Guidance

3. Roles and responsibilities

Updated 9 April 2024

Applies to England and Wales

Introduction

NHSP is dependent on relationships between stakeholders, which include:

• maternity services
• the hearing screening team
• audiology departments
• neonatal intensive care units (NICU) or special care baby units (SCBU)
• paediatric medical services
• primary care
• GPs
• health visitors
• child health records (CHRDs)
• social care and specialist services

NHS England (NHSE) and local commissioning teams

NHSE’s role can be found in the NHSP service specification. This specification is not intended to replicate, duplicate or supersede any other legislative provisions that may apply. It sets out outcomes to be achieved and funding provided for NHSE to commission public health services. It is reviewed and published annually.

This should be used as a commissioning framework that:

• outlines the newborn hearing screening and paediatric audiology services that should be provided, where and to whom
• clarifies the commissioner’s expectations regarding the level and quality of services to be provided
• details the processes through which the commissioner will monitor and manage performance and assure themselves of the quality of those services

Providers should ensure their service adheres to the national service specification with any local variance and local reporting schedules agreed between themselves and their screening and immunisation leads at Public Health England (PHE) on an annual basis, when the Department of Health and Social Care (DHSC) and NHSE review and publish the current year’s specification.

Public health commissioning in the NHS guidance will assist local programmes to ensure their services meet the requirements set in national service specifications.

Public Health England

PHE, through the national screening programmes, is responsible for leading high-quality, uniform screening, providing accessible information to both the public and health care professionals and developing and monitoring standards. It is also responsible for the delivery of national quality assurance and for ensuring training and education for all those providing screening is developed, commissioned and delivered through appropriate partner organisations.

PHE is responsible for the delivery of the essential elements of screening programmes which are best done once at national level.

These include:

• setting clear specifications for screening equipment, IT and data
• procurement of screening equipment and IT where appropriate (procurement may be undertaken by NHSE with advice from PHE Screening)
• evaluation and modification of changes to screening protocols

Provider

The provider will be expected to fully contribute to ensuring that systems are in place to maintain the quality of the whole screening pathway in their organisation. This will include, but is not limited to:

• provision of robust screening coordination which links with all elements of the screening pathway
• ensuring that responsibilities relating to all elements of the screening pathway across organisations and organisational boundaries are identified
• developing joint audit and monitoring processes
• agreeing joint failsafe mechanisms where required to ensure safe and timely processes across the whole screening pathway
• contributing to any NHSE and public health screening lead initiatives in screening pathway development in line with NHS screening programmes expectations
• providing robust electronic links for screening services across the screening pathway
• linking with primary care

The provider is expected to have the following posts (and appropriate deputies) in place to oversee the screening programme: team leader, local manager and screeners.

Team leader

The NHSP team leader will be someone from an existing senior post (typically from audiology or paediatrics) responsible for being the champion of, and strategic lead for, the local programme. The team leader is responsible for the quality and governance of the programme. It is expected that the role requirements will be fulfilled in 0.1 whole time equivalent (WTE).

Team leaders should be familiar with:

• section 7a of the service specification public health commissioning in the NHS for NHSP
• programme standards and Key Perfomance Indicator
• NHSP local programme management tasks

The main components of the role are to:

• act as the strategic lead for the local NHSP programme with responsibility and authority for leading the service
• implement service developments and negotiate necessary funding and resources
• ensure appropriate staffing levels are maintained to be able to provide a safe, efficient and effective screening service for all families eligible for screening
• oversee the running of the local NHSP programme in accordance with national policies, procedures and protocols
• take overall responsibility and accountability for the management, quality assurance and clinical governance of all aspects of the local NHSP programme
• ensure local NHSP programme performance meets standards, and provide appropriate reports to Public Health and Quality Assurance (QA) teams
• receive, read, disseminate and act upon regular and other reports, emails or blogs supplied by the national programme
• act as a single point of contact for the local NHSP programme in relation to quality assurance and any resulting improvement plan
• take professional responsibility for the programme where appropriate. If this is not appropriate the responsibility should be appropriately devolved to a named lead
• ensure that the local NHSP programme inputs to an operational Children’s Hearing Services Working Group (CHSWG)
• ensure that the local NHSP programme inputs to an operational provider antenatal and newborn (ANNB) screening board
• act as a single point of contact for the entire local NHSP programme across multiple professional groups and multiple screening facilities (where these exist)
• liaise with appropriate staff within health, education, social care services and the voluntary sector to ensure policies and procedures are adhered to across all agencies and professional groups involved in the local NHSP programme
• to ensure that services meet the capacity and quality requirements of the programme

