nsc standards & competencies

8/9/2019 NSC Standards & Competencies

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Provided by the

http://www.screening.nhs.uk/home.htmhttp://nipe.screening.nhs.uk

Newborn and Infant Physical Examination

Standards and competencies

March 2008



2

Contents

Executive Summary…………………………………………………………………….…..4

Introduct ion…………………………………………………………………………….........5

Definit ions o f p rofessional competency………………………………………………..5

Background…………………………………………………………………………….…….6

1.1 Setting Standards …… 9 Section 1: Standards

1.2 Information giving prior to the examinations…………..…….………………..…..……10

1.3 The Generic Pathway………………………………………..….…..………..….……..……11

1.4 Generi c Standards .......................................................................................................12

1.5 Generic Components : Newborn Physical Examination..........................................13

1.6 Generic Component s : 6-8 week Examination ..........................................................14

Section 2: Developmental Dysplasia of the Hip

2.1 Developmental Dysplasia of the Hip: Newborn Examination..................................15

2.2 Developmental Dyspl asia of the Hip: 6-8 week Examination ..................................17

2.3 The Process Map fo r Developmental Dysplasi a of t he Hip screening ...................19

Section 3: Examination of the Eye

3.1 Examination of the Eye: Newbor n Examination .......................................................20

3.2 Examination of the Eye: 6-8 week Examination........................................................21

3.3 The process map for Examination of the Eye...........................................................22 Section 4: Congenital Heart Defects

4.1 Congenital Heart Disease: Newborn Examination ...................................................23

4.2 Congeni tal Heart Disease: 6-8 week Examination ....................................................25

4.3 The Process Map for Congential Heart Disease screening .....................................26

4.4 Additional Point………………………………………..…..………………………..…….…27

Section 5: Undescended Testes

5.1 Undescended Testes: Newborn Examination……………………………..……………29

5.2 Undescended Testes: 6-8 week Examination………………………….…………...…..30



3

5.3 Undescended Testes: Process Map……………………………………..……………..…33

Section 6: General Physical Examination

6.1 Component s of the General Phys ical Examination: ................................................34

Section 7: Roles and Responsibi lities for Service Commissioning and Provisi on

7.1 Commiss ioning Services ...........................................................................................36

7.2 Providing Services ......................................................................................................37

7.3 Respons ibi li ty and Accountabi li ty ............................................................................37

7.4 Performance Moni tor ing and Outcomes ..................................................................38

7.5 Quality Assurance .......................................................................................................39

7.6 Training and Educat ion ..............................................................................................41

Section 8: Competencies

8.1 Definitions ....................................................................................................................42

8.2 Competencies 1 – 6…………………………………………………………..……………..43

Acknowledgments ……………………………………………………….…………………………57

References…………………………………………………….………………………………..….…61

Bibliography……….……………………………………………………….…………………………63



4

Executive Summary

Routine physical examinations of the neonate and 6-8 week infant is an integral part of theuniversal Child Health Promotion Programme. It has been carried out by NHS health careprofessionals for many decades, but apart from NICE guidance on Postnatal Caresummarising the content of the examinations and guidance in relation to developmentaldysplasia of the hip, there has been no national guidance on the standards andcompetencies necessary to deliver a good service.

The newly launched Child Health Promotion Programme (DH 2008) sets the context for theexaminations as do the NICE guidelines. This document concentrates mainly on pathways,standards and competencies for the screening components of the examination, namely

examination of the hips, eyes, testes and cardiovascular system, but also includes, in lessdetail, the remainder of the examination. It should be useful to both providers andcommissioners of the service.

The main messages from the document are:- Each trust offering maternity services/primary care should nominate an individual with

clear responsibility for coordinating newborn and 6-8 week examinations (Section 7.1) Resources for clinical locations at which the newborn and 6-8 week examinations are

carried out must be fit for purpose. Where possible, this should include a dedicatedlocation which should have a warm and consistent temperature and which affordssome privacy and confidentiality.

A firm surface to examine the hips is necessary (Section 8: Competency 2.4). Information about the newborn and 6-8 week infant physical examinations should be

given to the mother at around 28 weeks gestation and again prior to the newbornexamination being offered.

An opportunity for discussion should be made available (Section 1.2). The newborn and 6-8 week examinations must be performed by practitioners who are

trained and competent in the skills required (Section 7.6). Skills should be practisedand maintained with an appropriate number of examinations performed to retain them(Section 7.6).

The detailed newborn examination should normally be undertaken within the first 72hours of birth, following consent to perform the examination. This is different from thebriefer examination carried out at the time of birth (Background section).

Where possible, the 6-8 week examination should be combined with the mother’spostnatal examination and the infant’s vaccination to provide a ‘one stop service’(Background section).

Non-consent of parent(s) to examination should be recorded and followed up. Notification of non-consent should be communicated to appropriate health

professionals and the child health information department according to the localpolicy (Section 8: Competency 5.2).

Where there are questionable or abnormal findings appropriate referral should bemade according to these guidelines (Section 1.3).

Standards for timeliness of referral at each stage of the examination have been setout for the newborn examination in these guidelines (Section 2 – 5) those for the 6 –8 weeks are under discussion with relevant stakeholders.

Information should be collected for the standards in these guidelines (Section 7.4),and audit of the service undertaken at appropriate intervals (Section 7.5). Comments on this document should be sent to Professor Adrian Davis by email to

[email protected] and Dr David Elliman at [email protected] .

mailto:[email protected]






5

Introduction

Th is document describes standards for clinical care and professional competenciesrequired for healthcare professionals (HCPs) who undertake physical examination ofnewborn babies and the 6-8 week infant examination.

It is of relevance to:

healthcare professionals who work in the acute and primary health caresectors who have direct contact with postnatal women and their babies

those with responsibilities for commissioning and planning health servicessuch as Primary Care Trust commissioners and Public HealthPractitioners

public health and trust managers

providers of education programmes for health care professionals

Who provides clinical care for newborn babies and infants?Care is likely to be provided by midwives, health visitors, general practitioners andhealth care support workers working across the acute and primary care sectors.Paediatricians may also be involved with some babies.

Professional competence

Competence is an outcome: it describes what someone can do. In order to measurereliably someone’s ability to do something, there must be clearly defined and widelyaccessible standards through which performance is measured and accredited. (NIACE 1989)

All health care professionals working in the NHS and should be working to the level

of competency as defined by their professional qualification, and should ensure that ifthey do not have the appropriate competency for a particular aspect of care, that theymake appropriate referral.



6

Newborn and 6-8 week Infant Physical Examinations

Background

The importance of offering and delivering highest quality routine care for infants up to eightweeks of age is well recognised. Physical examinations form part of the Child HealthPromotion Programme in the National Service Framework for Children, Young People andMaternity (DH, 2004, DH 2007), which has recently been expanded updated and expandedupon (DH 2008). The physical examinations are included in the NICE clinical guideline forthe NHS : Routine postnatal care of women and their babies (NICE 2006). The threedocuments complement each other.

