Scope of this report
| Service* | Provider | Commissioner | Within the scope of this visit |
|---|---|---|---|
| Sickle cell and thalassaemia screening laboratory services | Full blood count and HPLC Confirmatory testing: St George’s Hospital NHS FT (South-West London Pathology) | NHS England – London | No |
| Infectious diseases screening laboratory services | HIV, Hepatitis B and Syphilis Confirmatory testing: St George’s Hospital NHS FT (South-West London Pathology) | NHS England – London | No |
| Fetal anomaly screening – combined screening services | Dating/NT scan: Croydon Health Services NHS Trust Screening laboratory: Birmingham Women’s and Children’s NHS Foundation Trust | NHS England – London | Ultrasound element only |
| Fetal anomaly screening – quadruple screening laboratory services | Dating scan: Croydon Health Service NHS Trust Screening laboratory: Birmingham Women’s and Children’s NHS Foundation Trust | NHS England – London | Ultrasound element only |
| Fetal anomaly screening – NIPT screening laboratory services | South-West London Pathology | NHS England – London | No |
| Fetal anomaly screening – 20-week screening scans | Croydon Health Services NHS Trust | NHS England – London | Yes |
| Diabetic eye screening | Croydon Health Services NHS Trust | NHS England – London | Yes |
| Newborn and infant physical examination | Croydon Health Services NHS Trust | NHS England – London | Yes |
| Newborn blood spot screening laboratory services | South-West London Pathology | NHS England – London | No |
| Newborn hearing screening programme | Kingston and Richmond NHS Foundation Trust | NHS England – London | Yes |
| Child Health Information Service (CHIS) | Your Healthcare | NHS England – London | Yes |
Screening laboratories are quality assured by the United Kingdom Accreditation Service (UKAS).
Summary
Quality assurance looks at the antenatal and newborn screening pathways starting with identifying the eligible population of pregnant women and babies. It also includes the relevant screening tests for each programme. For women and babies with screen positive/higher chance results it will also include the pathways for referral, diagnosis and/or treatment.
The findings in this report relate to the quality assurance visit on 11 September 2025 to Croydon Health Services NHS Trust Screening Service which is commissioned by NHS England (London) Public Health Commissioning team. Any commissioning findings are outside the scope of this report and will be followed up directly with the commissioner.
We use the term ‘woman’ or ‘mother’ to encompass all gender identities and is intended for anyone who is pregnant. Similarly, where the term ‘parents’ is used, this encompasses anyone who has main responsibility for caring for the baby.
Quality assurance purpose and approach
Quality assurance (QA) aims to achieve and maintain national standards, promote continuous improvement in antenatal and newborn (ANNB) screening and support reducing health inequalities. This is to ensure all eligible people have access to a consistent high quality, effective, equitable and safe service wherever they live.
QA visits are carried out by the NHS England Screening Quality Assurance Service (SQAS).
The evidence for this report comes from the following sources:
- monitoring of routine data collected by NHS England
- data and reports from external organisations
- evidence submitted by the provider(s) and external organisations
- discussion with the commissioner in advance of the visit
- information collected during pre-review visits to Your Healthcare on 01 September 2025 and an interview with Croydon Sickle cell centre staff on 08 September 2025
- information shared with SQAS as part of the visit process.
The screening service
Croydon Health Services NHS Trust comprises of the main hospital site, Croydon University Hospital in Thornton Heath, London and Purley War Memorial Hospital, in Purley. Croydon University Hospital provides high risk obstetric care and low risk maternity care for women. There is a co-located birth centre. There is a level 2 neonatal unit.
Croydon Health Services are part of the South-West London footprint, alongside their neighbouring trusts; St George’s University Hospitals NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust and Kingston and Richmond NHS Foundation Trust. Laboratories, child health information services (CHIS) and newborn hearing screening services (NHSP) are provided across this geography.
Croydon is one of the largest London boroughs by population and the trust provides care to a population of 390,800 residents (Census data, 2021). Nearly 50% of births in 2022 were to women who were born outside of the UK. Census data (2021) shows that population of Croydon includes 17.6% Asian, 22.7% Black and 48.5% white ethnicity. In 2024, Trust data shows that 21% of women booking were recorded as white, 26% African or African Caribbean and 27% South Asian. In Croydon there is an immigration centre.