Local manager

The NHSP local manager is the operational lead for the local screening programme. They are responsible for the day-to-day management of all aspects of the programme, including prompt and appropriate referral to audiology. This role normally requires 1 WTE per 10,000 births, with a minimum of 0.5 WTE.

The main components of the role are to:

• act as the professional lead for the day-to-day management, evaluation and quality assurance (QA) of the screening process, including the provision of antenatal information, the screening procedures and any onward referral
• ensure all parents of eligible babies are offered the newborn hearing screen in a timely fashion
• ensure that a high quality service is maintained to promote the principles of family friendly hearing services for children
• ensure that parents and carers are given clear and accurate information regarding NHSP
• ensure quality improvements are implemented
• ensure that NHSP screening protocols and procedures are adhered to and to write, review and update local protocols and procedures as and when necessary
• ensure that NHSP key performance indicators and programme standards are met
• establish and maintain effective methods of communication to the parents, primary care teams, other NHSP teams where appropriate and audiology services where follow-up is indicated
• lead the hearing screening team and line manage their activities, ensuring regular reviews of screener activity are undertaken and appropriate continued personal development (CPD) plans are in place
• manage all aspects of the screening equipment, ensuring:
• protocols are followed
• QA checks are undertaken
• service and calibration is completed at the required intervals
• equipment is safely secured
• software and firmware changes are installed as required
• liaise with other NHSP teams and ANNB screening programmes to ensure families receive a seamless screening and follow-up service
• liaise with the national programme for NHSP and to attend regular updates and training events provided by them
• keep the screening team, local professionals and stakeholders informed about national developments
• liaise with relevant health professionals and other agencies in particular with education services for hearing-impaired and deaf children

Specific components of the role

Management and supervision of the screening team

Local managers need to:

• establish and maintain an organised working environment for the screening team working in maternity, special care or neonatal intensive care units and other settings
• be responsible for the recruitment, retention and training of the screening team in accordance with local and national guidance
• organise a full induction programme and participate in the training of new screeners (or in community NHSP models for the health visitors) in accordance with local and national guidance including completion of the level 3 diploma in health screening (NHSP) for relevant staff
• be responsible for the day-to-day management of the screening team
• develop and continually assess working patterns, including the management of shift rotas, to best meet the needs of the service to develop the team and carry out regular competency assessments in order to provide performance feedback and to assist in the identification of individual training needs, including annual completion of NHSP e-learning

Maintaining screener competency and continued professional development

All NHSP screeners should have access to NHSP updates and refresher sessions. Screener competency assessments should be carried out annually, using the performance observation checklists located within pages of the Level 3 Diploma for health screeners guidance. By an experienced assessor, such as a local manager or learning mentor who has successfully completed NHSP screener training. The assessment will either deem the screener as competent to screen or will identify areas for further learning or training.

It is the responsibility of the local manager to ensure that all newborn hearing screeners are fully competent to perform the role.

