Healthcare Screening Programme Report 2015-2016
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Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
1
Healthcare Screening
Programme Report
2015-2016
Author Christina Morrison, Health Protection and Screening Nurse Specialist
Date Version control Next review due date Reviewers/review team
03.03.2017 V 4 Annual PH Governance Group
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Contents
Executive Summary ............................................................................................................ 4
1 Screening in Scotland ................................................................................................. 6
2 Antenatal Screening .................................................................................................... 7
2.1 Overview ................................................................................................................. 7
2.2 Delivery of NHS WI pregnancy screening programmes .......................................... 8
2.3 Ultrasound scanning ............................................................................................. 11
2.4 Future developments ............................................................................................ 12
3 Newborn Bloodspot Screening ................................................................................. 13
3.1 Overview ............................................................................................................... 13
3.2 Delivery of Bloodspot Screening in NHS WI .......................................................... 14
3.3 Future developments ............................................................................................ 18
4 Hearing Screening ..................................................................................................... 19
4.1 Overview ............................................................................................................... 19
4.2 Service delivery .................................................................................................... 19
4.3 Future developments ............................................................................................ 21
5 Abdominal Aortic Aneurysm Screening ................................................................... 22
5.1 Overview ............................................................................................................... 22
5.2 Background........................................................................................................... 22
5.3 Aim of screening ................................................................................................... 22
5.4 Eligible population for screening ........................................................................... 22
5.5 AAA screening test ............................................................................................... 23
5.6 Screening Key Performance Indicators (KPIs) and screening outcomes ............... 23
5.7 Future developments ............................................................................................ 29
6 Diabetic Retinopathy Screening (DRS) ..................................................................... 30
6.1 Overview ............................................................................................................... 30
6.2 Background........................................................................................................... 30
6.3 Aims of screening programme .............................................................................. 30
6.4 Eligible population for screening ........................................................................... 30
6.5 The screening test ................................................................................................ 33
6.6 Screening outcomes ............................................................................................. 33
6.7 Grading ................................................................................................................. 35
6.8 Following a negative result .................................................................................... 36
6.9 Following a positive result ..................................................................................... 36
6.10 Future developments ............................................................................................ 37
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Figures & Tables
Figure 1: Uptake of newborn hearing screening by deprivation quintile in all of NHS
WI, financial period 2013/14 – 2015/16. ................................................................... 20
Figure 2: AAA Screening Pathway of care ............................................................... 27
Figure 3: Summary of DRS outcomes - period 2015-16 ........................................... 32
Table 1: NHS WI Cohort for antenatal screening by deprivation quintile .................... 8
Table 2: Total uptake of antenatal screening in NHS Western Isles by number and
percentage. ................................................................................................................ 9
Table 3: NHS WI Rubella screening uptake by deprivation quintile ........................ 10
Table 4: NHS WI HIV screening uptake by deprivation quintile ................................ 10
Table 5: NHS WI Hepatitis B screening uptake by deprivation quintile .................... 11
Table 6: NHS WI Syphilis screening uptake by deprivation quintile ......................... 11
Table 7: Eligible cohort for Newborn Screening, NHS WI by Deprivation quintile,
period 2014-15 and 2015-16 .................................................................................... 15
Table 8: Distribution of ancestry groups, NHS WI .................................................... 15
Table 9: Number and percentage of mothers born in the UK, NHS WI .................... 16
Table 10: Total specimens received by the lab for testing on NHS WI newborns .... 16
Table 11: Avoidable repeat samples ........................................................................ 17
Table 12: Number and percentage of babies tested vs specimen days in transit ..... 17
Table 13: NHS WI hearing screening uptake by deprivation quintile ........................ 20
Table 14: Number of men eligible, invited and uptake rates for NHS WI AAA
screening, period 1st April 2015 to 31st March 2016 ................................................. 24
Table 15: KPI 1.3 Uptake of AAA screening by SIMD quintile, NHS Western Isles &
Scotland ................................................................................................................... 25
Table 16: KPI 1.4a Percentage of annual surveillance appointments due where men
are tested within 6 weeks of due date ...................................................................... 26
Table 17: Number of self referral men and positive screen results by year and
cumulative number to end of period 31st March 2016. ............................................ 26
Table 18: NHS WI Cumulative number of men with initial screen positive results by
aneurysm size since introduction of the AAA programme in 2012 ........................... 28
Table 19: KPI 3.1: Percentage of men with AAA≥5.5cm seen by vascular specialist
within two weeks of screening .................................................................................. 28
Table 20: DRS uptake, DNA rate and successful screening rate ............................. 34
Table 21: DRS KPIs 8 and 9; written report result within 4 weeks ........................... 35
Table 22: Grading of Diabetic Retinopathy Screened images .................................. 36
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Executive Summary
This report provides information relating to the non-cancer screening programmes in
place in NHS Western Isles. It encompasses the screening of pregnant women and
their newborn babies, screening of older men for abdominal aortic aneurysm, and of
all people aged 12 years and above with diabetes for retinopathies.
Each programme is Scotland wide and is supported by national training and
education and a national screening group, enabling those responsible for the
programmes to exchange information, make comparisons across geographies and
learn from each others’ experiences of activities around the programmes.
Healthcare Improvement Scotland is responsible for the development and monitoring
of key performance indicators, intended to ensure that programmes are operating to
best effect, and also to highlight areas where improvement would be beneficial. The
success of screening programmes, across the organisation as a whole, relies on
individuals working in a coordinated manner to deliver a safe, effective and quality
assured programme to our population.
Successful measurement of screening programmes requires robust information
management systems to be in place. Historically, this has been a weakness within
NHS Western Isles, however, systems are being adapted and established to provide
effective data collection. All programmes, with the exception of the universal national
hearing screening progamme, have established data collection systems.
Our geography offers a unique position for partnership working which can be seen
with diabetic retinopathy screening, where NHS Western Isles Public Health and
Health Strategy Division work closely with local Optometrists to provide a safe and
effective person-centred programme, enabling multicentre or domiciliary access to
the screening programme, throughout the islands.
