Guidance

NHSP annual standards data report for the period 1 April 2019 to 31 March 2020

Published 12 January 2023

Applies to England

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:

  1. 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.
  2. 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