Almost immediately a baby is born, they should have an initial examination to ensure theyhave no gross physical abnormalities. This examination is normally carried out by one of thehealth professionals attending the birth.

Later, a comprehensive newborn examination should be performed, ideally, within the first 24hours of birth (Hall & Elliman 2006), and certainly within 72 hours. This should be repeatedbetween 6-8 weeks of age. There is no optimal time to detect all abnormalities (Sherratt2001). The ages recommended are based on best practice and current evidence.

The aim of the newborn physical examination is to detect less obvious adverse conditions orabnormalities. It includes screening for congenital cardiac defects, developmental dysplasiaof the hip, some ocular disorders (including congenital cataract), and undescended testes as

well as a general physical examination. The 6-8 week examination also incorporatesassessment of some aspects of social and gross motor development. Where poss ible, the6-8 week examination should be combined with the mother’s postnatal examinationand the infant’s vaccination to provide a ‘one stop service’. Vaccination may beperformed at the same visit however standards and competencies relating to vaccination arenot covered in this document.

These comprehensive physical examinations take place in the context of assessments whichinclude opportunity to:

• review any problems arising or suspected from antenatal screening, family history orlabour

• discuss matters such as baby care, feeding, vitamin K, hepatitis B and BCG vaccines,and reducing the risk of SIDS and any other matters relevant to the infant

• identify parents who may have major problems (e.g. recognising and managingdepression, domestic violence, substance abuse, learning difficulties or mental healthproblems)

• explain problems such as jaundice that might not be observable in the newborn butcould be significant a few days or weeks later

• convey information about local networks and services, confidentiality, data-handlingand access to the members of a primary health care team

• inform families how they can request and negotiate additional help, advice, andsupport as needed (Hall & Elliman D, 2006 p 143)

The process of the examination and assessment should be standardised and evidence-based information (where available) readily accessible to support decision-making. Anydeviation from the agreed process should be recorded with the reasons for this.



7

When their baby is examined it should be explained to his/her parents that some physicalconditions do not become evident until the baby is older and that this is why, for example, thecomprehensive newborn examination is followed by another comprehensive examination at6-8 weeks after birth. Parents should be advised to report any concerns they have abouttheir baby’s wellbeing to a health care professional at any time.

Unwell and premature babies

Although screening is performed universally on all babies the standards set out in thisdocument apply to well babies only . This is because some babies may be ill at the timethe examination is due and so some components may have to be deferred.

Some babies will need additional specific examinations. For example, babies who have abirth weight ≤ 1500g and/or are ≤ 31 weeks gestational age will need more detailedexamination of their eyes. Guidelines about this produced by the Royal College ofOphthalmologists and the British Association of Perinatal Medicine (1995) are currently beingrevised. The latest document can be viewed at:http://www.bapm.org/documents/publications/rop.pdf .

For babies who have Down’s syndrome, the Down’s Syndrome Medical Interest Group haveproduced a number of documents on screening(http://www.dsmig.org.uk/publications/guidelines.html )

For babies with antenatally diagnosed congenital heart defects, a Report of the Paediatricand Congenital Cardiac Services Review Group (December 2003) makes additionalrecommendations for diagnosis, treatment and information during the postnatal period.(http://www.dh.gov.uk/assetRoot/04/07/08/18/04070818.pdf )

Who should carry ou t the examinations?

“The professional qualification of the person(s) delivering the various aspects of thisprogramme is less important than the quality of their initial and continuing training, audit andself-monitoring”. (Hall & Elliman 2006, p337)

The need to standardise clinical practice and improve quality, has led to several strands ofwork by the UK National Screening Committee around standards, competencies, trainingresources, information for parents and professionals, and information systems

Only one study has compared the results of neonatal care including the newborn physicalexamination performed by two groups of healthcare professionals and this suggested that

Advanced Neonatal Nurse Practitioners performed the newborn physical examination as wellas paediatric SHOs with increased levels of maternal satisfaction (Lee et al, 2001). It isimportant to have a competent team of health professionals who can perform the screen,whilst maintaining a number that does not dilute the clinical experience of the team.

These examinations should therefore be performed by a suitably trained and competenthealthcare professional who has appropriate levels of ongoing clinical experience.

http://www.bapm.org/documents/publications/rop.pdf

http://www.dsmig.org.uk/publications/guidelines.html

http://www.dh.gov.uk/assetRoot/04/07/08/18/04070818.pdf

http://www.dh.gov.uk/assetRoot/04/07/08/18/04070818.pdf





8

Competencies of health care professionals carrying out the examinations

The newborn examination is most often carried out by junior doctors, and in some areas, bymidwives or advanced neonatal nurse practitioners. The physical examination at 6-8 weeksafter birth is usually performed by GPs or community paediatricians in conjunction with healthvisitors.

Midwives and nurses are required to achieve post-basic learning, work in a framework ofprofessional supervision, and maintain competence to carry out the physical examination andscreening of the newborn and 6-8 week infant. Doctors are expected to demonstrate on-going professional development.

Regardless of the health care professional’s qualifications, background and experience, thestandard, quality and content of the examination should be consistent throughout the UK (DH2000). Development of nationally agreed standards for education and audit for all healthcareprofessionals undertaking this role would underpin practice.

The Newborn and 6-8 week Infant Physical Examination dig ital too lbox

The Newborn and 6-8 week Infant Physical Examination digital toolbox was commissioned

as part of these national standards and competencies. The toolbox contains listings ofrelevant journal articles, books, and reports, CD-Roms/videos, websites and simulators. Itwas designed to make existing resources readily available to learners, educators andpractitioners



9

Part 1: Standards

1.1 Setting Standards

The aim of setting standards is to raise the quality of the examinations which can bemonitored against an agreed benchmark, by assurance processes. Achieving thesestandards across the UK will assure consistency in screening processes.

It is important that these standards can be broadly achievable, with the capacity to beimproved upon in an iterative manner. Standards have been set at two levels: Core, andDevelopmental to address this, and take account of current variability in service provision,associated with local resources and information systems. These levels are in line with the

process already defined in the UK Newborn Programme Centre standards document and theDepartment of Health publication “Standards for Better Health” (July 2004):

Core Standard: expected level of performance to deliver an acceptable level of quality

Developmental Standard: a level of performance that delivers enhanced quality

These standards are subject to review as part of an ongoing process to raise quality and willbe linked to specified core competencies for training in newborn physical examination(www.skillsforhealth.org.uk ). These competencies apply to all who currently practice thenewborn and 6 – 8 week examination in addition to those undergoing training.

The number of standards has been kept to a minimum whilst remaining sufficient to covercore elements of the newborn physical examination process. They are measurable andauditable. The standards presented relate mainly to timeliness of the examination and to anysubsequent assessments. Other aspects of quality are clearly important and standards andcriteria for these may be examined in the future.