This screening report aims to provide an overview of screening programmes in the
period 1st April 2015 to 31st March 2016. There are differences in timeframe reporting
in AAA screening as ISD data on uptake is cumulative, based on men who have
turned 65 years of age from 29th June 2012 to 31st March 2016.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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In the pregnancy and newborn screening programme, figures are given for the
period 2013-14 - 2015-16 to enable comparisons of data and give deeper
understanding of our population. There are limitations to the data as a robust
information management system is required for the inter-island reporting of
pregnancy and newborn data and is not yet functional.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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1 Screening in Scotland
Screening programmes are designed to detect early signs of disease in the healthy
population and then to provide a reliable method of referral for diagnostic testing and
further treatment. Early detection and management should result in better outcomes
for screen positive individuals.
In order for a screening programme to be considered for national designation, it must
be acceptably accurate and designed to test for a disease where earlier detection
and intervention would be of benefit to the patient. Introduction, modification or
withdrawal of a population screening programme is based on a set of internationally
recognised criteria and rigorous evidence review, weighing the ethical benefit versus
harm of a screening programme.
Screening policy is set by the Scottish Government Health Directorate on the advice
of the UK National Screening Committee (UK NSC) and others such as the Scottish
Screening Committee (SSC).
The UKNSC reviews the best quality evidence available worldwide to assess
whether a screening programme should be established for a new condition.
Evidence is used both to recommend the introduction of a new screening
programme and to monitor the effectiveness/need for existing programmes. The
evidence is usually sourced from peer reviewed journals, which means that it has
been subject to critical analysis by other experts.
Evidence is also important for explaining why screening is not recommended for
some conditions when people might believe it should be. In addition, some
conditions are routinely tested for in a person’s clinical care when attending their
General Practitioner. In these cases testing is not the responsibility of the UK NSC or
SSC.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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2 Antenatal Screening
2.1 Overview
Antenatal screening in pregnancy is offered to all pregnant women at the first
booking visit. Women in NHS WI are encouraged to access an antenatal booking
appointment prior to 12 weeks gestation. Booking appointments can be accessed by
the woman from either direct contact to Maternity services or via their general
practitioner (GP). In the antenatal booking appointment, all women are offered
screening tests for:
a) Haemoglobinopathies: An antenatal blood test that screens for sickle cell and
thalassaemia which aims to identify couples at risk of having an affected child. This
identification allows the couple to have information on which to base reproductive
choices.
The pregnant woman is requested to complete a family origin questionnaire. The
information on the questionnaire and the blood test are assessed to identify the risk
of either parent being a carrier of sickle cell and other haemoglobin variants. Where
a mother is identified as a carrier, the baby’s father will also be offered testing to
identify risk to the baby.
b) Communicable diseases: An antenatal blood test that screens for HIV, Hepatitis
B (HBV), Syphilis and Rubella. This screening is carried out to identify infection and
allow for the management and treatment of affected individuals, their families and
their babies to be put in place at the earliest opportunity. Screening allows for the
treatment of the mother and to minimise the risk of mother to child transmission,
improve long term outcomes and enhanced care of the mother and baby.
c) Down Syndrome and Congenital anomalies screening: A blood test combined
with an ultrasound anomaly scan of the developing fetus and analysis of maternal
risk factors aims to detect the risk of Down Syndrome and other congenital
anomalies in the early antenatal period. A test called AFP is offered at 20 weeks if
the woman books for antenatal care after 12 weeks or has changed her original
decision not to be screened at the earlier offer. The decision for a pregnant woman
to accept screening for Down Syndrome and other congenital abnormalities raises
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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moral and ethical issues in pregnancy. Screening allows women and their partners to
have information on which to base management of pregnancy choices which can be
planned for in the antenatal period.
2.2 Delivery of NHS WI pregnancy screening programmes
There is a statutory requirement for NHS Boards to submit data on antenatal activity.
Key Performance indicators (KPIs) are set by Healthcare Improvement Scotland,
and incorporate HEAT targets, to measure outcomes which demonstrate
standardised service delivery of person-centered, safe and effective healthcare.
Pregnancy and Newborn KPIs and HEAT targets can be accessed from:
http://www.healthcareimprovementscotland.org/our_work/reproductive,_maternal__c
hild/programme_resources/pns_indicators.aspx and
http://www.gov.scot/About/Performance/scotPerforms/partnerstories/NHSScotlandpe
rformance/AntenatalAccess
There were 184 women booked to attend antenatal clinic care throughout the
Western Isles, recorded in the Scottish Birth Record (SBR), in the financial period of
1st April 2015 to 31st March 2016. Data can be further divided by Scottish Index of
Multiple Deprivation (SIMD) quintile.
Deprivation quintiles split data into 5 groups, each containing 20% of the data and
with each group described from group 1 (the most deprived) to group 5 (the most
affluent). Table 1 shows the total number of women booked by SIMD in NHS WI,
documented in the SBR.
Table 1: NHS WI Cohort for antenatal screening by deprivation quintile
Local Deprivation Quintile
Born in financial year 1 2 3 4 5
Total Cohort
2013-14 47 42 27 45 46 207
2014-15 39 29 16 46 42 172
2015-16 37 32 35 41 39 184
Source: Scottish Birth Record (SBR) Cohort for Antenatal screening. (This does not include records not recorded on SBR or those delivered in Western Isles where residence is elsewhere).
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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A quick glance table of the screening uptake by pregnant women in NHS Western
Isles is provided below (Table 2).
Table 2: Total uptake of antenatal screening in NHS Western Isles by number and percentage.
Number Uptake (%)
Eligible cohort 184*
Haemoglobinopathies** 18 9.7
Rubella 171 92.9
Hep B 163 88.5
Syphilis 165 89.6
HIV 160 86.9 Source: SBR. *Haemoglobinopathies % uptake is based on samples sent for testing not actual
consent for screening. **Anomaly screening shows above 100% uptake, this is due to some anomaly
scans requiring multiple visits to complete screening requirements.
The Scottish Morbidity Record - Maternity (SMR-02) provides data on when women
attend for antenatal booking with the midwife. Eighty two percent of antenatal
bookings occurred within 10 weeks gestation and 94% of women booked by 12
weeks gestation in the period 1st April 2015 to 31st March 2016. This highlights that
NHS WI Maternity Services in NHS Western Isles are achieving the HEAT target by
successfully booking over 94% of pregnant women before 12 weeks gestation.
KPI 4.2 is timeliness of screening for haemoglobinopathies, measuring this on the
screening sample being received by 10 weeks gestation. The screening is carried
out in two parts; a screening questionnaire, and processing of the blood sample to
identify the presence of haemoglobinopathies.
