NHS England and NHS Improvement (NHSE&I) is responsible for commissioning Child Health Information Services across England, designed to support safe and effective public health programmes for 0-19 year-olds. In 2015, NHS Arden & GEM CSU was tasked with taking on a county-wide service for Derbyshire, including the newborn screening and child immunisation programmes.
We have developed a robust and responsive approach to monitoring and managing all aspects of the CHIS. This has seen our newborn screening programme successfully adapt to include a new pilot screening requirement, and our childhood immunisation programme keep pace with the fast-changing landscape of vaccinations during the coronavirus pandemic.
The challenge
The scale of the task is significant. There are approximately 918 births in Derbyshire every month, most of which are received directly into SystmOne via an NHS number feed from the Derbyshire hospitals. Every child born in Derbyshire and registered with a Derbyshire GP practice must be entered into the CHIS by our team.
In providing a single source of health information for children and young people, our responsibilities include recording information and monitoring take-up of:
- Newborn and infant physical examination completed within 72hrs of birth by the Trust offering the maternity service
- Newborn Blood Screening completed on day five by the Community Midwifery Service
- Newborn Hearing Screening completed by the Newborn Hearing Screening Service of the Trust offering the maternity service
- Childhood Immunisation Programme
- HEP B - Antenatal Infectious Diseases Screening Programme
- School Age Immunisation Service.
Most information is held and shared through the SystmOne clinical system. However, 19 of the 111 GP practices in Derby and Derbyshire CCG do not use SystmOne, requiring separate processes to ensure all relevant data is appropriately recorded and shared. All records must be kept up to date as a child’s status changes. For example, each month our team deals with approximately 600 requests to change GP practice and approximately 2,000 change of address notifications alongside other record updates.
The scale and complexity of immunisation recording and monitoring has increased significantly during the pandemic, due to a combination of additional vaccines and interruptions to the normal processes during lockdown, requiring a flexible approach from our team.
Our approach
Arden & GEM has established an approach which makes best use of our experienced team, to ensure we have the right information at the right time. We handle myriad data sources, from multiple systems and locations, to monitor, validate and report on service delivery.
We have developed strong working relationships with the commissioning team and neighbouring CHIS teams, enabling us to share best practice and work together to identify solutions when challenges arise.
Introducing electronic registration
As the previous provider only delivered their CHIS Service for 0 to 5 year-olds, Arden & GEM had to apply to NHS Digital for a report of all 6-19 year-olds registered with a Derbyshire GP. We put in place an electronic registration system to enable the 59,000 children in this cohort to be registered efficiently and accurately, avoiding manual processes.
The initial one-off report was followed by weekly ‘Movements In’ reports, using the same electronic processes. This has proved so successful that a ‘Movements In and Movements Out’ weekly report has since been incorporated into the CHIS specification. Following an initial audit, our Derbyshire CHIS team now processes 330 records each month for 0-19s that have been confirmed in the Movements In and Movements Out report, including checking these children are either required to be registered within the Derbyshire CHIS System or moved to another CHIS.
Adapting to change
New screening tests: The regional laboratory in Sheffield is one of a handful of laboratories trialling an extra newborn screening test for severe combined immunodeficiency (SCID) to determine whether a baby can safely receive a live BCG vaccine against tuberculosis. This is given by the TB Service at Royal Derby Hospital by 28 days of age. GPs also administer a live vaccine at eight weeks to all babies, so it is imperative a live vaccine is not given to any baby until they have received a ‘not suspect’ result for SCID.
Our team has set up a new system to incorporate this complex new test in the Derbyshire screening programme. This includes responsibility for receiving laboratory results, promptly informing the TB services and GPs not on SystmOne of the outcome, as well as running audits to monitor take-up.
COVID-19 impact: The pandemic brought fresh challenges, with thousands of COVID-19 vaccinations needing to be recorded every month for the GP practices not using SystmOne, and additional monitoring required in view of school and GP-led vaccination programmes being interrupted during lockdown. We devised a new approach to proactive reporting by reformulating our existing retrospective monitoring processes to provide a solution to highlighting missed vaccinations, making it much quicker and easier for the commissioner and the NHSE&I Immunisation Team to identify take-up of the programme.
The outcomes
Derbyshire has a robust and effective CHIS service operating across the county. Experienced staff proactively monitor screening and vaccine take-up, working with maternity staff, GP practices and neighbouring CHIS teams to accurately record child health information, and address gaps promptly. We have set up processes to ensure seamless integration and sharing of data with those GP practices using a different clinical system. We have made further improvements in how we work with GP practices thanks to improved digital take-up post pandemic, and data is more complete as a result.
Our experienced team has adapted well to new challenges such as SCID screening, COVID-19 vaccinations as well as the challenges of remote working during the pandemic. This has seen us meet – and often exceed – deadlines set so that all those involved in the care of new babies and young people have access to the right information at the right time.
"The CHIS team has supported DCHS Children’s Community Services to report on missed vaccinations and understand the impact of COVID-19 on the uptake of the childhood immunisation programme. The team helps to support us with screening and identifying missing information. They are key to enabling us to audit this."
Claire Scothern, Professional Quality Lead Children and Families at Derbyshire Community Health Services