Implementation solutions will be influenced by local organisational structures, geography andcurrent practice and therefore will vary. What is important is not how standards are achievedbut the assurance that they are being achieved. The health care professional performing theexamination should be appropriately trained, meet the core competencies and remainregularly updated.

http://www.skillsforhealth.org.uk/

http://www.skillsforhealth.org.uk/



10

1.2 Information g iving prior to the examinations

Parents should be offered information antenatally, at around 28 weeks, in written form aswell as verbally and should be repeated prior to the newborn examination being offered. Theinformation should cover the rationale for the Newborn Physical examination and itslimitations, for example that some conditions cannot be detected as part of the routineexaminations (Rahi, Dezateux 1999). This should include:

Process Timing Components of the examination Limitations of screening Risks Outcomes Further sources of information

The assessment of the newborn is a continuing process during which health professionalsand parents work together to assess the baby. This aspect of the assessment requiresemphasis. Evidence points to parents being more satisfied with care characterised bycontinuity of care and opportunities to ask questions (Wolke et al 2002).

Development and evaluation of information for parents is a separate project beingundertaken as part of the Newborn and 6-8 week Physical Examination sub-group workprogramme.

The aim of producing the parent information leaflet will be to provide high quality andappropriate patient information which will allow parents to make an informed decision aboutthe choices they are offered, give them confidence in the way that the physical examinationsare carried out, and will make sure that they are involved in the screening process andpossible follow up if the screening reveals a problem. Information about the follow-up ofbabies for whom a problem is identified is outside the remit of this project.



11

1.3 The Generic Pathway

The flow chart below sets out the general framework for the examinations. Details, such asrisk factors and action to be taken on identification of a potential anomaly, will varydepending on the condition being sought.

T h e O v e r a l l P r o c e s s f o r N e w b o r n a n d 6 - 8 w e e k E x a m i n a t io n s

I d e n ti f y b a b y t o b e s c re e n e dI n f o r m a t io n r em i n d e r g i v e n a n te n a ta l l y a t a ro u n d 2 8

w e e k s a n d p ri o r t o s c re e n . C o n s e n t s ou g h t. A s s e ssr i s k f ac to r s . P h ys ic a l e x a m i n a t io n i n fi r s t 7 2 h r s

b y t ra i n e d H C P

E x p e r te x a m in a ti o n / fu r t h e r t e s t s

F o r o b s e r v a t io n / re p ea ts c r ee n i n g

I d e n ti f y b ab y t o b e s c re e n e d . In f o rm a ti o n g i v e n . C o ns e n ts o u g h t . A s s e s s ri s k fa c t o r s , p r e vi o u s his t o r y a n d in t e r im

f i n d i n g s . E x a m in a ti o n b y 8 w e e k s b y t ra i n e d H C P

R e f e r re d f o r t r e at m e n t asa p p r o p ri a te

E x p e r t e x am in a ti o n / fu r t h e r t es ts

F o r o b s e r va t io n /r e p e a t s c r e e n i ng

- v e s c re en w it h- v e r is k f a c t o rs

- v e s c re en w it h+ v e r is k f a c t o rs

+ v e s c re en wit h+ / - v e r is k f a c t o r s

+ v e

-v e + v e

+ v e-v e

1 s t S C R E E N

B y 7 2 h o u rs

+ v e s c re en wit h+ / - v e r is k f a c t o r s

- v e s c re en w it h+ v e r is k f a c t or s

- v e s c re en w it h- v e r is k f a c t o rs

-v e

N o f u r t h e r a c t i o n r e q u i re d* R a is e p a r en t a l / p r o f e s s i o n ala w a r e n e s s

-v e

2 n d S C R E E N

B y 6 -8 w e e k s

+ v e

N o f u r t h e r ac t io n r eq u i re dR a is e p a r e n ta l / p r o fe s s i o n a la w a r e n e s s

* Screening is not a fool-proof process. It can reduce the risk of developing a condition or itscomplications but it cannot offer a guarantee of protection. In any screening programme, there is an

irreducible minimum of false positive results (wrongly reported as having the condition) and falsenegative results (wrongly reported as not having the condition). The NSC is increasingly presentingscreening as risk reduction to emphasise this point. (UK National Screening Committee 2004)



12

1.4 Generic Standards

These generic standards apply to well babies with no detected abnormalities or identified riskfactors. However, generic standards may still apply to unwell or premature babies, unlessthere is good reason to the contrary, and they should undergo the routine screeningprocedures but if risk factors are present , or when a possible problem is detected, furthertests may be indicated and the condition-specific standards are outlined in Parts 2 – 5.

In the standards that follow we have been very clear about those for the newbornexamination, however, there have been some aspects of the standards for the 6 – 8 weekexamination that we have not been able to conclude at this stage. Where possible, the 6-8week examination should be combined with the mother’s postnatal examination and theinfant’s vaccinations to provide a ‘one stop service’ in this time window.



1.5 Generic Components: Newborn Examination

Standard Standard

Core 95% babies screened byST1a

Timeliness of *offer/screenfor newborn examination for

all babiesDevelopmental Al l babies screened by 7

StandardStandard

ST1b Timeliness of conveyinginitial results / concerns

Core All results conveyed immediately to paand results en

Personal Child Health Recor

*both terms have been included as an offer assumes that the screen will take place immediately after the offer



1.6 Generic Components: 6-8 week examination

Standard Standard

Core UndeST1c Timeliness of offer/screen for 6-8 week

examination for all babiesDevelopmental Unde

Standard Standard

ST1d Timeliness of conveying initial results /concerns Core All results conveyed imme

examination and re



Part 2: Condition-Related Standards

2. Developmental Dysplasia of the Hip

2.1 Developmental dysplasia of the hip: Newborn Examination

Standard Standard

Core 95% babiesST2a

DDHTimeliness of ultrasound

with an abnormality detected onexamination Developmental Al l babies b

Standard Standard

Core 95% babies seeST2b

DDHTimeliness of *expert

consultation

for babies with an abnormalitydetected on clinical examination

and positive ultrasoundDevelopmental Al l babies see

*definition of expert consultation – the baby is seen by a clinician who is able to diagnose and initiate treatment for this



2.1 Developmental dysplasia of the hip: Newborn Examination

Standard Standard

Core 95% babiesST2c


For babies with a irisk factor butno abnormality detected on

examinationDevelopmental Al l babies b

Standard Standard

Core 95% babies seeST2d

DDHTimeliness of expert

consultation For babies with positive risk

factor, negative examination and

positive ultrasound

Developmental Al l babies see

iRisk factors for DDH:1. Family histo ry : defined as a family history of congenital dislocation of the hip as defined by a positive reply to the following question