The laboratory risk-assesses women based on the questionnaire; into high and low
risk categories, with the blood samples of those in the high risk category being sent
for further screening.
Of all women booked in NHS WI for 2015-16, 18 samples were sent away for
screening of haemoglobinopathies, however data are not available to identify the
total of individuals consenting to being screened or when the screening took place.
All women are offered haemoglobinopathy screening in NHS WI. However, it is not
possible to identify the uptake and delivery of this screening within 10 weeks
gestation, as recommended by the KPI, since our recording system is set up for 12
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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weeks. It is anticipated that the Badger net IT system will enable this KPI to be
assessed.
Uptake for all four communicable diseases screening tests offered at initial booking
varied between 86.9% and 92.9% (Table 2), noting that data is incomplete in the
SBR system. Tables 3-6 show the uptake rates of each communicable disease
screened for in NHS WI and by deprivation quintile. The identified percentage uptake
of antenatal screening is lower in deprivation quintile 3 in period 2015-16; however, it
is too early to draw conclusions from this as more data would be required to
establish if this is a pattern unique to NHS WI.
Table 3: NHS WI Rubella screening uptake by deprivation quintile
Rubella WI Deprivation Quintile n (%)
Delivery in financial year 1 2 3 4 5 Grand Total
2013/14 46
(98) 41
(98) 25
(93) 43
(96) 45
(98) 200 (97)
2014/15 36
(92) 28
(97) 15
(94) 46
(100) 42
(100) 167 (97)
2015/16 35
(95) 31
(97) 29
(83) 40
(98) 36
(92) 171 (93)
Source: SBR
Table 4: NHS WI HIV screening uptake by deprivation quintile
HIV Deprivation Quintile n (%)
Delivery in financial year 1 2 3 4 5 Grand Total
2013/14 44
(94) 39
(93) 25
(93) 42
(93) 42
(91) 192 (93)
2014/15 31
(80) 29
(100) 12
(75) 44
(96) 42
(100) 158 (92)
2015/16 34
(92) 30
(94) 25
(71) 36
(88) 35
(90) 160 (87)
Source: SBR
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Table 5: NHS WI Hepatitis B screening uptake by deprivation quintile
Hep B Deprivation Quintile n (%)
Delivery in financial year 1 2 3 4 5 Grand Total
2013/14 45
(96) 41
(98) 26
(96) 40
(89) 45
(98) 196 (95)
2014/15 35
(90) 29
(100) 15
(94) 46
(100) 41
(98) 166 (97)
2015/16 33
(89) 29
(91) 28
(80) 38
(93) 35
(90) 163 (89)
Source: SBR
Table 6: NHS WI Syphilis screening uptake by deprivation quintile
Syphilis Deprivation Quintile n (%)
Delivery in financial year 1 2 3 4 5 Grand Total
2013/14 46
(98) 42
(100) 26
(96) 41
(91) 45
(98) 200 (97)
2014/15 36
(92) 28
(97) 15
(94) 46
(100) 42
(100) 167 (97)
2015/16 33
(89) 29
(91) 28
(80) 39
(95) 36
(92) 165 (90)
Source: SBR
2.3 Ultrasound scanning
Ultrasound scanning is carried out in pregnancy to assist with dating of pregnancy, to
confirm fetal growth and development and to identify specific anomalies. Three
hundred and six dating scans were carried out in the 2015-16 reporting period.
Numbers of dating scans are higher than the number of women booked as repeat
scans can be carried out for reasons such as:
unsure of dates
too early to scan for dating
poor visualisation
the need for a second opinion.
There were 220 women recorded in SMR-02 as pregnant in the reporting period, of
which 96% were reported to have received dating scans carried out in NHSWI.
Anomalies in numerator identification are apparent in pregnancy and newborn
screening due to a number of reasons; different recording systems, quality of data
recording, women may receive tertiary care in the perinatal period, or when patients
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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move residence. Thus identification of eligible cohorts is different from antenatal
communicable diseases to ultra sound scanning.
All pregnant women (100%) are offered screening for Down syndrome at booking.
Whilst 122 Nuchal dating scans were carried out, only 92 completed the CUBS
(combined ultrasound and biochemical screening) screening, therefore, uptake for
first trimester Down Syndrome screening from nuchal scans was 75% or 42% of total
women receiving local antenatal care. In the reporting period, no women in NHS WI
were tested in the second trimester of pregnancy.
It is important to note that not all CUBS samples have been recorded, as samples
from the Southern Isles have historically been sent directly to Glasgow. This system
has recently changed to ensure a more robust service and reduce possible errors or
omissions due to unrecorded information. All samples now go through NHS WI
Laboratory to Glasgow for processing.
There was a 96% uptake for anomaly scans in period 2015-16, with less than five
referrals to tertiary care.
2.4 Future developments
Gaps have been identified in the recording screening processes of antenatal care of
pregnant women. The future provision of a robust system has been identified as the
Badger net IT system and is due to be implemented in 2017-18. Badger net enables
the recording, viewing and auditing of data gathered on pregnant women in the
antenatal period, throughout NHS Western Isles. It allows women to access their
password protected information via an online portal, which can be downloaded to
their mobile phones, a positive development in woman centered care.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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3 Newborn Bloodspot Screening
3.1 Overview
NHS WI offers all babies born in NHS WI Newborn Bloodspot on day 5 after birth. A
capillary blood sample is gained by the midwife from the baby’s heel and collected
on a specialised bloodspot card, which is sent for analysis to the Scottish Newborn
Screening Laboratory, Southern General Hospital, Glasgow. The screening aims to
identify those babies at risk of abnormalities that can lead to growth and
developmental problems later in life. The identification of disease allows for
appropriate and timely management of conditions, which can result in a normal and
healthy life. Screening is carried out for five markers:
i) Phenylketonuria (PKU): is a condition that affects 1 in 8,000 babies born in
Scotland. It means that the baby cannot digest the amino acid phenylalanine,
and the buildup of phenylalanine can cause damage to the brain. Symptoms
appear after 6 months of age and can manifest as developmental delay and
may lead to seizures, learning disabilities and behavioural difficulties.