In 2024/25, 4232 women booked for maternity care at Croydon University Hospital and 3192 babies were delivered in the same period (Trust data).
The trust is designated as high prevalence for sickle cell and thalassaemia (SCT) screening. Counselling services for SCT are provided in the community by Croydon Health Services NHS Trust. Prenatal diagnostic testing for SCT is provided by Kings College Hospital NHS Foundation Trust.
Fetal medicine services for women providing specialist care following screening (combined and quadruple screening and the 20-week screening scan) is provided by St George’s University Hospitals NHS Foundation Trust.
Newborn Hearing Screening Programme (NHSP) is provided by Kingston and Richmond NHS Foundation Trust.
Child health information services (CHIS) are provided by Your Healthcare, a Community Interest Company (CIC).
Findings
The maternity leadership team has had many changes this year. Work is underway to review and update the directorate governance structures and processes and embed new ways of working.
There are several examples of inefficiencies within the screening services, including the use of senior clinical staff to complete administration tasks.
Maternity ultrasound sits within the Allied Health Professionals directorate. Estates and administrative support sit within the Integrated Women’s Children’s and Sexual Health (IWCS) directorate. There is minimal evidence of collaboration across the two directorates including lack of collaborative incident investigation, audit and support regarding interpretation and counselling services across the fetal anomaly screening programme (FASP).
The obstetric lead sonographer has been in post for just over a year. Prior to this, there was no lead since 2019. The lead sonographer is very experienced and passionate about improving the screening services and there are many examples of improvements that have been made to the service so far including training a new substantive sonography team and reducing the use of agency staff.
There are several issues identified in relation to the newborn infant physical examination programme including performance against standards and key performance indicators, referral, tracking and reporting outcomes. There is no operational NIPE lead with oversight of the programme.
Immediate concerns
There were no immediate concerns
Urgent recommendations
The QA visit team identified four urgent recommendations. A letter was sent to the Interim Director of Midwifery on 15 September 2025 asking that the following items were addressed:
Review the pathway to ensure that informed consent is appropriately sought for participation in FASP screening.
Currently it is not clear if all women have had the appropriate information about FASP screening to be able to make an informed decision. Radiology report that their access to translation services can be difficult and that they are measuring nuchal translucency (NT) in case it is needed when they are unsure about consent. This means that these women may then be completing the screen without understanding about the screening test.
Make sure that appropriate counselling is available for women requiring referral to fetal medicine
FASP guidance states that all unexpected findings of the 20-week screening scan are discussed with the woman on the day. Currently women are referred to fetal medicine at St George’s Hospital but are given minimal information about the findings of the scan on the day. This may cause additional anxiety.
Risk assess the layout of the ultrasound rooms and take action to minimise transcription errors
The current room set up could be modified with simple changes to reduce the risk. This includes the lighting in the room and layout of the equipment for manual data transfer which is in place until the equipment is replaced. Further guidance is available in: Standards for the provision of an ultrasound service | The Royal College of Radiologists
Confirm that the correct charts are being used for FASP within Viewpoint 6
It was unclear on the day of the visit which charts were being used for FASP within Viewpoint 6. If the wrong charts are used, the pregnancy may not be dated correctly, and this could impact on eligibility and accuracy of screening tests.
A response including an action plan was received informing the visiting QA team of the steps taken to partially resolve the urgent recommendations.
High priority findings
The QA visit team identified high priority findings as summarised below:
- The trust screening group (TSSG) is missing key members of the screening multidisciplinary team. The terms of reference do not include escalation to Trust board
- Incidents are not always reported in a timely manner to the screening quality assurance service and commissioners. There are gaps in the reporting of incidents by maternity ultrasound. There is a lack of collaboration between the maternity service and the ultrasound department in the reporting and investigation of screening incidents. The incident management process is not documented in local guidance.
- There are senior clinical staff undertaking administrative roles in both the maternity screening team and the ultrasound team. This means that there is limited capacity for the clinical team to undertake their own roles including sonographers having a reduced amount of time to perform screening scans.