" Is there anyone in the family who has had a hip problem that started when they were a baby or young c hild2. Breech presentation : defined as breech presentation at delivery or a clinically diagnosed in pregnancy or history of intervention for



pregnancy (e.g external cephalic version) irrespective of gestational age at delivery or mode of delivery

2.2 Developmental dysplasia of the hip : 6-8 week examination

Standard Standard

Core UndeST2e

DDHTimeliness of screen for all

babiesDevelopmental Unde

Standard Standard

Core UndeST2f


of babies with abnormalitydetected Developmental Unde



2.2 Developmental dysplasia of the hip : 6-8 week examination

Standard Standard

Core Unde

ST2g

DDHTimeliness of first appointment

for expert assessmentof babies with abnormality

detectedDevelopmental Unde



2.3 The Process Map for Developmental Dysplasia of t he Hip screening

19

No further action required. Raise parental /professional awareness

Examination in first 72 hrs by trained HCP. Identify baby to be screened. Information reminder should be given antenatallyat around 28 weeks and prior to screen. Consent sought. Assess risk factors (family history, breech presentation).

All b abies re-examined at 6-8 weeks bytrained HCP. Identify baby to bescreened. Information given. Consentsought. Assess risk factors, previoushistory and interim findings.

No further action required. Raiseparental / professional awareness

2

3

4

5

6

7

8

9

10

11

12

13

weeks

111DEVELOPMENTAL DYSPLASIA OF THE HIP

+ve OB screen with+/-ve risk factors

-ve OB screen with+ve Risk Factors

-ve OB screen with-ve risk factors

Ultrasound by 2 weeks

+ve

Referred forultrasound by 6weeks

Expertexaminationby 8 weeks

-ve

+ve

+ve

-ve

+ve

-ve

Expert examination

Expert examination by 4 weeks-ve

Ultrasound examination-ve



3 Examination of the Eye

3.1 Examination of the Eye: Newborn Examination

Standard Standard

Core 95% babies by ST3a

*EYE EXAMINATIONTimeliness of screen for all babies

Developmental Al l babies by 7

Standard Standard

Core 95% babies bST3b

EYE EXAMINATIONTimeliness of first appointment forbabies with abnormality detected

All babies byDevelopmental



3.2 Examination of the Eye: 6-8 week examination

Standard Standard

Core UnderST3c

EYE EXAMINATIONTimeliness of screen for all babies

Developmental Under

Standard Standard

Core UnderST3d

EYE EXAMINATIONTimeliness of first appointment for

expert consultationfor babies with abnormality

detected at 8 weeksDevelopmental Under

*(Red reflex and observation)



22

3.3 The Process Map for Examination of the Eyes

NoRaaw

further action requiredise parental / professionalareness

Seen by ophth almic consultant,by 2 weeks of age

-ve screen with+ve risk factors

+ve screen with+/-ve risk factors

-ve screen with-ve risk factors

+ve

-ve+ve

-ve

All babies examined in first 72 hrs by trained HCP. Identify baby to be screened. Information reminder should be givenantenatally at around 28 weeks and prior to screen. Consent sought. Assess risk factors (very low birth weight <1500g,low gestational age <32 weeks, family history of any eye disorder of childhood onset including congenital cataract ,glaucoma and retinoblastoma).

All babi es re-examined at 6-8 weeks by trained HCP.Identify baby to be screened. Information given. Consent sought.

Assess risk factors, previous history and interim findings .

Referral for expert examination within 72 hoursof age

-ve


2

3

45

6

7

8

9

10

11

12

13

weeks

111

Seen by ophthalmologist by

EXAMINATION OF THE EYES



4 Congenital Heart Defects

4.1 Congenital Heart Defects: Newborn Examination

Standard Standard

Core 95% baST4a

CHDTimeliness of screen for all

babiesDevelopmental Al l bab

Standard Standard

Core 95% babies ST4b

CHDTimeliness of referral of all

babies with abnormality detectedfor Pulse oximetry and expert

consultationDevelopmental Al l babies b



4.1 Congenital Heart Defects: Newborn Examination

Standard Standard

Core 95% bST4c

CHDTimeliness of review for babiesconsidered at continuing risk of

clinical deteriorationDevelopmental

Standard Standard

Core 9ST4d

CHDTimeliness of first appointment for

babies who are screen positive,but no significant risk of clinical

deteriorationDevelopmental A



4.2 Congenital Heart Defects: 6-8 week examination

Standard Standard

CoreST4e

CHDTimeliness of screen

appointment for all babiesDevelopmental

Standard Standard

ST4f CHD

Timeliness of referral forscreen positive baby

symptomatic / not thriving

Core All babies referr

Standard Standard

ST4g CHD

Timeliness of first appointmentCore



for positive screen where babythriving Developmental



Provided by the

4.3 The Process Map for Congenital Heart Defects screening


+ve screen with+/-ve risk factors

-ve screen with-ve risk factors

CONGENITAL HEART DISEASE All babies examined within 72 hrs by trained HCP. Identify baby to be screened. Information reminder given antenatallyat around 28 weeks and prior to screen. Consent sought. Assess risk factors (low birth weight, family history, otherrelated conditions eg Down’s Syndrome, extracardiac defects, lethal trisomy, GI malformations).

All babies re-examined at 6-8 weeks by trained HCP. Identify baby to be screened. Informationgiven. Consent sought. Assess risk factors, previous history and interim findings .


2

3

4

5

6

7

8

9

10

11

12

13

weeks

111Pulse Oximetry and Expert Opinion within 24hours of examination. Assess ment will depend onthe specific heart condition suspected .

Telephone call and baby seenwithin 24 hours of examination,or less depending on thecircumstances.

Letter to paediatric consultant


-ve and nocontinuing risk

+ve but not atimmediate risk

+ve screen. Baby not thriving / symptomatic(e.g. breathless, cyanosis, absent femorals)

Continuingclinical risk,but able togo home

No further action

required. Raise parental /professional awareness

For observation.Sent home withdetails of what toobserve / emergencycontact details. Forreview with10 daysof age

Detailed specialist opinionwith treatment optionswithin 4 weeks of birth

Information on support

groups offered.

+ve screen.Baby thriving.

-ve



28

4.4 Additional Point At the Congenital Heart Defects Workshop (2006), consideration was given to the use ofpulse oximetry and it was recommended that, until further evidence became available,pulse oximetry should be used as an aid to diagnosis, rather than as a screeningprocedure.

The consensus of the CHD Workshop was that pathways would vary depending on thediagnosis and the condition of the baby.