Phenylalanine is a natural part of the protein within our body and is found in
most of our foods. PKU is treated with a special low-protein diet, which
reduces levels of phenylalanine in the body preventing brain damage.
ii) Congenital Hypothyroidism (CHT): is a condition that affects approximately 1
in every 3,500 babies born in Scotland. Congenital means that a baby is born
with the condition of Hypothyroidism meaning that the baby won’t produce
enough of the hormone thyroxine, which is needed for healthy mental and
physical development.
Although CHT cannot be cured it can be treated simply and successfully by
giving daily thyroxine, which will result in children being able to live a full and
active life.
iii) Cystic Fibrosis (CF): This condition affects 1 in every 2,500 babies born in
Scotland. It is an inherited condition that occurs when a baby inherits an altered
form of the CF gene from each of its parents, which together cause CF. Both
parents are healthy carriers of the altered gene and are unaffected by the
condition themselves. CF affects the lungs and the pancreas the most, causing
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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chest infections and problems with digesting food. One in 25 people in Scotland
is a CF gene carrier. Being a carrier has no effect on the baby's health,
however knowing that your baby is a carrier is valuable for when they grow up
and have children of their own.
Babies with cystic fibrosis may not gain weight well and frequently have chest
infections. Babies with the condition can be treated early with a high-energy
diet, medicines, and physiotherapy. Although children with cystic fibrosis may
still become very ill, early treatment can help them live longer, healthier lives.
iv) Sickle Cell Disorder (SCD): is an inherited condition affecting 1 in 2,500
babies born in the UK. It is a condition that affects the quality of the cells which
carry oxygen in the blood. The blood cells of someone with SCD change from a
round shape to a ‘sickle’ shape, and get stuck in the small blood vessels. This
can cause pain and damage to the baby’s body, sometimes leading to serious
infection and can be fatal. Once detected, treatment includes antibiotics and
immunisations to help prevent serious illness. Screening will also identify
carriers of SCD.
v) Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD): affects
approximately 1 in 10,000 babies born in Scotland. Babies with this inherited
metabolic condition have problems breaking down certain fats in order to make
energy for their body. This is not a problem when a baby is well and feeding
normally but it can lead to serious illness and in some cases could be fatal
where a baby has an infection or goes for a long time without food.
3.2 Delivery of Bloodspot Screening in NHS WI
There were 232 babies eligible for newborn bloodspot screening in NHS WI during
2015-16 (Table 7), 229 (98.7%) of the total population were screened, a 4.7%
increase on season 2014/15.
Data were unable to be broken into different Island groups.
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Table 7: Eligible cohort for Newborn Screening, NHS WI by Deprivation quintile, period 2014-15 and 2015-16
Deprivation Quintile (number)
Born in financial year 1 2 3 4 5 Total Cohort
2014-15 52 32 35 52 45 216
2015-16 39 39 60 51 43 232
Source: Child Health System (This will include babies born outwith Western Isles and transferred in and exclude babies that have transferred out since birth)
Ancestry is requested for screening purposes as some conditions may be inherited
through genetic changes such as sickle cell. Conditions such as congenital
hypothyroidism are based on TSH concentration and can also be affected by a
newborns ethnic background. Table 8 shows the breakdown of the ancestry for
babies tested in NHS WI. 88% had white UK ancestry. Southern and other European
(White) and South East Asian ancestry were both 2%, whilst for 5% the ancestry was
not stated. Table 9 shows that 95% of mothers were born in the UK.
Table 8: Distribution of ancestry groups, NHS WI
Health Board Western Isles
Number %
A African or African-Caribbean 0 0
B. South Asian (Asian) 1 0.5
C. South East Asian (Asian) 4 2
D. Other non-European (other) 0 0
E. Southern & other European (White) 3 1.5
F. United Kingdom (White) 203 88
G. North Europe (White) 3 1.5
H. Don’t Know 0 0
I. Declined to Answer 0 0
J. Any Mixed Background 3 1.5
Z. Not Stated 12 5
Total 229 100
Source: Scottish Newborn Screening Laboratory data report 2015-16
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Table 9: Number and percentage of mothers born in the UK, NHS WI
Source: Scottish Newborn Screening Laboratory data report 2015-16
There were a total of 250 cards received in the West of Scotland Laboratory for
newborn screening (Table 10).
Table 10: Total specimens received by the lab for testing on NHS WI newborns
Source: Scottish Newborn Screening Laboratory data report 2015-16
*More than one outcome may apply.
Table 11 identifies that 14 avoidable repeat samples were carried out within this
period, 3.6% (9) were due to insufficient samples, 1.6% (4) due to no CHI being
reported and 0.4% (1) noted as other unsatisfactory, and some cards had multiple
errors resulting in repeat samples being required.
Mother born in UK
Yes
No.
(%)
No
No.
(%)
Unknown
No.
(%) Totals
Western Isles
217
(95%)
10
(4%)
2
(1%)
229
Specimen Test – Outcomes* NHS
WI Refused all tests 0
Partial refused 0
Insufficient blood to perform all
tests
9
Unsatisfactory >14 days in transit 1
Unsatisfactory Other 1
Updated info 2
IRT tested late (total) 2
IRT tested late (Born in Scotland) 2
<3 days post T/F 1
Normal result 227
Pre-TF 1
Sent for SCD DNA 0
Total Specimens received 250
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Table 11: Avoidable repeat samples
Health
Board Insufficient
>14
days
transit
<4
days
old
No
CHI Expired
Other
unsat
Total
avoidable
repeats
Total
cards
received
Western
Isles 9 1 0 4 0 1 14* 250
Source: Scottish Newborn Screening Laboratory data report 2015-16. * Total avoidable repeats are
less than the sum of all columns because some cards are included in more thean one category.
Timeliness of samples is important to enable specialist treatment of conditions
identified by the newborn bloodspot screening process. KPI 16 identifies that
specimens should reach the Laboratory within four working days. This KPI was
achieved for 80.2% (n 183) as shown in Table 12. This is an improvement of 4% on
period 2014-15, where 76% of samples reached the Laboratory in four working days.
Key performance indicators identify that babies screened positive for
Phenylketonuria, congenital hypothyroidism and MCADD require early access to
specialist care by 14 days of age (KPI 19), to treat and reduce severity of conditions.
This would not be possible if delays occur in the transportation to labs or the
requirement for repeat samples. However, 98% (n 223) of NHS WI samples arrived
within 7 days; this allows for processing and timely referral to specialists. It is not
possible to identify if all delays were due to remote and rural location.
