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Antenatal Screening Updates
Alison Fiddler QA Advisor
Public Health England leads the NHS Screening Programmes
FASP
Implementation of 3 vessel trachea view
• Two regional workshops with practical training have
been completed for the screening support sonographers
from each Trust across London
• Roll out and implementation to be completed within 16
weeks of attending the workshop
2 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
FASP
T18/13 screening has been implemented in the majority of laboratories
and maternity units. Some issues in a few laboratories using
Viewpoint are still to be resolved
Quad testing for twins has been implemented in all second trimester
screening laboratories
FA2 KPI coverage for 18 – 20+6 scan
This will be included in the 2016/17 KPI schedule – a practical tips and
guidance document will be released shortly
3 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
FASP: elearning
The 18-20+6 elearning resource has been fully revised and
relaunched: 6 units aimed at midwives and
sonographers
CEMT21 is currently being updated: due end of 2016 - to
include T18/13 and Quad test for twins & NIPT module
to be inserted on implementation
4 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
FASP: NIPT
Scoping of NIPT implementation
Awaiting ministerial decision
Planning groups are in development around:
• Laboratory issues
• Procurement
• Education and information
• Data reporting and monitoring
• NIPT ethical issues online survey: deadline 25th July
5 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
IDPS – data collection 2016/17
Streamlining and reducing duplication
Collate matched cohort data and ensure consistency
Data submitted annually 30 June: Fiscal year April – March
Data will include:
• NAISM previously submitted quarterly
• 5 of the 7 standards (2 standards are reported quarterly
as KPI’s)
In the longer term: data may be available from the
maternity and children’s dataset via HSCIC
6 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
IDPS KPI changes 2016/17:
• ID1: Threshold change
Acceptable raised from >90% to >95%
Achievable raised from >95% to >99%
• ID2 Definition change:
Inclusion criteria: All newly positive or high infectivity
• 2017/18: Plans to incorporate standard 2 and 3 into quarterly KPI
reporting (HepB and Syphilis coverage). 2016/17 pilot planned
• Reoffer of IDS screening is now by 20/40
7 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
IDPS: New leaflets available
8 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
“What does my positive
screening result mean?”
Leaflets available for download:
• HIV
• HepB
• Syphilis
• Available in English and 12
other languages
https://www.gov.uk/government/collections/infectious
-diseases-in-pregnancy-screening-clinical-guidance
IDPS
New resources planned:
• eLearning resources – a higher knowledge version
• Counselling resource tool
• Posters and specialised guidance for Delivery Suites
9 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
Update e- FOQ
Sunquest have been commissioned to design an Electronic Family
Origin Questionnaire to be incorporated into their blood test
requesting system ICE.
Testing at a pilot site (Wexham Park): issues at the midwife end
have been fixed.
There have been several challenges with the lab side of the process
which have been undergoing fixing and testing.
Roll out expected to start in July
4 Trusts in London use Sunquest
10 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
SCT documents
11 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
SCT programme handbook 2011
Handbook for laboratories 2012
Updated documents due end of
2016
Annual data report 2014/15
• Data report for 2014/15 was published on
24th March
• Available on gov.uk at
• https://www.gov.uk/government/publications/
sickle-cell-and-thalassaemia-screening-data-
trends-and-performance-analysis
12 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
ST2 – Improving timeliness of screening
and PND
Aims of SCT antenatal screening are to offer reproductive choice to
women/couples at risk of having an affected child
To maximise choice the aim and the national standard is that prenatal
diagnosis is performed by: 12+6
Acceptable standard: 50%
Achievable standard: 75%
A working group was formed with members from the SCT advisory group
Reasons for why women are tested late were explored
13 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
ST2: Why are women tested late?
Contracts, financial incentives
PND data: incomplete, sensitive data
Ease of access to maternity care
Lack of awareness of the screening programme
Cultural issues
No fast track for at risk couples
Complex pathway
HCP’s/hospital staff: roles, responsibilities, awareness, knowledge base
Multitude of IT and systems issues
14 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
15 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
Early testing: KPI ST2
16 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
61.3
56.0
37.4
60.1
53.1
58.1
56.8
48.6
40.7
60.7
51.2
0
10
20
30
40
50
60
70
80
90
100
East
Midlands
East of
England
London North East North West South
Central
South East South West West
Midlands
Yorkshire &
The Humber
England
%
Excludes 16 trusts that did not provide data for all four quarters.
Pregnancy outcomes: early testing and
offer of informed choice (2008-15)
17 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
75.1 67.7 57.3
0
10
20
30
40
50
60
70
80
90
100
<12+6 weeks 13+0 - 14+6 weeks ≥15+0 wks
%
Gestation
Proportion of affected results where parents opted to terminate, grouped by gestation
at PND for known pregnancy outcomes, 2008-15: England
*Excludes cases where the gestation at PND was unknown, and cases where the pregnancy outcome was unknown.