Provided by the


5 Undescended Testes

5.1 Undescended testes: Newborn Examination

Standard Standard

Core 95% babiST5a

TESTESTimeliness of examination for

all baby boysDevelopmental Al l babie

Standard Standard

ST5b TESTESTimeliness of first appointment

for babies with bilateralundescended testes

Core Al l of babies to



5.2 Undescended testes: 6- 8 week examination

Standard Standard

CoreST5c

TESTESTimeliness of examination for

all baby boys Developmental

Standard Standard

Core 95%ST5d

TESTESTimeliness of first appointmentwith a surgeon for babies withbilateral undescended testes Developmental Al



5.2 Undescended testes: 6- 8 week examination

Standard Standard

Core 95% babST5e

TESTESTimeliness of review by GP for

babies with unilateralundescended testes Developmental Al l babie

Standard Standard

Core 95%ST5f

TESTESTimeliness of being seen by a

surgeon for babies withunilateral undescended testes Developmental Al

Standard Standard

Core 95%ST5g

TESTESTimeliness of operation for

babies with unilateral orbilateral undescended testes Developmental Al



33

5.3 The Process Map for Undescended Testes sc reening

No further action requiredRaise parental / professionalawareness

Both testesundescended

Both testes normallydescended Unilateral undescended

testis

One or moretestesundescended

-ve

All babies e xamined withi n 72 hrs by trained HCPIdentify baby to be screened. Information reminder given antenatally at around 28 weeks and prior to screen. Consentsought. Assess risk factors (family history, other related conditio ns).

Identify baby to be screene d. I nforma tion given. Consent sought. Assess riskfactors, previou s history and interim findings . All babies re-examined at 6-8 weeksby trained HCP.

No further action required. Raiseparental / pr ofessional awareness

2

3

4

5

6

7

8

910

11

12

13

weeks

111 Oneundescendedtestis

Refer to GP to be examined at 22-26 weeks

Referred and seen by a surgeon byone year old

Operation by 2 years old

Bilateral undescended testes

Urgent referral to asenior paediatrician to beseen within 24 hours –subsequent managementdepends on the presenceof any underlyingpathology



34

Part 6: General Physical Examination

6.1 Components of the General Physical Examination

A review of the medical history including: family history, maternal,antenatal and perinatal history, infant, fetal and neonatal historyincluding any previously plotted birth-weight and head circumference

A review of parental concerns

Feeding

Ensure relevant information is available to healthcare professionals

Initial Communication Give relevant information to parents before the examination together with anopportunity to discuss the forthcoming screens

Whether the baby has passed meconium and urine (and the nature of the urinestream in a boy)

Observe the baby’s appearance including colour, breathing, behaviour, activityand posture

Examine fontanelle(s), face, nose, mouth including palate, ears, neck and generalsymmetry of head, vault, sutures, fontanelles and facial features

Check eyes – opacities and ‘ red reflex’

Examine the neck and clavicles, limbs, hands, feet and digits, assessingproportions and symmetry

Cardiovascular system – heart rate, rhythm and sounds , murmurs andfemoral pulse volume

Respiratory system – effort rate and lung sounds

Abdomen – shape and palpate to identify any organomegaly. Check condition ofthe umbilical cord

Genitalia and anus. Check anus for patency. Check genitalia for form andundescended testicles in males

Spine – inspect and palpate bony structures and integrity of skin

Skin – note the colour and texture of the skin as well as any birthmarks or rashes



35

Central nervous system – observe tone, behaviour, movements, and posture andelicit newborn reflexes only if concerned

Hips – check symmetry of the limbs and skin folds. Perform Barlow andOrtolani’s manoeuvres

Cry – note sound of baby’s cry

Measurement of weight and head circumference

Further communication Parents of babies who are referred should be given a full explanation of thereason for and timescale of referral

Record details, including time and age of baby at examination, location ofexamination, problems identified, referrals made, healthcare professionalsinvolved and discussions with parents in Personal Child Health Record.

Confirm findings with parents and allow time for discussion.



36

Part 7: Roles and Responsibil ities for ServiceCommissioning and Provision

7.1 Commissioning Services

Strategic Health Authorities provide a co-ordination and leadership function in promotingscreening and managing issues which cover several Primary Care Trusts in relation tolearning from incidents.

Primary Care Trusts (PCTs) are responsible for ensuring that a comprehensive servicefor physical examination of newborn and 6-8 week infants is adequately commissioned

and performance managed.

Commissioners should ensure :

♦ there is a nominated lead in PCTs

♦ there is an agreed service level agreement/contract with an appropriate provider thatcovers performance monitoring and governance arrangements

♦ there is a service specification covering all aspects of the physical examination ofnewborn and 6-8 week infants

♦ standards, outcomes and monitoring within the above should comply with thosedetermined by the UK National Screening Committee covering:

staff training requirements fail safe mechanisms to ensure that babies who leave hospital before the

neonatal examination is performed, or who are born at home, are examined,in a timely fashion, by an appropriately qualified practitioner

appropriate diagnostics, referral and follow up availability of appropriate resources clear quality indicators for process and outcomes for screening are

established (including those set nationally), regularly evaluated and reported

contract monitoring arrangements are in place



37

7.2 Provi ding Services

Providers of the comprehensive service for physical examination of newborn and 6-8week infants should ensure that :

♦ a nominated lead has been identified for each PCT and acute trust

♦ there are sufficient appropriately qualified staff to undertake the physical examinationof newborn and 6-8 week infants in all health care settings, including at home

♦ the scope of practice and competencies are commensurate with professional, legal

and ethical codes/guidance for practice♦ clear written guidelines are provided to support the screening process and referral

pathway

♦ appropriate education and supervised practice is available for the designated healthcare professionals in line with current national recommendations and guidance forthe NHS (e.g. National Screening Committee, NICE)

♦ the process is standardised and evidence-based information is readily available tosupport decision-making.

♦ data are collected analysed and reported to monitor quality and inform serviceprovision and improvement

7.3 Responsibi lity and Accountabilit y

The UK Newborn Screening Programme Centre standards document states that:

“Population screening is clearly a public health function and each Director of Public Healthwithin each PCT (or equivalent) is expected to take responsibility, and be held accountable totheir Strategic Health Authority, for the quality of newborn screening provided to their residentpopulation. Improving and maintaining quality in screening will by its nature require

multidisciplinary collaboration. It is recommended that the Directors of Public Health (in PCTshosting Child Health Records Departments) establish and oversee multi-disciplinary QualityManagement Groups.

The Newborn and 6-8 week Infant Physical Examination Subgroup support thisstatement and recommend that responsibility and accountability for this screeningprogramme is established as outlined above.



38

7.4 Performance Moni tor ing and Outcomes

The quality of screening services should be monitored by commissioners and thefollowing outcomes measured and reported:

coverage, both by maternity unit and place of residence data available for % of newborn screening achieved in first 72 hours data available for % of infant screening performed at 6-8 weeks of age data available to allow comparison across PCTs

timeliness further investigations referral cases diagnosed outside the screening programme

data available to identify number and rate per population clear process for dealing with adverse incidents

Commissioners and Providers need to ensure that sufficient administrative resourcesare available to collect, analyse and report the information requirements, processes andoutcomes of the screening programme.