Table 12: Number and percentage of babies tested vs specimen days in transit
Health Board Western Isles
Days in Transit: No. %
≤4 183 80.2
5-7 40 17.5
8-10 4 2.0
over 10 1 0.5
Total excluding pre-
transfusion cards 228 100
Source: Scottish Newborn Screening Laboratory data report 2015-16
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3.3 Future developments
A midwife has been identified to take the lead on implementation of Newborn blood
spot screening. Steps to raise awareness and provide further education on the taking
of a blood spot sample have been adopted aiming to reduce the number of avoidable
repeats.
The blood sample cards used in the screening process are changing in September
2016, reducing the amount of blood spots from five to four, similar to the sample
cards used across the rest of the rest of the UK. This will provide the opportunity to
increase awareness of the techniques required in the screening process.
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4 Hearing Screening
4.1 Overview
The Universal Newborn Hearing Screening Programme (UNHS) in Scotland aims to
identify all children born with a moderate to profound permanent bilateral deafness
early and to promote the provision of ongoing high quality and appropriate
assessment and support for deaf or hearing impaired children and their families. One
or two babies in every 1,000 are born with a hearing loss in one or both ears. Most of
these babies are born into families with no experience or history of hearing loss. The
hearing screening test is a simple test carried out within the first few weeks after a
baby is born.
4.2 Service delivery
In November 2013, Healthcare Improvement Scotland set out a new set of quality
indicators (KPI), for hearing screening, identified as indicators 11 – 13:
Indicator 11: Newborn hearing screening - timely completion.
Indicator 12: Newborn hearing screening - timely assessment of screening
referrals
Indicator 13: Newborn hearing screening - outcome
In NHS WI, 100% of parents were offered UNHS within the first four weeks of life,
achieving the KPI. The Scottish Birth Records indicate that uptake of screening in
2015-16 was 96%, a decrease of 1% on period 2014-15. However, NHS Tayside
UNHS (the oversight group encompassing NHS WI) reports 100% (n184) of the
eligible cohort were successfully screened in period 2015-16. This difference may be
due to discrepancies in date of screening data recording.
Uptake can be broken down further by SIMD as set out in Figure 1 and Table 13; no
clear deprivation gradient can be seen in the local data.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Figure 1: Uptake of newborn hearing screening by deprivation quintile in all of NHS WI, financial period 2013/14 – 2015/16.
Source: Scottish Birth Record
Table 13: NHS WI hearing screening uptake by deprivation quintile
Hearing Screening Deprivation Quintile n (%)
Born in financial year 1 2 3 4 5 Grand Total
2013/14 39
(91) 41
(95) 25
(93) 42
(98) 46
(88) 193 (93)
2014/15 39
(98) 29
(100) 13
(87) 46
(100) 40
(95) 167 (97)
2015/16 36
(97) 31
(97) 31
(89) 40
(98) 36
(97) 174 (96)
Source: Scottish Birth Record
The Scottish Birth Record shows that two neonates were referred for follow up to
specialist audiology services, after failed or incomplete result of screening, in the
period 2013-14 with no instances noted in period 2014-15 and period 2015-16.
However, there is missing data within the SBR system and timing of the decision to
refer is not recorded.
80
82
84
86
88
90
92
94
96
98
100
2013/14 2014/15 2015/16
1
2
3
4
5
TOTAL UPTAKE
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Audit base system records show that seven infants were referred to audiology in
NHS Western Isles, in the 2015-16 reporting period, due to a family history of
hearing loss. These children were followed up at eight months of age; all were
discharged from audiology as hearing was within normal limits.
Timeliness and final screening outcome data are not accessible from SBR,
Audiology systems or the National Hearing Screening Co-ordinator, thus KPIs 12
and 13 cannot be measured or commented on.
As planned for 2015, the Audit base system was implemented in the audiology
department NHS WI. This has provided a robust patient pathway tracking system
from screening to diagnostics.
4.3 Future developments
Hearing screening equipment requires replacement in period 2016-17. The new
machines will have the added capability of carrying out both AABR (automated
auditory brainstem response) and OAE (otoacoustic automated emission) screening,
allowing increased accuracy and flexibility in the screening process.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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5 Abdominal Aortic Aneurysm Screening
5.1 Overview
Abdominal Aortic Aneurysm (AAA) screening was implemented in NHS Western
Isles in June 2012. In the north west of Scotland AAA screening is carried out in
collaboration with NHS Highland. This report will inform on AAA screening in NHS
Western Isles only.
5.2 Background
An abdominal aortic aneurysm is described as the dilatation of the aorta within the
abdomen, where the aortic diameter is identified as being 3.0cm or more.
There are risk factors associated with the development of abdominal aneurysms,
including smoking, age, gender, family history of AAA, hypertension, atherosclerosis,
hyperlipidaemia, obesity and being Caucasian. Men from areas of higher deprivation
are more likely to have an abdominal aortic aneurysm than the least deprived. It is
unknown the effect that deprivation has on mortality rates. Research identified
Scotland as having a death rate of 42.7 per 100,000 men aged 65 to 74 years from
AAA in the year 2000, whilst a randomised controlled trial in England identified that
the mortality rates may be as high as 88 per 100,000 men aged 65 to 74 years.
Aneurysms are often asymptomatic and present a risk of rupture; the bigger the
aneurysm the greater the risk of rupture. Mortality following a ruptured aneurysm is
very high. When an aneurysm ruptures less than half of patients will reach hospital
alive and of those who receive surgery, only 60% can be expected to survive.
5.3 Aim of screening
The aim of AAA screening is to detect aneurysms in the male population early and to
monitor or treat by elective repair thus preventing spontaneous rupture.
5.4 Eligible population for screening
All men aged over 65 years of age who are resident in NHS Western Isles are
invited, by letter, to attend for an abdominal ultrasound scan. Men aged 66 years and
over can self refer to be included in the AAA screening programme.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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5.5 AAA screening test
Screening for AAA is carried out at two areas in NHS WI – at the Western Isles
Hospital and at the Uist and Barra Hospital.
Measurement of the abdominal aorta is achieved by an ultrasound scan of the
abdomen; this scan is carried out by an experienced and accredited Sonographer.
Clinics are run on a monthly basis and are a mixture of new men invited to attend
and follow up or ‘surveillance’ scans. Results will be given to the participant at the
point of screening. The result will dictate the pathway of care to be followed.