- There is no operational newborn infant physical examination lead covering all aspects of the role. There are various aspects not covered including oversight and monitoring of training and competency for NIPE examiners, consistent and timely referral processes for babies who screen positive and the monitoring of outcomes.
- Cohort tracking is undertaken by the screening team. There is no failsafe support. When capacity is low, cohort tracking is not completed in a timely way. The follow up of missing screening results process is not timely. The follow up of women who do not attend ultrasound appointments is not always completed due to lack of administrative support.
Examples of practice that can be shared
The QA visit team identified several areas of practice for sharing, including:
- The SCT centre implement various strategies to maximise the uptake of father of the baby testing including education, outreach and pre-conceptual awareness and testing.
- The SCT centre has a family centred pathway for the communication of results to families of babies who screen positive for sickle cell disease.
- There is an annual away day provided for the NHSP team. The agenda includes updates to national guidance and quality improvement initiatives. The service also hosts an external speaker such as a teacher of the deaf. The next away day will have a representative from Hearing Dogs for the Deaf.
Recommendations
Immediate concerns – there are no immediate concerns
Urgent recommendations
| No. | Recommendation | Pathway theme | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|---|
| 01 | Review the pathway to ensure that informed consent is appropriately sought for participation in FASP screening. | Invitation and access | 1, 2, 9 | 14 days | Urgent | Action plan |
| 02 | Make sure that appropriate counselling is available for women requiring referral to fetal medicine | Fetal anomaly screening | 1, 2, 9 | 14 days | Urgent | Action plan |
| 03 | Risk assess the layout of the ultrasound rooms and take action to minimise transcription errors | Infrastructure | 16 | 14 days | Urgent | Action plan |
| 04 | Confirm that the correct charts are being used for FASP within Viewpoint 6 | Infrastructure | 9, 16 | 14 days | Urgent | Action plan |
The following recommendations are for the provider to action unless otherwise stated.
Service provider and population served – no recommendations in this section
Governance and leadership
| No. | Recommendation | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|
| 05 | Formalise regular communication and information sharing between radiology and maternity to ensure the safe delivery of the FASP | 1, 2, 9 | 6 months | High | ToR and minutes from Screening and Imms MDT Examples of feedback between departments to manage failsafe and share information about screening incidents. |
| 06 | Implement a business continuity plan for the newborn hearing screening programme | 1, 2, 10 | 6 months | Standard | Business continuity plan (that is signed off) |
| 07 | Amend the terms of reference of the TSSG to maximise attendance and ensure adequate oversight of the screening programmes, including escalation to Trust board | 1, 2 | 3 months | High | Amended terms of reference Documented attendance from sonography and DES |
| 08 | Formalise the fortnightly antenatal screening and immunisation multidisciplinary team meeting | 1, 2 | 6 months | Standard | Terms of reference |
| 09 | Make sure that all potential screening safety incidents are notified to NHS England and managed in line with ‘Managing safety incidents in NHS screening programmes’ | 1, 2, 5, 6 | 6 months | High | Local guidelines (that are signed off) Timely reporting of screening incidents to SQAS and commissioners Timely completion of investigation reports (if relevant) Closure of action plans Shared learning |
| 10 | Complete a screening health equity audit to identify and reduce screening inequalities in under-served and protected population groups, including an audit of the referral of babies who require audiology services | 1, 2, 10 | 12 months | Standard | Completed health equity audit and action plan Audiology referral health equity audit |
| 11 | Change guidelines to comply with national policy and ensure local processes are documented | 1, 2, 7, 8, 9 | 6 months | Standard | Local guidelines and standard operating procedures (that are signed off) SCT, IDPS and NHSP FASP guidelines aligned between maternity and sonography services |
| 12 | Implement an audit schedule for antenatal and newborn screening which is included in the organisations audit schedule. | 1, 2 | 12 months | Standard | Audit schedule |
| 13 | Make sure that there is a collaborative process between the maternity and sonography service for undertaking a clinical review when a baby is born unexpectedly with one of the FASP conditions | 1, 2, 9 | 12 months | Standard | Local guidance (that has been signed off) |