39

7.5 Quality Assurance

The following check-list outlines issues relating to structures and processes forimplementation of the standards and competencies for the delivery of this screeningprogramme.

Criteria Assessment/Assurance Questions

1. There is a nominated health careprofessional for managing theprogramme on behalf of eachprovider

Who has the responsibility foroverseeing and monitoring theprovision of physical examination forthe newborn?

Are there regular meetings with thecommissioner?

Is action taken from stakeholdermeetings monitored?

2. There is a nominated health careprofessional responsible for

managing the programme on behalfof each provider

Who has the responsibility foroverseeing and monitoring the

provision of physical examination forthe newborn at an operational level? Are there regular meetings with the

commissioner? Is there a process for information

dissemination to all personnel providingthe physical examination?

Is information transmitted to thecommissioners to reflect Trust activityand its quality?

3. Regular review of data collected Is data available for each component ofthe screening programme?

Is referral data available for eachcomponent of the screeningprogramme?

How often is data reviewed? What additional data is collected? Is practice development informed by

data analysis?

4. Centralised and routine checkingthat results are received andrecorded on the total population inplace where held

How often is this done? Are Trusts informed of the findings? Is documentation consistent and

relevant? Are the results recorded in the



40

Personal Child Health Record? Is this audited? Are procedures in place for tracking

patient outcome?


5. There is a process for dealing withadverse incidents

Are adverse incidents, shared,monitored and acted upon?

Is the relevant ‘best available evidence’cascaded by the nominated lead?

Does stakeholder representation reflectkey players?

6. The activity required for thenewborn and/or 6-8 week physicalexamination is included in the Trustbusiness plan

Is the activity for the newborn and 6 – 8week physical examination included inthe Trust business plan?

7a. There are sufficient appropriatelytrained health care professionals tomeet service need

7b. Health care professionalsproviding the physical examination ofthe newborn are competentpractitioners.

What is the current status in the Trust? Who undertakes examination in your

Trust? Are staffing levels adequate to demand

based on the number of births in the

Trust? Has size of target population increasedand does staffing reflect this?

Are there plans to increase staffing toreflect projected population size overthe next 5 years?

What are the competencies required? How are they assessed? Who monitors staff competence? Are CPD/refresher courses available

for staff performing the examination?

Is there regular assessment ofcompetence?

Is this monitored? Are there named assessors?

8. The equipment required for thephysical examination of the newbornis readily available and wellmaintained.

How often is equipment checked? Who is responsible for repair and

maintenance? Are the resources sufficient for the

number of babies requiring screening?



41


9. All parents are provided withinformation about the screeningprogramme which accounts for thechanging needs of babies as theydevelop which describes the benefitsand limitations of screening.

Is written information available to allparents in the latter stages ofpregnancy?

Is written information available to allparents after delivery and in advance ofthe examination?

In both cases, is this the nationallyapproved leaflet?

Are mechanisms available to supporttranslation/communication relevant toclients in your locality

Are parents informed about the benefitsand limitations of screening?

Is parent satisfaction audited?

7.6 Training and Education

Delivery of this screening programme requires all health care professionals involved inservice provision to be appropriately trained and competent. This includes maintenance of skills and knowledge. A regular appraisal to assess competence is recommended.The competencies in this document have been mapped to the NHS Key Skills Framework and The Skills for Health Maternity and Care of the Newborn CompletedFramework and will support the appraisal process.

Commissioners and Providers should ensure that the indicative content of educationand training courses for physical examination of the newborn address the standards andcompetencies outlined by the screening programme.



42

8. Competencies

8. 1 Definit ions

Matillon et al (2005) defines competence as:

"professional competence is based on the initial diploma, the implementation ofeffective continuing education, a minimal professional activity and a regular peer

review process "This definition reflects not only the knowledge and skills, but also the professionalaccountability aspects, including being responsible for one’s own professionaldevelopment needs and appraisal in accordance with the individual professionalrequirements in order to maintain registration.

The abbreviations used in the Competency tables are as follows:

GEN : The Skills for Health Gen eral Health Care

HSC : The Skills for Health and S ocial C are Completed Framework which contains 201competencies

HWB: KSF specific dimension Health and Wellbeing which contains ten components

KSF refers to the NHS Key S kills F ramework which is a way of describing all posts in theNHS in terms of groups of skills. There are 6 core dimensions, which apply to all postsin the NHS and 24 specific dimensions, which may only apply to individual jobs.

MCN:The Skills for Health Maternity and C are of the Newborn Completed Frameworkwhich contains 25 competencies

MSCN : The Skills for Health Management and Leadership

Details can be accessed viahttp://www.skillsforhealth.org.uk/tools/view_framework.php?id=115 .

Since these competencies were drawn up and consulted upon, Skills for Health now tendto group competencies in an overall Health Functional Map, so in using those presentedin this report, one should only use them as a guide and refer for more detail to the Skillsfor Health website.

http://www.skillsforhealth.org.uk/tools/view_framework.php?id=115
































1.3 Demonstrates personal professionalcompetence by choosing to undertake theexamination or refer to a more appropriatelyqualified member of staff.

1.4 Collects appropriate equipment anddocumentation to undertake and record theprocess

Code of Conduct, Scope of professional practice, Legal/ ethical issues that may inflautonomy.

Documentation process & IT including notes, referral documentation and parent infProfessional guidance on record keeping.Familiar with equipment and able to use as appropriate e.g. tape measure, stethoscocentile charts, scales. Knowledge of health & safety issues relating to equipment.



Competency 2 Ensures the environment is conduci ve to effective and safe examination

SfH Competencies and KSF Mapping: MCN1 / KSF Core 1, level 2MCN5 / KSF HWB 6, level 3MCN18 / KSF HWB7, level2

Benchmarks

2.1 Ensures parent’s physical and emotional status iscommensurate with effective communication

2.2 Ensures infant’s physical status is commensuratewith an effective examination

2.3 Enables effective communication of sensitive andconfidential information between parent and examiner

2.4 Ensures the baby’s safety and comfort – beforeand during assessment

2.5 Ensures the baby’s safety and comfort oncompletion of assessment

Knowledge/skill s/curriculum guidance

Knowledge of the effects of parent’s emotional state when receiving infochanges and mood status. Able to observe and monitor for post-natal denegative effect of partner’s/significant other’s presence. Effect of distres

Confirm identity of infant and relationship to adult present. Consider faccommunication & compliance of infant, timing of examination: mealtimfeeding/hunger. Infant settled hygiene/elimination.

Code of conduct in relation to confidentiality of information. Considerafactors: quiet surroundings, free from interruption, adequate heating, adezones of proximity.