5.6 Screening Key Performance Indicators (KPIs) and screening outcomes
The outcomes are categorised into four different groups:
Normal: Aorta measures less than 3.0 cm. Normal aorta, patient discharged
from screening.
Small: Aorta measures 3.0cm to 4.4cm. Patients are monitored on an annual
basis.
Medium: Aorta measures 4.5cm to 5.4cm. Patients are monitored on a
quarterly basis.
Large: Aorta measures 5.5cm and over. Patient is referred to vascular
services in NHS Highland for assessment.
All participants identified as having a large aneurysm are referred for vascular
assessment; however they may not all be suitable for treatment due to their
individual health status and/or personal choice not to have further treatment.
The KPIs for AAA screening are points of measurement that cover the patient’s
journey from invitation, delivery of the scan, referral to vascular services and
outcome. They provide information that can be analysed to ensure quality of the
programme and inform on performance at a local and national level. The KPIs are
expressed in two thresholds:
Essential: the minimum level of performance which the programme is
expected to attain
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
24
Desirable: the screening programme should aspire to attain and maintain this
level of performance.
KPIs for the AAA programme are available at http://www.isdscotland.org/Health-
Topics/Public-Health/AAA-Screening/2017-03-07-AAA-KPI-Definitions.pdf
KPIs for AAA screening are based on HIS 2011 AAA screening standards, available
at
http://www.healthcareimprovementscotland.org/our_work/cardiovascular_disease/scr
eening_for_aaa/aaa_screening_standards.aspx
KPI 1.1 measures the percentage of the eligible population who are sent an initial
invitation for screening before the age of 66 years. 100% (203) of the NHS Western
Isles eligible population was invited to be screened in the period from 1st April 2015
to 31st March 2016 (Table 14), achieving the desired threshold.
The uptake of screening is reported at the age of 66 and 3 months (KPI 1.2), this
allows for men to have a further 3 months to attend for screening following their 66 th
birthday. NHS Western Isles met the desirable threshold (≥85%), with an 85.2%
uptake of screening which is above the national average of 84%.
Table 14: Number of men eligible, invited and uptake rates for NHS WI AAA screening, period 1st April 2015 to 31st March 2016
NHS Board of residence
Number of men eligible
Offered screening Attended screening
(uptake)
N % N %
Western Isles4 203 203
100.0 173
85.2
Scotland 30,560 29,650 97.0 24,893 84.0
Source: ISD; Scottish AAA Call Recall System at 1 September 2016.
NHS Western Isles achieved the desirable threshold for KPI 1.3 with two out of three
SIMD identified deprivation quintiles, whilst achieving the essential threshold for the
third (Table 15). Uptake of screening is lower in the most deprived areas; this is
comparable with national findings.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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NHS Western Isles achieved the essential threshold of ≥ 90% for surveillance screen
attendance within 6 weeks of invite (KPI 1.4a at 91.7%) and attendance within 4
weeks of invite (KPI 1.4b at 90%). Interestingly, had one more participant attended
for screening within 6 weeks of invite, then NHS Western Isles would have had
achieved the desirable threshold of 100% for KPI 1.4a (Table 16).
Table 15: KPI 1.3 Uptake of AAA screening by SIMD quintile, NHS WI & Scotland
NHS Board of residence
National SIMD quintile
Turned 66 in year ending 31 March 2015
Turned 66 in year ending 31 March 2016
Offered screening
before the age of 66
Tested before age 66 and 3 months
Offered screening
before the age of 66
Tested before age 66 and 3
months
N N % N N %
Scotland
Total 25,659 21,622 84.3 29,650 24,893 84.0
1=most deprived
4,199 3,163 75.3 5,109 3,881 76.0
2 4,771 3,950 82.8 5,698 4,654 81.7
3 5,611 4,779 85.2 6,354 5,358 84.3
4 5,599 4,888 87.3 6,456 5,644 87.4
5=least deprived
5,427 4,801 88.5 5,987 5,317 88.8
Unknown 52 .. .. 46 .. ..
Western Isles
Total 231 191 82.7 203 173 85.2
1=most deprived
.. .. .. .. ..
2 56 47 83.9 50 41 82.0
3 153 126 82.4 141 120 85.1
4 19 17 89.5 10 10 100.0
5=least deprived
- .. .. - .. ..
Unknown 3 .. .. 2 .. ..
Source: ISD; Scottish AAA Call Recall System at 1 September 2016. Data is provided on known
SIMD
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Table 16: KPI 1.4a Percentage of annual surveillence appointments due where men are tested within 6 weeks of due date
NHS Board of residence
Due to attend annual surveillance in year ending 31
March 2015
Due to attend annual surveillance in year ending
31 March 2016
Appointments due Tested
Appointments
due Tested
N N % N N %
Scotland 557
535
96.1
1,008
971
96.3 Western Isles
11
9
81.8 12
11
91.7
Source: ISD; Scottish AAA Call Recall System at 1 September 2016
In the cumulative period from 29th June 2012 to 31st March 2016, 35 men self
referred to AAA screening, of whom 94.2% (33) were screened negative and 5.7%
(2) were screened positive .There were six self referrals in the financial period 2015-
16, none of whom had an abdominal aortic aneurysm identified (Table 17).
Table 17: Number of self referral men and positive screen results by year and cumulative number to end of period 31st March 2016.
NHS Board of residence
Screened in year ending 31
March 2013
Screened in year ending 31
March 2014
Screened in year ending 31 March
2015
Screened in year ending 31
March 2016
Cumulative total to 31 March
2016
Men tested
Positive screen result
Men tested
Positive screen result
Men tested
Positive screen result
Men tested
Positive screen result
Men tested
Positive screen result
n n % n n % n n % n n % n n %
Western Isles
2 - - 13 - - 14 2 14.3 6 - - 35 2 5.7
Scotland 268 6 2.2 1,630 38 2.3 1,394 45 3.2 877 29 3.3 4169 118 2.8 Source ISD: Scottish AAA Call Recall System at 1 September 2016.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Figure 2: AAA Screening Pathway of care
Note:
1. When aortic measurement is less than 3.0cm at initial screen, a discharged participant can self-refer at a later
date.
2. Clinical decision to discharge from screening programme would be made only if the AAA is stable or following
surgery.