Local managers should:

• discuss all assessments with the screener and the screener’s line manager prior to carrying them out
• offer constructive feedback after completion and agree appropriate action or further training requirements
• keep a record of screener assessments, as evidence of staff competency
• screeners who carry out AOAE only screening are exempt from assessments for AABR screening
• health visitors and registered nurses should have their competencies assessed every 2 years

Data issues and record keeping

Local managers need to:

• ensure all administrative and clinical information including test results are accurately recorded on paper records, the national IT system and in the screening equipment
• ensure that all hearing screening data is archived securely where appropriate
• carry out administrative functions and regular data quality checks within the national IT system as specified by NHSP national guidance
• audit the programme regularly as required locally and produce written and statistical reports on request
• liaise with the local IT department and national IT system suppliers as required

Equipment issues

Local managers need to:

• ensure arrangements are made for the routine calibration, maintenance and repair of all screening and technical equipment in accordance with NHSP national and local guidance
• maintain sufficient supplies of consumables and any other stock or non-stock items required by the programme and reorder as necessary
• ensure that equipment is used in accordance with NHSP national guidance
• liaise with the local IT department and equipment suppliers as required to ensure the latest software versions are in use

General tasks

Local managers need to:

• assist in or be responsible for the management of budgets associated with the programme as required
• report and record all incidents or ‘near misses’ as per incident policy and to report such incidents to the NHSP national team and PHE screening QA teams in a timely fashion
• provide the required evidence for the PHE screening QA teams when requested It is the service provider’s responsibility to ensure that the service is appropriately governed and managed according to the Section 7a Service Specification No. 20

The roles outlined above are core to the delivery of a high-quality screening programme. If a local manager is not in post there is a risk that:

• programme performance may suffer without adequate monitoring
• screening team development, competency and training will be adversely affected
• incidents will not be managed quickly, efficiently and in a sensitive manner and lessons are not learned
• babies with a hearing loss will be missed by the screening programme
• parents will not experience a satisfactory service
• there will not be effective multi-disciplinary working

Additional guidance can be found in patient journey from screen to referral, the local programme management tasks and local manager mentorship framework.

Screener

NHSP screeners undertake the screening tests, gathering and recording clinical and test data relevant to the screening process, and communicating with parents about outcomes. This role normally requires 8 WTE per 10,000 births in a hospital based programme.

The NHSP screener works as a member of a team providing the hearing screening service for newborn babies, under the supervision of the NHSP local manager. The role involves gathering an accurate recording of clinical and test data relevant to the screening process, direct handling of newborn babies and contact with parents.

It is essential that any staff performing hearing screening complete the screener training and competency assessment in line with national procedures and protocols.

Hospital model

The screen is undertaken in the hospital, outpatient clinics or the home, by one or a combination of NHSP trained and competent healthcare professionals (HCP), including:

• dedicated hospital hearing screeners
• maternity support workers (MSWs)
• community hearing screeners
• NICU staff
• registered nurses
• audiologists

Community model

The screen is undertaken in the home usually at the time of the health visitor primary birth visit or at a later date, depending on the protocol and stage of the screening pathway by one or a combination of the following trained and competent HCPs:

• Health Visitors
• MSWs
• NICU staff
• Automated Auditory Brain Response (AABR) screener
• registered nurses
• audiologists

The main components of the hearing screener role are to:

• identify which babies require screening
• liaise effectively with parents, NHSP team members and other health care professionals
• offer the automated otoacoustic emission (AOAE) or automated auditory brain response (AABR) screening test and gain informed verbal consent
• carry out the hearing screening of newborns and accurately record clinical and test data
• promote a professional, welcoming and caring environment endorsing a family friendly approach to care
• maintain up to date knowledge of NHSP procedures and protocols relevant to the role of NHSP screener
• maintain the confidentiality of the babies and their families at all times
• ensure the safety and security of equipment at all times and report any problems to the NHSP local manager at the earliest opportunity
• ensure babies and families retain their dignity, privacy and individuality at all times
• be aware of ‘safeguarding’ issues and adhere to local procedures

Paediatric audiology

Paediatric audiology must work closely with the NHSP team to ensure a seamless and timely transition of babies that refer from the screen into the audiological assessment service. Similarly, an effective transition is required for babies identified for targeted follow-up. Services must agree and put in place failsafe mechanisms to ensure that no babies are lost to follow-up.