Ensures heating and light adequate for undressing baby and visual inspethe infant. At an appropriate stage of the examination the baby should beenvironment should support this. Cot/crib safety if appropriate. A firm snecessary. See 1.1, 1.2, 1.3, 1.4.Health & safety issues: ease of access toequipment safely. Knowledge and application of trust/unit policies & promaintenance and cleaning of equipment and reporting faulty equipment.

Ensures the parent is safely and competently able to care for his/her chilsafety issues, positioning, adequate clothing and nutrition, safe transportchild protection procedures if there is cause for concern . Know



clothing, ID intact (newborn).



Competency 3 Facilit ates effective informed decision-making

SfH Competencies and KSF Mapping : MCN1 / KSF Core 1, level 2MCN5 / KSF HWB6, level 3EC30/ KSF Core 5, level 2MSCN12 / KSF HWB2, level3

Benchmarks

3.1 Ensures parent/infant’s physical and emotional status iscommensurate to effective communication and examination

3.2 Explains reasons for undertaking examination & provides anoverview of the examination process

3.3 Determines the parent’s understanding of the nature of theexamination

3.4 Elicits parent’s views of health/wellness status & identifies anyanxieties

3.5 Ensures the parent is aware of benefits and limitations of thephysical examination & screening tests in general

Knowledge/skills /curriculum guidance

Communication skills: clear, articulate, pace of speech. Imand appropriately qualified to perform examination. Imporbadge. See 2.1

Able to undertake a logical structured overview. Utilises cuphysical and screening aspects of the examination, Pitchedtime parent vs multi-gravida, teenager. Consideration of peterminology, consistent approach. Note danger of stereotyp

Use of open and closed questioning, listening, paraphrasingconversation with parent, and show parent’s opinion/experithat the parent can contribute to the assessment (infants maKnowledge of cultural issues related to effective communiappropriate.

Directs conversation/revises language used to elicit clearerInterpretation of non-verbal cues to determine parental und

Positive & negative aspects of screening & physical examifuture. Confirms normality at time of examination & detecabnormalities. Value of detection and early intervention.



3.6 Obtains permission to undertake the examination inaccordance with Trust policy / standards of professional practice

3.7 Draws upon professional and legal codes/guidance forpractice to make an informed decision regarding theappropriateness and timeliness of the examination and to supportdialogue with the parent(s)

3.8 Provides any supplementary information e.g. leaflets whereappropriate

Consent obtained when satisfied parent understands as aboapply Trust policy / standards of professional practice. Knoprofessional issues related to consent, verbal or written, agissues.

Code of conduct, duty of care, draws on knowledge & skill1-3, e.g. lack of resources and lack of information of parenKnowledge of key health promotion topics and ability to direlevant to parents’ needs e.g. on safety issues, SIDS, feediplanning, developmental issues, Personal Child Health Recschedules: blood spot, hearing, immunisation. Knowledge professionals in facilitating on going health promotion suppParental rights, duties, confidentiality, access to informatio

In conjunction with key skills/knowledge identified in 1.1,



Competency 4 Utilises a holist ic, systematic approach, to comprehensively examine the neonate / infant.

SfH Competencies and KSF Mapping : MCN5 / KSF HWB6, level 3EC30 / KSF Core 5, level 2EC17 / KSF HWB7, level 3HSC32 / KSF Core 3, level 2MCN24 / KSF HWB4, level 3

Benchmarks

4.1 Involves the parent(s) in the examination andsensitively responds to any questions posed at alevel appropriate to their need.

4.2 Uses assessment skills of inspection,auscultation, percussion and palpation to informdecision making

4.3 Undertakes observational assessment ofinfants status at rest

4.4 Determines gestational age in newbornexamination

4.4. Completes base line observations fornewborn examination and at 6-8 weeks

Knowledge/skills/curriculum guidance

Interpretation of non-verbal cues to determine parental understanding/anxiety.and non-verbal communication strategies to ask relevant questions and facilitais important that the practitioner interacts with the baby and the parents durinutilise an appropriate knowledge base in order to address any concerns expresexplain the reason for and procedures/techniques used during the examination

Knowledge of, and ability to correctly perform, appropriate technique relevanexamination. Assess 6 sleep states and behaviours, eyes, auditory, cardio vascsystem, hips and genitalia, skeletal, skin and gastro-intestinal.

Knowledge of process of assessment, importance of observations best taken wwith current recommendations, observe colour, cry, movement, posture, respi

Knowledge and application of assessment tools e.g. Dubovitz.

Takes into account gestational age of infant at birth and assesses according to Knowledge of relevant observations and normal parameters, in accordance wirecommendations, - Head circumference, respirations, apex rate, weight. Abilthese observations using appropriate equipment.



competence and actively seeks assistance when

these limitations are reached.

activities when in situations that are beyond current personal competence.



Competency 5 Effectively and sensit ively records and communic ates findings to parents and relevant professionals

Mapping: MCN1 / KSF Core 1, level 2MCN5 / KSF HWB6, level 3MCN6 / KSF HWB2, level 3HSC31 / KSF Core 1, level 3MCN12 / KSF HWB2, level 3

Benchmarks

5.1 Informs unit staff of any significant findingsand seeks assistance from other health careprofessionals if advice or confirmation of

findings is required.

5.2 Ensures details of the examination arecorrectly and concisely documented inaccordance with unit/Trust policy

5.3 Sensitively communicates the outcome ofthe examination and the need for any referral, tothe parent

5.4 Provides information on the referral processand possible outcome.

5.5 Contacts appropriate personnel and ensuresall relevant information is documented and/orcommunicated verbally to inform referral

Knowledge/skills /curriculum guidance

Knowledge of key staff and how to contact them.

Guidelines/recommendations for record keeping. Use of appropriate documentData protection issues. Clear concise written documentation presented in a logiaction taken, who informed and when. This should include recording and followshould be communicated to appropriate health professionals and the child healthaccordance with local policy.

Knowledge of the impact of ‘breaking bad news’ timing of information given, wKnowledge of ‘false positive/negative results and need to retest / refer.

Knowledge of the reason for referral and knowledge of what parents may expec Awareness of resources available to parents for further information and opportu

Ability to document and verbalise key information required by referee, Knowlereferral. Accurately record information on referral in notes. Use appropriate chacontact paediatrician/consultant, social services or relevant Allied Health Profe



5.6 Ensures organisation of any follow up

appointments following newborn examination isin place prior to the baby’s discharge home.

5.7 Collaborates effectively and courteouslywith all unit/ referral personnel, ensuringrelevant information is communicated tofacilitate optimum family support

5.8 Ensure relevant information iscommunicated to health care professionals whowill support the family in the community.

5.9 Ensures parents have relevant informationof support services available to them afterdischarge home

Knowledge of discharge planning process & ability to complete this in accordan

Knowledge of whom will be involved in the family’s ongoing care needs and prcontacting them if needed. Details of results recorded as appropriate in paper / iPersonal Child Health Record. Code of Professional Conduct.