ST2 – Improving timeliness of screening
and PND
SCS and UKTS collaboration awarded the contract
for public engagement
Working with 2 of the lowest performing Trusts:
One in London and one in West Midlands
18 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
ST2 project
Key messages on early testing have been added to:
• NHS choices
• BMJ e-learning
19 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
Thank you
20 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016

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1. Antenatal screening updates

  • 1. Antenatal Screening Updates Alison Fiddler QA Advisor Public Health England leads the NHS Screening Programmes
  • 2. FASP Implementation of 3 vessel trachea view • Two regional workshops with practical training have been completed for the screening support sonographers from each Trust across London • Roll out and implementation to be completed within 16 weeks of attending the workshop 2 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 3. FASP T18/13 screening has been implemented in the majority of laboratories and maternity units. Some issues in a few laboratories using Viewpoint are still to be resolved Quad testing for twins has been implemented in all second trimester screening laboratories FA2 KPI coverage for 18 – 20+6 scan This will be included in the 2016/17 KPI schedule – a practical tips and guidance document will be released shortly 3 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 4. FASP: elearning The 18-20+6 elearning resource has been fully revised and relaunched: 6 units aimed at midwives and sonographers CEMT21 is currently being updated: due end of 2016 - to include T18/13 and Quad test for twins & NIPT module to be inserted on implementation 4 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 5. FASP: NIPT Scoping of NIPT implementation Awaiting ministerial decision Planning groups are in development around: • Laboratory issues • Procurement • Education and information • Data reporting and monitoring • NIPT ethical issues online survey: deadline 25th July 5 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 6. IDPS – data collection 2016/17 Streamlining and reducing duplication Collate matched cohort data and ensure consistency Data submitted annually 30 June: Fiscal year April – March Data will include: • NAISM previously submitted quarterly • 5 of the 7 standards (2 standards are reported quarterly as KPI’s) In the longer term: data may be available from the maternity and children’s dataset via HSCIC 6 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 7. IDPS KPI changes 2016/17: • ID1: Threshold change Acceptable raised from >90% to >95% Achievable raised from >95% to >99% • ID2 Definition change: Inclusion criteria: All newly positive or high infectivity • 2017/18: Plans to incorporate standard 2 and 3 into quarterly KPI reporting (HepB and Syphilis coverage). 2016/17 pilot planned • Reoffer of IDS screening is now by 20/40 7 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 8. IDPS: New leaflets available 8 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016 “What does my positive screening result mean?” Leaflets available for download: • HIV • HepB • Syphilis • Available in English and 12 other languages https://www.gov.uk/government/collections/infectious -diseases-in-pregnancy-screening-clinical-guidance
  • 9. IDPS New resources planned: • eLearning resources – a higher knowledge version • Counselling resource tool • Posters and specialised guidance for Delivery Suites 9 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 10. Update e- FOQ Sunquest have been commissioned to design an Electronic Family Origin Questionnaire to be incorporated into their blood test requesting system ICE. Testing at a pilot site (Wexham Park): issues at the midwife end have been fixed. There have been several challenges with the lab side of the process which have been undergoing fixing and testing. Roll out expected to start in July 4 Trusts in London use Sunquest 10 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 11. SCT documents 11 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016 SCT programme handbook 2011 Handbook for laboratories 2012 Updated documents due end of 2016
  • 12. Annual data report 2014/15 • Data report for 2014/15 was published on 24th March • Available on gov.uk at • https://www.gov.uk/government/publications/ sickle-cell-and-thalassaemia-screening-data- trends-and-performance-analysis 12 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 13. ST2 – Improving timeliness of screening and PND Aims of SCT antenatal screening are to offer reproductive choice to women/couples at risk of having an affected child To maximise choice the aim and the national standard is that prenatal diagnosis is performed by: 12+6 Acceptable standard: 50% Achievable standard: 75% A working group was formed with members from the SCT advisory group Reasons for why women are tested late were explored 13 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 14. ST2: Why are women tested late? Contracts, financial incentives PND data: incomplete, sensitive data Ease of access to maternity care Lack of awareness of the screening programme Cultural issues No fast track for at risk couples Complex pathway HCP’s/hospital staff: roles, responsibilities, awareness, knowledge base Multitude of IT and systems issues 14 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 15. 15 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 16. Early testing: KPI ST2 16 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016 61.3 56.0 37.4 60.1 53.1 58.1 56.8 48.6 40.7 60.7 51.2 0 10 20 30 40 50 60 70 80 90 100 East Midlands East of England London North East North West South Central South East South West West Midlands Yorkshire & The Humber England % Excludes 16 trusts that did not provide data for all four quarters.
  • 17. Pregnancy outcomes: early testing and offer of informed choice (2008-15) 17 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016 75.1 67.7 57.3 0 10 20 30 40 50 60 70 80 90 100 <12+6 weeks 13+0 - 14+6 weeks ≥15+0 wks % Gestation Proportion of affected results where parents opted to terminate, grouped by gestation at PND for known pregnancy outcomes, 2008-15: England *Excludes cases where the gestation at PND was unknown, and cases where the pregnancy outcome was unknown.
  • 18. ST2 – Improving timeliness of screening and PND SCS and UKTS collaboration awarded the contract for public engagement Working with 2 of the lowest performing Trusts: One in London and one in West Midlands 18 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 19. ST2 project Key messages on early testing have been added to: • NHS choices • BMJ e-learning 19 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016
  • 20. Thank you 20 Antenatal Screening Updates LCO & HoM Forum – 1 July 2016