Screening Quality Assurance Service NIPE update July 2017

1. Screening Quality Assurance
Service Update for Newborn and
Infant Physical Examination
SQAS North regional NIPE event 19.07.17
Pam Tarn

2. • Update on QA operating model
• Programme specific operating model
• New areas for ANNB
• New format QA visit report
• Themes from visits and incidents
• Shared learning

3. Operating model

4. Operating Model for QA
“QA is the process of checking that national standards are met
(ensuring that screening programmes are safe and effective) and
encouraging continuous improvement.”
What is Quality Assurance?

5. Screening Pathway for QA
“The antenatal and newborn screening QAbegins with
the identification of eligible women and babies and
relevant tests as per each screening programme. It
includes acknowledgement of the referral by treatment or
diagnostic services as appropriate (for individuals/families
with screen-positive results), or the completion of the
screening pathway”
Ref: QA Operating Model

6. • Four regional teams with sub-regional
offices
• Senior (consultant) team providing
leadership and oversight
• Portfolio approach for senior team
• Programme specific staff
• Using clinical experts central –
Professional & Clinical Advisors
• National team coordinating ‘do once
activities’
• National data & analytic team
Screening QAService (SQAS)

7. Aims of the SQAS
• Deliver a consistent QA process across England
• Provide support to commissioners and providers
• Be a resource of specialist advice/expertise on screening
• Devise and operate robust monitoring arrangements to ensure that
services are delivered to the highest levels of quality, safety and
efficiency
• Monitor and review performance of each individual service
• Take appropriate action when screening performance is highlighted
as a concern
• Contribute to the development of national policy
• Support the implementation of national screening initiatives

8. SQAS lead arrangements
National portfolio leads
Antenatal: Nadia Permalloo Newborn: Dr. Helen Lewis-Parmar
National oversight and leadership for incidents, visits,
National groups
Work with programme managers
Regional portfolio leads
North: Helen Lewis-Parmar Midlands and East:: Jane Woodland
South: Morag Armer London: Jan Yates
Regional SQAS
Attendance at public health commissioning team programme boards
Incident support and advice
Support for roll out of new programmes/initiatives
Data and audit
Visits
Professional QA networks/meeting
Proactive engagement with providers/PHCT

9. • Programme Specific Operating Model
• QA Visits
• Annual prioritisation process
• New areas for ANNB
• New format QA reports

10. Why Do We Need PSOMs?
Transparency
• Making sure providers knows what they are being assessed on and
what we QA
• Enables us to communicate clearly about what we do
Consistency (reliability)
• Assessing all providers in the same way
• Enables us to develop tools, evaluate them and decide which are
the best at picking up quality
Effective use of resources
• Enables us to plan and use our resources effectively across all of
SQAS, only doing what we have agreed to do

11. NewAreas forANNB Screening
Change in terminology – still a peer review model, peer reviewers are
now called ‘Professional and Clinical Advisors’ or PCAs
Flexible time period between visits
• maximum visit interval of five years
• can bring visits forward
• can target specific elements for quality assurance activity
New areas include
• revised annual prioritisation tool
• diabetic eye screening in pregnancy
• working with UKAS for laboratory quality assurance
• new national programme standards and revised datasets
• new format visit report

12. Annual prioritisation
Annual assessment of services providing antenatal and newborn
screening to prioritise screening quality assurance activities
• systematic transparent approach to prioritise quality assurance
activity
• tool developed for use all across all programmes
Brings together
• routine data
• progress against previous recommendations
• information about how incidents have been managed
• intelligence from providers and commissioners
Outcomes
• agree visit schedule for following year, can bring forward a visit
• or target quality assurance support to specific pathway or
performance area

13. Visit Recommendations
Recommendations are all evidenced against
• National service specification,
• Key performance indicators , standards and national guidance
Immediate safety concern
• Letter issued to trust within 48 hours, confirm action 7 days
High or standard priority recommendations
• Timeline is independent of priority (usually 3, 6 or 12 months)
Evidence required for closure of recommendation is defined
Process
• Trust develops an action plan in response to recommendation
• SQAS and commissioners follow progress for 12 months
• SQAS letter at 12 months to commissioner and provider
summarising progress and outlining further actions needed

14. New SQAS Visit Report Format
• Changed in response to feedback from commissioners and
providers
• Shorter, less repetition, easier to read following plain English
principles
• Stand alone Executive Summary published on GOV.UK
• Recommendations
• appear only in once summarised in a table
• are evidenced against a programme standard or the national
service specification
• Continued emphasis on shared learning that highlights
• high quality work that is above expected as standard practice
• innovative solutions to areas that other services are struggling
with

15. NIPE

16. Notifying Incidents
• National screening incident guidance
• Revised Screening Incident Assessment Form (SIAF)
• plain English
• improved instructions
• clarity on who completes each section
• revised screening incident categories
• confirms issue and defines action
e.g. internal investigation (RCA removed)
• states if final report is expected

17. Themes from incidents
• Missed or delayed NIPE
• Missed or delayed referral for hip USS (clinical findings or risk
factors)
• IT problems resulting in failure to refer
• Documentation problems including e.g. NHS number, missed
components in NIPE SMART
• All ANNB – processes for follow-up when women and babies move
into or out of areas
• Increased use of NIPE SMART expected to identify weakness in the
screening pathway which can then be rectified

18. Actions from incident monitoring
• Themes from incidents are monitored regionally and nationally
• Summary reports are produced every quarter
• Learning from incidents is highlighted within screening programme
boards
• SQAS and the national programmes work together to agree actions
in response to incident themes
Examples include
• development of quality improvement processes for
recording of outcomes on NIPE SMART
• revision of e-learning resources
• updating documents and guidance

19. Recommendations from visits
• Timeliness of NIPE examination
• Referral pathway for all four conditions included in the NIPE
examination
• Timely USS referral for hips
• Clinical leadership
• Failsafes and implementation of NIPE SMART
• Competency of screeners
• Guidelines, policies and SOPs including the reference to the
national screening incidence guidance and management
• NIPE results transfer to CHIS

20. Shared learning
Shared learning is highlighted in SQAS visit reports
SQAS share these into professional forum and networking groups
• NIPE clinical lead annual audit of screen positive outcomes
• competencies for NIPE examination are incorporated into appraisal
and personal development review processes for the identification of
further training needs

21. Questions?