Responsibilities include:

• audiological assessment of babies referred by NHSP within the timescales stipulated in the programme standards
• assessment of babies identified as candidates for targeted follow-up at 7 to 9 months
• entry of audiological assessment data into the national IT system
• review of cases of later ascertained permanent childhood hearing impairment (PCHI) and reporting of relevant cases to the national programme
• ensuring there are trained and accredited clinical audiologists of appropriate grade and experience to undertake the post screen audiological assessments
• participating in and maintaining accreditation to defined quality standards operating under the umbrella of the United Kingdom Accreditation Schemes (UKAS) or Improving Quality in Physiological Services (IQIPS) participate in a scheme for external peer-review process of auditory brain response (ABR)

Aetiological investigation service

Audiology departments are responsible for ensuring outcome data from screened babies, including aetiological information, as well as any children with later identified PCHI, is entered into the national IT system to allow screening outcomes to be effectively assessed.

Medical teams are responsible for adding aetiological investigation data into national IT system for children with PCHI. Details are given in the aetiology chapter of this guidance.

Multi-disciplinary working

To ensure delivery of a seamless service with the family and child at the centre, a successful newborn hearing screening programme must work cohesively with a number of different professionals and agencies.

NHSP stakeholders

Acute trust

These include:

• administrative staff
• midwives
• NICU and SCBU staff
• postnatal ward staff
• ward receptionists
• ANNB co-ordinators
• audiologists
• audiological physicians
• clinicians
• commissioners
• Ear Nose and Throat (ENT)
• interpreters
• paediatric teams

Primary care

These include:

• GPs
• health visitors
• health visitor managers, health visitor tutors and team leaders
• community midwives
• child health

Public health

These include:

• PHE screening and immunisation teams
• PHE screening quality assurance teams

Service users

These include:

• carers
• parents
• wider family members or siblings

Other stakeholders

These include:

• social services
• speech and language therapists
• teachers of the deaf

To maximise the benefit of early identification of hearing loss and meet the needs of children and their families it is essential that effective and positive multiagency links are made. Cross-boundary co-operation is required regarding information sharing, care pathways, fast-tracking and developing family-friendly services. Programmes should regularly audit services and review service users views and perceptions.

A generic parent satisfaction survey can be adapted to help local programmes develop local satisfaction audits.

Health visitors

Health visitors deliver NHSP in some programmes in England, where they carry out the first screen in the home as part of the primary care visit.

Additionally, health visitors have an important role in supporting families. This may include communicating with parents effectively about the screen along the screening pathway, offering support during periods of uncertainty about their baby’s screening outcome and working with the family and other professionals in supporting them if a hearing loss is diagnosed.

Health visitors need to know:

• hearing screening is offered or performed for both ears
• screening should be completed by 4 to 5 weeks
• results are available at the time of test
• the importance of the screen and the benefits to child and family of early identification and management of hearing loss
• information within the Screening tests for you and your baby and the Screening tests for you and your baby: babies in special care units booklets
• guidelines for surveillance and audiological monitoring following the newborn hearing screen
• to alert the hearing screening team of any babies moving into area less than 3 months of age without any evidence of screening

The family support role of the health visitors in NHSP is to:

• empower parents to make an informed choice about the hearing screen
• offer guidance and support during the screening process
• share responsibility in ensuring completion of hearing screen if offer taken up
• contact and offer support as appropriate during the audiology assessment process
• support families to access local services if newborn hearing screen declined
• empower parents to identify later concerns about their baby’s hearing or development of speech
• keep up to date about NHSP and parent support information

It is essential that local NHSP programmes and audiology inform health visitors and GPs of all babies that have been:

• referred from the screen for audiological assessment
• discharged following audiological assessment
• diagnosed as having hearing loss

Midwives

Midwives are an important source of health information for mothers-to-be. Hospital and community midwives need to know:

• to offer verbal information about screening for hearing loss from the Screening tests for you and your baby booklet given during the third trimester of pregnancy
• hearing screening is offered for both ears
• screening should be completed by 4 to 5 weeks
• results are available at the time of test
• the importance of the screen and the benefits to child and family of early identification and management of hearing loss
• information within the Screening tests for you and your baby and the Screening tests for you and your baby: babies in special care units booklets
• to complete birth registrations on the patient demographic system (PDS) without delay to enable automatic transfer of demographic information into the NHSP national IT system and allow accurate and timely identification of the population eligible for screening
• to advise NHSP team if they should be cautious when contacting families to offer screening in order to avoid contact in the event of a death or very sick baby or mother
• that hearing screening may be offered when mothers attend clinics for post-natal care if not already completed (not available if a health visitor community model screening programme)

Midwives also have an important role in supporting NHSP programmes that deliver screening within the hospital. The screen is delivered by teams of dedicated screeners who are usually managed by an NHSP local manager.

Midwives can support the NHSP by:

• knowing the aim is to screen babies before they leave hospital
• promoting the importance of the screen
• alerting screeners of babies leaving the hospital that day
• alerting screeners to known problems prior to their approaching a parent
• referring screen enquiries to the screening team
• appreciate the need for quiet during screening and if appropriate provide a quieter area
• inputting to new screener induction and training

Screening teams can support midwives by:

• liaising with midwives before screening session and approaching parents
• alerting midwives to any parental concerns they have identified
• alerting midwives to any patient demographics data inaccuracies they are made aware of
• advising midwives of screen outcomes, particularly ‘no clear’ responses that require referral
• appreciating midwives role
• inputting to student midwife training
• inputting to new midwife induction
• delivering regular awareness and update sessions to midwifery team
• informing midwives of NHSP achievements by regular newsletter articles

NICU staff

Within the NICU or SCBU unit, newborn hearing screening is carried out by the screening team in a hospital model or the unit staff in a community model programme.

NICU and SCBU staff need to know:

• the importance of the screen and the benefits to child and family of early identification and management of hearing loss
• information within the Screening tests for you and your baby: babies in special care units booklet
• hearing screening is offered for both ears
• the aim is to screen babies who are not less than 34 weeks gestation, have stayed in the unit for more than 48 hours, before they leave hospital, but only when any major medical or drug treatment is completed or they are well enough to be discharged
• if the screen cannot be completed in hospital an outpatient appointment or home visit is required to complete the process
• results are available at time of test

NICU and SCBU staff can support the NHSP by:

• alerting screeners of babies leaving the hospital
• confirming when babies are well enough to screen
• providing information regarding NHSP risk factors
• referring screen enquiries to the screening team
• appreciating the need for quiet during screening and if appropriate provide a quieter area
• inputting to new screener induction and training

Where they are a fully qualified NICU screener staff can support the NHSP programme by:

• liaising effectively with their NHSP local manager
• ensuring they screen babies before discharge home
• providing information regarding NHSP risk factors to the NHSP local manager

NHSP can support NICU and SCBU staff by:

• contacting NICU and SCBU staff before screening session
• advising NICU and SCBU staff of screen outcomes; particularly no clear responses that require referral
• appreciate NICU and SCBU staff role
• input to new NICU and SCBU staff induction
• deliver regular awareness and update sessions to NICU and SCBU staff
• inform NICU and SCBU staff of NHSP achievements by regular newsletter articles

A generic risk factor template is available to local programmes to aid the gathering of this information.

General practitioners

To enable GPs to promote NHSP and answer parental enquiries it is important that GPs are aware of the newborn hearing screen and the screening process. GPs should also be aware of local programme contact details to enable them to refer parents who request further information relating to NHSP.

When conducting the 6 to 8 week physical examination the GP checks that the baby has received or declined the hearing screen and contacts the NHSP local manager if there is any doubt.