3. Non-attendees receive two invites for screening before being discharged from the programme. However, they
are advised to return as a self referral any time after the age of 66 years should they wish to be screened in
future.
Entry to programme
Aneurysm found Attend
screening
No aneurysm
found
4.5cm – 5.4cm
Discharge from
programme
Decline
screening
3.0cm – 4.4cm >5.5cm Discharge from
programme
Yearly scan 3 monthly scan Referral to
vascular service
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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From the positive screening results, aneurysms can be further identified by size (Table 18),
described earlier in screening outcomes.
Table 18: NHS WI Cumulative number of men with initial screen positive results by aneurysm size since introduction of the AAA programme in 2012
NHS Board of residence
Number of men with
initial screen positive results
Number of men with positive results by aneurysm size grouping
Small (3.0 to 4.4cm)
Medium (4.5 to 5.4cm)
Large (≥5.5cm)
Western Isles 11 9 1 1
Scotland 1,308
1,059 160 89 Source: ISD; Scottish AAA Call Recall System at 1 September 2016
When a large aneurysm is found, measuring ≥5.5 cm, participants are referred for surgical
assessment and intervention. A total of six referrals have been made either from identification at
initial scan or from the surveillance programme to vascular services, NHS Highland at Raigmore
Hospital, from NHS Western Isles since the onset of the screening programme in June 2012.
Table 19: KPI 3.1: Percentage of men with AAA≥5.5cm seen by vascular specialist within two weeks of screening
NHS Board of residence
Screened in year ending 31 March 2015
Screened in year ending 31 March 2016
Referrals
Seen within two weeks of screening Referrals
Seen within two weeks of screening
N N % N N %
Western Isles
2 2 100.0 3 2 66.7
Scotland 87 65 74.7 93 67 72.0
Source: ISD; Scottish AAA Call Recall System at 1 September 2016
For KPI 3.1, NHS Western Isles has met the desirable threshold of greater than or equal to 95%,
achieving 100% year ending 31st March 2015. Period ending 31st March 2016 saw NHS Western
Isles failing to meet the essential threshold of ≥ 75% for KPI 3.1, reflecting a 66.7% achievement
rate. However, data should be interpreted with caution due to small numbers as 2 out 3
participants were seen by vascular services within two weeks of referral (Table 19).
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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The AAA screening pathway of care (Figure 2), illustrates how men progress within the screening
programme and the interval period between surveillance screens, leading to referral to vascular
services.
5.7 Future developments
In NHS WI all men that attend screening are offered advice on healthy lifestyle and given
information on how to access smoking cessation services.
If men are found to have an aneurysm, they are given the opportunity to access both smoking
cessation and dietetic services (as appropriate) by referral at the point of screening. If men wish to
access this service at a later date they can do so either through their GP or calling the AAA
screening assistant.
The development of KPIs for the AAA screening programme is ongoing and projected to be
completed by year end 2016. This will also be combined with the launch of data by ISD.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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6 Diabetic Retinopathy Screening (DRS)
6.1 Overview
Diabetic Retinopathy screening has been offered to people aged 12 and over with
diabetes in NHS WI since 2006. It is a long standing programme and assessment of
screening is linked with NHS Tayside.
6.2 Background
Diabetic retinopathy is a condition that affects the retina at the back of the eye in
people with diabetes. Retinopathy can cause serious damage to the eyes which may
result in blindness. If retinopathy is detected early and treated appropriately, damage
can be minimised and early changes reversed.
In NHS Western Isles screening is carried out by local optometrists and is offered at
three sites, Stornoway, Balavanich and Castlebay. This allows for screening to be
easily accessible throughout the Western Isles. Domiciliary visits are also offered to
those who are unable to attend screening due to mobility problems.
6.3 Aims of screening programme
The aim of the screening programme is to reduce risk of sight loss due to diabetic
retinopathy.
The screening programme aims to identify pathological features associated with an
increased risk of sight loss. If retinopathy is detected, this will result in referral to
hospital ophthalmic and diabetic services, for monitoring, support, advice and/ or
treatment.
6.4 Eligible population for screening
Diabetic Retinopathy Screening is offered to all diabetic patients aged over 12 years
in NHS Western Isles. All those identified in this cohort are invited by letter to attend
screening.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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There were 1267 people eligible for screening in NHS WI in the reporting period 1st
April 2015 to 31st March 2016 (Figure 3).
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Figure 3: Summary of DRS outcomes - period 2015-16
Source: SOARIAN National DRS Co-ordinator for Scotland
Diabetic Retinopathy Screening
(DRS)
Total Population: 1503
Eligible for screening
1,267
84% of total population
Did not attend
(indicative)
24%
Screened
996
79% of eligible population
71.5% of total population
12 month recall
1045
82.5% of eligible population
6 month recall
10
1% of eligible population
Referral to Ophthalmology
37
3.5% of eligible population
Unsuccessful screen
36
2.6% of eligible population
2.5% of total population
Not eligible for screening
236
16% of total population
Permanently suspended
96
37% of not eligible population
Temporarily suspended
174
73% of not eligible population
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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6.5 The Screening test
The screening consists of a digital photograph of the participant’s retina. If this is
unobtainable under normal processes, the patient may be given an eye drop to dilate
the pupil. Dilatation of the pupil is to allow for the digital image to be taken. In some
cases this is unsuccessful and a slit lamp examination of the eye will be carried out.
6.6 Screening outcomes
The identified diabetic population is initially screened for suitability to take part in the
screening process. Those deemed unsuitable will be temporarily or permanently
excluded from the programme Key Performance indicators and screening standards
are set by Healthcare Improvement Scotland and can be accessed from:
http://www.ndrs-wp.scot.nhs.uk/wp-content/uploads/2013/04/KPI-definition-v1.5-.pdf
and
http://www.healthcareimprovementscotland.org/previous_resources/standards/diabet
ic_retinopathy_screening.aspx
Uptake of screening in NHS WI was 78.6%, above the national average of 77.9%.
The Did Not Attend (DNA) rate of 23.6% is above the national average of 20.4%
(Table 20).
