional summary (number of providers) | NIPE-S01 (KPI NP1) (%) | NIPE-S02 (%) | NIPE-S03 (KPI NP2) (%) | NIPE-S04 (%) | NIPE-S05 (%) |
|---|---|---|---|---|---|
| England (120) | 95.3 | 17.3 | 8.7 | 29.4 | 6.3 |
| London (14) | 94.3 | 3.9 | 5.4 | 15.2 | 1.0 |
| Midlands and East (38) | 95.5 | 25.1 | 10.7 | 39.4 | 8.4 |
| North (35) | 94.9 | 14.0 | 8.8 | 27.7 | 5.2 |
| South (33) | 96.2 | 20.6 | 8.1 | 27.3 | 9.0 |
| Acceptable | ≥ 95.0 | ≥ 95.0 | ≥ 95.0 | ≥ 90.0 | 100.0 |
| Achievable | ≥ 99.5 | 100.0 | 100.0 | ≥ 95.0 | N/A |
Data for NIPE-S01 shows that screening outcomes are entered for nearly all babies, and that the acceptable threshold is met at a national level.
However, for standards NIPE-S02 to NIPE-S05 the data is incomplete as post referral outcomes are not entered on to the NIPE IT system. In the 2018 to 2019 screening year, between 33 and 74 providers did not enter any post referral outcome data on the system. For services that did enter data, on average only around 50% of outcome data is entered on to the IT system following attendance for hip ultrasound or specialist appointment or assessment, with lower figures reported for the other standards.
Performance is calculated by the number of recorded babies with screen positive results seen within the required time frame with the data entered on to the NIPE IT system. Where there is no outcome data, it is not possible to distinguish babies with screen positive results who were seen outside the required timescales from those babies who have been seen within the required timescales as no outcome was recorded.
A review of practice identified that in many cases non-recording of outcomes in the NIPE IT system is a result of the failure to get information back following specialist assessment rather than the failure to refer, or the failure to see babies with screen positive results.
The incompleteness of the data impacts the ability of screening providers to ensure babies with screen positive results have been seen by specialist services and within clinically relevant timescales. In addition, relevant organisations cannot adequately monitor performance of providers.
In 2018 to 2019, 120 out of 136 providers had implemented use of the NIPE IT system. Only data for providers using the NIPE IT system is included in this report. The NIPE programme team is confident the data in the NIPE IT system for this period can be published to demonstrate a baseline for comparison in future.
From 1 April 2020, the method for KPI monitoring for the NIPE programme changed from providers self-reporting their data to outcomes being extracted directly from the NIPE IT system. Providers should be aware that lack of data completeness and accuracy in the NIPE IT system, particularly for babies screened positive for DDH, will have a negative impact on their published outcomes for the KPIs.
3. Recommendations
In line with guidelines published by the NIPE programme, it is recommended that all providers follow these recommendations:
R01-NIPE-1819
Review reporting routes to make sure accurate and timely data entry of outcomes for babies with screen positive results on to the NIPE IT system.
R02-NIPE-1819
Review internal processes to make sure babies with screen positive results are seen within timescales specified in the screening standards, and babies who are not seen within the timescales are identified and reasons for this are investigated.
R03-NIPE-1819
Review processes for accurately recording screen positive results for suspected DDH and hip risk factors to ensure that only babies who meet the screen positive criteria as outlined in national guidance are recorded on the NIPE IT system as screen positive.
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Reported performance for this standard is underestimated and should be interpreted with caution. The data is incomplete as many post referral outcomes are not entered on to the NIPE IT system. ↩