Knowledge of who will be involved in home care and process for informing theneeded. Details of results recorded in paper / information systems documentatioPersonal Child Health Record.

As 5.5. See 7.7



Competency 6

Maintain and fu rther develop prof essional competence in examination of the newborn / 6-8 week inf ant

Mapping : HSC33 / KSF Core 2, level 1HSC43 / KSF Core 2, level 3GEN13 / KSF Core 2, level 3

Benchmarks

6.1 Be regularly assessed by a senior practitioner

6.2 Undertake directed study or attend workshopsto update knowledge/skills

6.3 Utilise IT and other resources to facilitateprofessional development of self and others .

Knowledge/skills/curriculum guidance

Application of Professional Code of Conduct re: accountability. Able to take smaintained by monitoring number of examinations performed and following tif non compliant .

Knowledge of national recommendations and unit policy. Take responsibility treassessment by a senior practitioner to confirm competence. Knowledge of wTrust re: updating

As in 4.9. Knowledge of recommended changes to practice. Knowledge and /coaching skills. Attend workshops to update knowledge/skill



Mr Robin W Paton Consultant Orthopaedic Surgeon, Blackburn RoyalInfirmary

Ms Christine Samson Project Manger, Child Health Screening

Members of the congenital heart defects work shop January 2004Dr David Elliman (chair) Chair, Child Health Sub group NSC

Dr Kate Brown Consultant, Paediatric Intensive Care, GreatOrmond Street NHS Trust

Dr Jackie Brown Dept of Social Medicine, BristolDr Kate Bull Great Ormond Street NHS TrustProf Carol Dezateux Paediatric Epidemiologist, Institute of Child

HealthDr Ingolf Griebsch MRC, BristolDr Alan Houston British Society of Echocardiography

Dr Barry Keeton President, British Paediatric Cardiac AssociationDr Rachel Knowles Institute of Child HealthDr Edmund Ladusans Mersey Cardiac Surgery Dataset, Alder HeyDr Robin Martin Cardiology, Royal College of Paediatrics & Child

HealthDr Wilf Kelsall Deputy Regional Adviser in Paediatric Training,

Royal College of Paediatrics & Child HealthDr Ian Peart Mersey Cardiac Surgery Dataset, Alder HeyDr D W Pilling British Medical Ultrasound SocietyDr Sam Richmond Sunderland Royal Hospital and BAPM Working

GroupMs Christine Samson Project Manager, Child Health Screening

Dr Gurleen Sharland Fetal Cardiology, Kings CollegeDr Rosalind Skinner Scottish ExecutiveProf Martin Whittle Dept Fetal Medicine, BirminghamMs Llywela Wilson Antenatal Screening WalesDr Christopher Wren Dept of Paediatric Cardiology, Newcastle upon

Tyne

Members of the Undescended Testes Workshop January 2007Dr David Elliman (chair) Executive Officer of NIPE Subgroup (Chair)

Dr Chris Barry General Practitioner, SwindonDr Nicholas Madden Paediatric Surgeon, Chelsea and WestminsterNHS Trust

Glenda Augustine Executive Officer of NIPE SubgroupDr Stuart O’Toole Paediatric Surgeon, Yorkhill NHS Trust Scotland

58



Members of the Child Health Subgroup

Dr David Elliman Chair

Ms Obi Amadi Community Practitioners' and Health Visitors' Association

Ms Glenda Augustine National Lead, Child Health Screening CoordinatorTeam

Ms Linda Bailey Royal College of NursingDr Ian Bashford Scottish ExecutiveDr Helen Bedford Institute of Child HealthMr John R Boyles British Dental AssociationDr Margaret Boyle Department of Health & Social Services, Northern

IrelandProf Carol Dezateux Royal College of Paediatrics Child HealthDr Henrietta Ewart Director of Public HealthSir Muir Gray UK Programme Director, NSCDr David Holton Royal College of General PractitionersDr Huw Jenkins National Assembly for WalesDr Ronke Jomo-Coco African Association for Maternal & Child Care

InternationalMs Barbara Jordens-Harris Department of HealthDr Stuart Logan Director of Health and Social Care ResearchDr Emma Loveman Health Technology Assessment Programme

Prof Theresa Marteau Professor of Health Psychology, Guy's King's &Thomas'sMs Christine Samson Project Manager, Child Health ScreeningDr Rosalind Skinner Scottish ExecutiveDr Allison Streetly Faculty of Public Health MedicineProf Stuart Tanner Medical Adviser, Paediatrics & Child HealthDr Andrea Thomas National Assembly for WalesMs Jacquie Westwood Director of Specialised ServicesDr Catherine Woodward Director of Health ImprovementMs Carol Youngs British Dyslexia Association

59



Acknowledgements - Competencies

Changing Workforce Neonatal PilotKaren Mitchell University of TeessideMarian McGill Changing Workforce ProgrammeMaria Barrell Northumbria UniversityElizabeth Mansion Scottish Multiprofessional Development ProgrammeJulie Bramley Sunderland Royal Hospital

Circulated toProf Alan Craft Royal College of Paediatrics & Child Health

Andy Willis Royal College of Paediatrics & Child Health (CPD)Kim Brown Royal College of Paediatrics & Child Health (training)Maria Barrell Midwifery Education & Training Group

Dr Alison Baker Royal College of GPsFrances Evesham Skills for HealthGlenda Augustine National Lead Child Health Screening CoordinatorKatie Howie Royal College of NursingLiz Whybourne Royal College of NursingPauline Byers CPHVASue MacDonald Royal College of MidwivesSusan Way Nursing & Midwifery CouncilVal Jones Birmingham PCTChristine Cooper BACCH/BAPMRadhakrishnan Nayar Royal College of Paediatrics & Child Health

(committees)Joint Standing Committee RCM/RCOG/RCPCH

Child Health Subgroup UK National Screening Committee

Newborn and 6-8 week Infant Physical Examinations Subgroup OF Fetal Maternal and Child HealthCo-ordinating Group

Educational Institutions

Bournemouth UniversityChristchurch University, CanterburyEIHMS, University of SurreyHomerton School of Health StudiesMiddlesex UniversityPractitioner Development UK LtdSt Bartholomew's SchoolCity University LondonUCE BirminghamUniversity of Central LancashireUniversity College WorcesterUniversity of BradfordUniversity of East Anglia, NorwichUniversity of GreenwichUniversity of Hertfordshire, Hatfield

University of HuddersfieldUniversity of HullUniversity of LeedsUniversity of LutonUniversity of ManchesterUniversity of Northumbria, NewcastleUniversity of NottinghamUniversity of PlymouthUniversity of SalfordUniversity of TeessideUniversity of the West of England, BristolUniversity of WolverhamptonSt Martins College, CarlisleTVU LondonJohn Moores University, Liverpool

60



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http://guidance.nice.org.uk/CG37



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