Listening to the sound of success can overcome scepticism of screening programmes

The Prime Minister’s announcement early in January that screening programmes are to be at the heart of an NHS which focuses on prevention was welcomed by many of us involved in the delivery of screening programmes. However, it also created scepticism amongst others.

Helping people make better choices about their health is at the heart of giving people more control, enabling them to take responsibility for their health; for preventing ill health; and promoting well-being. Screening programmes can be an invaluable public health service through facilitating early diagnosis of serious health conditions and in improving and increasing personalised provision. NHS resources can be targeted more accurately and appropriately through early identification and planning.

The only way that scepticism about screening can be overcome is to ensure that screening programmes are robustly tested, rigorously evaluated and continuously improved to respond to changing needs and the opportunities for innovation.

Only by integrating performance monitoring and programme evaluation into the screening process can we ensure that there is equity in service delivery — ensuring that some of those most vulnerable in society, who are most likely to benefit from screening, actually access it — and that the public at large is receiving a recognised cost-effective service.

The NHS Newborn Hearing Screening Programme

It is widely acknowledged that early identification of hearing impairment or deafness is important for the development of babies. Late identification of hearing impairment can lead to a lifetime of underachievement for the individual and prevent children from reaching their full potential.

One expert has said that, “If you hear from birth, you learn to listen.”(1) Many babies learn from listening, so it stands to reason that if a child is not provided with the necessary intervention and support until, for example, the age of two, their development will have been impaired. 

The NHS Newborn Hearing Screening Programme has been rolling out since 2001, and from March 2006 every parent in England has been given the chance to have their baby’s hearing screened shortly after birth. The Programme has achieved:

• in September 2007 the Programme reached the milestone of two million babies in England having had their hearing screened;
• every day around 1,700 babies are screened;
• 99% of parents offered the invitation to have screening say yes; and
• more than 3,400 babies have been identified as having permanent hearing impairment or deafness.

NHSP is now recognised as the most advanced universal hearing screening programme in the world. Its success is founded on an innovative and collaborative partnership between the public and private sector, which manages information and evaluates performance through the intelligent use of technology.

Information management

The success of screening programmes such as NHSP rely not only on the tests offered to individual patients, but also on the way that the data is used to inform and identify inequalities, trends, performance and quality in healthcare.

eSP (eScreener Plus), the national clinical IT system for NHSP developed and supported by Northgate, went live in 2003 and is recognised as one of the most successful electronic screening systems in the NHS.

NHSP is a fully managed service consisting of a national dataset with secure hosting at a data centre that provides a national online information and performance management system to the programme. This includes fully automated notification of new babies born, enabling clinicians to effectively manage screening and follow-up services.

eScreener Plus is used by every local hearing screening service in England — of which there are 120 — for management and audit. It handles approximately 600,000 babies on an annual basis and already contains over 2 million total records, increasing at 1,700 per day. It has over 1,500 active users and was the first national clinical system to be rolled out over the secure NHSnet network, as well as the first to link to the NN4B (NHS Numbers for Babies) service.

An interface between the NN4B and eSP systems was developed and went live in August 2003. Birth notifications are received by eSP within six seconds of an NHS number being generated, usually within 2-3 hours of birth. This saves screeners a great deal of time in entering baby demographics, whilst ensuring accurate data and high coverage.

Through an incremental approach, eSP is developed and enhanced as part of a process of continuous improvement. This involves collaborative and close working partnerships between key public sector and private sector partners involved in the operation of NHSP.

One of the latest enhancements being developed uses the InterSystems Ensemble rapid integration platform. This platform will enable data to be fed directly to the eSP from the 2,400 pieces of hearing test equipment located at 182 NHS trusts. This removes the need for manual importing or duplicate entry, which in turn leads to improved data quality and much less chance of a baby with a hearing loss being missed.

Data collected by eSP is reported, analysed and used to support quality assurance and quality improvement. It provides valuable feedback to local services that are provided with regular information about their progress, in particular towards meeting the NHSP quality standards. This ensures all services are working to achieve the same high standards across the whole of England.

All of the partners involved in developing, using and supporting eSP have recognised since its inception that this was not simply a technology programme. This is a major reason for its success. It is an integral part of the business of delivering more effective and efficient screening services and must be guided and led by the clinicians involved.

Training on technology was integrated into the general training of screeners. This helped to ensure screeners recognised that the use of technology to assist in managing performance and providing quality assurance was part and parcel of delivering the service.

Most recently, NHSP has concentrated on developing e-Learning opportunities, launching its first module in March 2007. The aim is to provide training for newly recruited NHSP screeners and a rich resource for trained NHSP screeners to support continuous development of their skills in line with the development of new technologies, evidence and practice.

Current screening programmes by and large are data rich but information poor. The Newborn Hearing Screening Programme and its use of eSP is an exception: the use of information to manage performance and guarantee quality is an integral part of its success.

Within the current national screening programmes there is huge potential to use data to identify areas of inequality and trends in performance. This data could also be linked up with other data held on secondary and primary healthcare such as HES (Hospital Episodes Statistics) and NHS Comparators. In this way, a holistic view of patient treatment and healthcare delivery could be achieved, irrespective of whether treatment is received within primary or secondary healthcare.

The Prime Minister’s early support for prevention and the use of screening programmes is welcome. There is much to learn from successful screening programmes that manage performance and use technology and innovation to deliver services with a proven track record. Scepticism about screening can be overcome, so long as the PM listens and does not leave it too late.

Dave Meaden, Managing Director of Public Services, Northgate Information Solutions.

Reference

1. Anne Oyler, audiologist for the American Speech, Language and Hearing Association, quoted in New York Times, 4 September, 2007.

More information

For more information on the NHS Newborn Hearing Screening Programme see: http://hearing.screening.nhs.uk/