NHS Western Isles successful screening rate is 75.8%, whilst comparable to the
national successful screening rate of 76%, NHS Western Isles did not achieve the
the KPI target of 80%.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Table 20: DRS uptake, DNA rate and successful screening rate
KPI 2: Screening uptake rate
DNA rate
KPI 3: Annual
successful screening
rate
Target 80% KPI
Target for Q4
Indicative
DNA rate by %
80% KPI Target
Bo
ard
of
tre
atm
en
t
Peo
ple
att
end
ing a
t le
ast o
nce
(AT
T)
% (
100 *
AT
T / E
P)
% (
100 *
IN
V -
AT
T)
Peo
ple
successfu
lly s
cre
en
ed
in t
he p
rev y
ear
(SU
C1)
% (
100 *
SU
C1 /
EP
)
Ayrshire & Arran 16946 79.0% 24.2% 16839 78.5%
Borders 4515 77.8% 24.9% 4417 76.1%
Dumfries and Galloway 7678 91.2% 10.5% 7626 90.6%
Fife 15709 82.1% 23.2% 15458 80.8%
Forth Valley 12844 81.2% 18.8% 12428 78.5%
Grampian 20906 78.9% 20.4% 20099 75.9%
Greater Glasgow 45002 78.8% 20.0% 44227 77.4%
Highland 10744 69.2% 20.6% 10161 65.5%
Lanarkshire 24354 72.0% 18.3% 23993 70.9%
Lothian 28139 76.2% 23.3% 27629 74.8%
Orkney 955 91.2% 9.8% 943 90.1%
Shetland 898 85.0% N/A 860 81.4%
Tayside 15801 78.7% 17.5% 15058 75.0%
Western Isles 996 78.6% 23.6% 961 75.8%
Scotland 205487 77.9% 20.4% 200699 76.0%
Source: SOARIAN. Screening performance KPIs produced by National DRS Co-ordinator Scotland.
Once an image is taken it is sent digitally to NHS Tayside for grading. Each
participant’s subsequent care pathway is dictated by the results of the graded image.
Grading of images by NHS Tayside ensures rigorous quality assurance in the
assessment of the diabetic cohort screened.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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NHS Western Isles’ timeliness of results being returned to individuals screened was
lower than those screened in NHS Tayside by 3.7% (Table 21). This issue has been
taken forward and although an initial improvement was noted in the first quarter of
2015, the final quarter showed a difference in KPI attainment of 3.7% between NHS
Tayside and NHS Western Isles, this continues to be addressed. However, it is
important to note that NHS Western Isles remains above the NHS QIS standard 3
target of 80% of individuals screened receiving their written results within 20 working
days.
Table 21: DRS KPIs 8 and 9 written report result within 4 weeks
KPI 8: Duration to written report
KPI 9: Written report success rate
Target
A minimum of 80% of people screened are sent the result in writing within 4 weeks (20 working days) of
the photograph being taken (STANDARD 3 ~ Screening Process).
QIS Standards
Bo
ard
of
tre
atm
en
t
Num
ber
of
epis
odes (
NE
)
Long
est re
cord
ed n
um
ber
of
days to w
ritt
en r
eport
(L
RD
)
Avera
ge
of th
e n
um
ber
of
days to w
ritt
en r
eport
(A
D)
Med
ian o
f th
e n
um
ber
of
da
ys
to w
ritt
en r
eport
(M
D)
Epis
odes w
ith <
= 2
0 w
ork
ing
days to w
ritt
en r
eport
(E
20
D)
% (
100 *
E20D
/ N
E)
Tayside 17267 79 7 7 16305 94.4%
Western Isles 1074 48 8 7 974 90.7%
Scotland 221835 249 6 5 212072 95.6%
Source: SOARIAN. Screening performance KPIs produced by National DRS Co-ordinator Scotland.
6.7 Grading
In accordance with the national grading protocol (Table 22), retinal images are
graded for retinopathy and maculopathy. Retinopathy grades of R3 or R4, and a
Maculopathy grade of M2 are all referable to ophthalmology care together with
retinal images graded as R1 or R2, also graded as M2. The M2 maculopathy grade
supersedes the retinopathy grade as changes have been identified in an area (the
macula) where the central vision could be affected.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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Table 22: Grading of Diabetic Retinopathy Screened images
Retinopathy Description Outcome
R0 No diabetic Retinopathy anywhere Rescreen 12 months
R1 Background diabetic retinopathy (mild) Rescreen 12 months
R2 Background diabetic retinopathy - observable
Rescreen 6 months or refer to ophthalmology if rescreen not feasible
R3 Background diabetic retinopathy - referable Refer ophthalmology
R4 Proliferative diabetic retinopathy PDR Refer ophthalmology
M0 No maculopathy Rescreen in 12months
M1 Observable maculopathy
Rescreen 6 months or refer to ophthalmology if rescreen not feasible
M2 Referable maculopathy Refer to ophthalmology
R6 Inadequate: Not visuailised
Technical failure. Patient requires alternative screening method
Adapted from the Scottish Diabetic retinopathy grading scheme 2007 v1.1
6.8 Following a negative result
When a person with diabetes has successfully attended the screening programme
and been found to have no or mild retinal changes (R0, R1, M0), (s)he is returned to
the twelve month review pathway. No further referral is required.
6.9 Following a positive result
When an image returns a positive result, there are three possible pathways of care:
rescreen in 12 months, rescreen in 6 months or referral to ophthalmology. The
pathway followed is dependent on the severity of the retinal changes found.
NHS Western Isles’ 6 month recall rate is 1.0% (10) which is below the national rate
of 1.6%.
The current referral rate to ophthalmology from the DRS service NHS Western Isles
is 3.5% (37), which is comparable to the national average of 3.8%.
A summary of DRS outcomes can be seen at Figure 3.
Board Meeting 30.01.19 Agenda Item: 10.1 Purpose: For Information
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6.10 Future developments
In NHS Western Isles our participants receive a good standard of screening, through
the optometrist clinics, as the slit lamp examination can be carried out in the same
appointment if image capture fails in the first instance. In other areas this test would
require a second appointment to complete the screening process.
A new national computer system for DRS will be introduced in 2016 called VECTOR.
This system will replace SOARIAN, scheduled for change-over in winter of 2016. It
will be a complete screening system that can follow individual participants from initial
appointment to completion of the screening process and ophthalmic intervention if
required. It also provides a robust audit package and can link with MyDiabetes,
which will enable patient centered care. It is hoped that with the implementation of
VECTOR, coupled with improved information returns on retinopathy and
maculopathy results, we can gain greater understanding of the needs of our diabetic
population to maintain a proficient and effective service.
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