The newborn and infant physical examination Cymru (WHC/2023/040)

Details:

Issue date:

9 November 2023.

Status:

Action.

Category:

Workforce / quality and safety.

Title:

The NHS Wales: Newborn and Infant Physical Examination Cymru (NIPEC).

Date of expiry/review:

Non applicable.

For action by:

• local health boards
• maternity and neonatal services
• paediatric services
• primary care services
• NHS Executive

Action required by:

November 2023.

Sender:

• Professor Chris Jones CBE (Welsh Government)
• Sue Tranka (Welsh Government)
• Dr Heather Payne (Welsh Government)

HSSG Welsh Government contact(s):

• Dr Heather Payne, Senior Medical Officer for Women, Children and Screening, Welsh Government
• Lois Huelin, Senior Children’s Health Manager, NIPEC Project Manager
• Alex Hicks, Head of Children’s Health, Quality and Nursing Directorate

Enclosure(s):

None.

1. We have published new set of guidelines and standards for the newborn and infant physical examinations for implementation by health boards in Wales.
2. The guidelines and standards have been coproduced with NHS Wales to align with UK national screening standards recommendations, to ensure every baby is offered a physical examination within 72 hours of birth and at 6 weeks of age to screen for early identification of treatable conditions relating to four areas, the eyes, hips, heart, and testes (in boys).
3. Newborn and infant examination practices are already embedded within each health board. The focus has been to improve the quality and consistency of these examinations across professions and throughout Wales. Expert groups of clinicians across Wales have agreed a clear set of standardised pathways to ensure a consistent, quality assurance process from examination to referral for more detailed assessment and any necessary treatment.
4. Accountability and delivery of NIPEC remains fully with individual health boards. These standards will assist meaningful reporting and assurance mechanisms, and ongoing quality improvement work.
5. The screening and referral pathways will help clinicians deal safely with any concerns identified, and identify when prompt referral is needed for more detailed assessment by the relevant clinical expert.
6. Successful early identification and timely referral for treatment in the four screening elements is highly prudent healthcare, as well as improving outcomes for children. Problems avoided include visual loss from congenital cataracts, death or heart failure from congenital cardiac disease, mobility limitations, pain and surgical intervention from developmental dysplasia of hips, and infertility or cancer risk from undescended testes.
7. The NIPEC project standards provide a defined set of measures that health boards must meet to ensure local delivery is safe and high quality. Health boards should make sure there are local systems for collecting and reporting coverage and timeliness data (such as date of post screen positive referral appointment or review) as key proxies for screening outcomes.
8. We expect health boards to ensure processes, including data capture, are developed and put in place for monitoring and quality assurance. The Integrated Quality Planning Delivery (IQPD) meetings are providing delivery oversight and scrutinising national consistency, pending any developments at NHS Executive level, with the introduction of a national Children’s Health Clinical Network and Maternity and Neonatal Clinical Network.
9. We would like to invite health boards to nominate a senior NIPEC lead within each health board, to form a national community of practice, pooling expertise with the aim of sharing good practice, and providing leadership on training, standards and implementation. Could health boards ensure they have sent details of their NIPEC lead nomination to hss-dph-populationhealthcare@gov.wales, marked for the attention of Children’s Health Branch by 18 December 2023.
10. This will create a sustainable legacy of the national work undertaken to date and continue the drive towards consistent service quality and skills for children’s care across Wales during implementation.
11. All healthcare professionals have a personal and professional responsibility to maintain their clinical competency. There is also an organisational responsibility to ensure a safe and competent workforce. Those who undertake NIPEC examinations must work in a framework of professional accountability and code of conduct. Each practitioner is responsible for maintaining their own competence to carry out the examination to the highest standard and to identify gaps in their knowledge and any training needs.
12. Health Education and Improvement Wales (HEIW) have developed a support offer for NHS Wales in the form of a multi-professional NIPEC continuing professional development for use across Wales. A range of tools have been developed to support NHS Wales’ workforce in implementation.

These include:

• a NIPEC webinar hosted by HEIW to launch the resources: 9th November 2023
• a multi-professional e-learning module hosted on ‘Y Ty Dysgu’
• quarterly webinars commissioned by HEIW and delivered by the University of South Wales, Cardiff, Swansea and Bangor Universities; commencing Spring 2024, these sessions can be attended live or will be recorded and hosted on ‘Y Ty Dysgu’
• a NIPEC handbook
• an annual learning framework and guidance with recommendations
• peer review framework, guidance, and template

13. Information for parents is incorporated within every child work led by PHW and the replacement for Bump, Baby and Beyond in the first new publication Your Pregnancy and Birth, which was published in May this year.
14. We would like to take this opportunity to extend our thanks to all NHS Wales colleagues who have led and supported this work.
15. All HEIW learning and training resources, the Welsh Government NIPEC Guidelines and Standards are hosted the HEIW website.