Infrastructure
| No. | Recommendation | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|
| 14 | Make sure that there is resilience and capacity within the screening services, including ultrasound | 1, 2, 9, 16 | 3 months | High | Workforce review within the screening and maternity ultrasound services Adequate scanning time for sonographers as defined by national guidance |
| 15 | Formalise the role of the screening support sonographer and deputy | 1, 2, 9 | 6 months | Standard | Job descriptions (that are signed off) |
| 16 | Implement and monitor a process for ongoing training and continuing professional development for health professionals involved in screening | 1, 2, 9, 10, 11 | 6 months | Standard | NIPE training tracker NHSP competencies tracker Sonography e-learning tracker |
| 17 | Introduce an induction resource for new and agency sonographers that includes the requirements of FASP | 9 | 6 months | Standard | Induction resource |
| 18 | Appoint a designated NIPE lead midwife/nurse and deputy for day-to-day oversight of the programme | 1, 2, 11 | 6 months | High | Job description (that is signed off) |
| 19 | Appoint a Team Leader to make sure that there is adequate oversight of the newborn hearing screening programme | 1, 2, 10 | 6 months | Standard | Job description (that is signed off) |
Identification of cohort (antenatal)
| No. | Recommendation | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|
| 20 | Implement a timely process (as a minimum weekly) to track each woman to make sure that screening is offered, screening tests are performed where accepted, results are received and entry into clinical care where required | 1, 2, 7, 8, 9 | 3 months | High | Tracking process which shows weekly tracking including process to expedite missing screening results Timely process to follow up women who do not attend ultrasound appointments |
Identification of cohort (newborn)
| No. | Recommendation | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|
| 21 | Make sure that there is a process to transfer newborn blood spot failsafe solution records for babies who move in and out of the area | 1, 2, 12 | 3 months | Standard | Local guidelines (that are signed off) |
| 22 | Implement a process for notifying key stakeholders about babies who die including updating the baby’s status as deceased on the newborn blood spot failsafe solution and SMART4NIPE | 1, 2, 11, 12 | 6 months | Standard | Local guidelines (that are signed off) Amended checklist |
Invitation and access
| No. | Recommendation | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|
| 23 | Change the website to make sure that nationally produced screening information is easily accessible prior to booking appointments | 1, 2 | 6 months | Standard | Revised website and weblinks are correct |
| 24 | Make sure that quadruple screening is offered at the earliest opportunity within the eligible window and that the 20-week screening scan is not rearranged for women who present between 18 + 0 and 19 + 6 weeks’ gestation | 1, 2, 9 | 6 months | Standard | Local guidelines (that are signed off) |
Sickle cell and thalassaemia screening
| No. | Recommendation | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|
| 25 | Change the electronic family origin questionnaire (FOQ) to make sure that more than one family origin can be selected | 1, 2, 7 | 6 months | Standard | Proof of updated family origin questionnaire Audit accurate completion of the FOQ |
| 26 | Implement and monitor a plan to meet the acceptable threshold for standard/key performance indicator SCT-S02/ST2 – the proportion of pregnant women having antenatal sickle cell and thalassaemia screening for whom a screening result is available at less than or equal to 10 weeks + 0 days gestation | 1, 2, 4, 7 | 12 months | Standard | Data quality issues amended by the laboratory Submission of data for standard/key performance indicator SCT-S02/ST2 ST2 check list and action plan that is agreed and monitored by the screening group and programme board |
Infectious diseases in pregnancy screening
| No. | Recommendation | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|
| 27 | Change the electronic request form to comply with the minimum data fields | 1, 2, 8 | 6 months | Standard | Proof of updated request form |
Fetal anomaly screening – no additional recommendations in this section please see governance and infrastructure sections
Diabetic eye screening in pregnancy – no recommendations in this section
Newborn hearing screening – no additional recommendations in this section please see governance and infrastructure sections
Newborn and infant physical examination
| No. | Recommendation | Reference | Timescale | Priority | Evidence required |
|---|---|---|---|---|---|
| 28 | Implement a process to track each baby to make sure that there is timely entry into clinical care for babies who screen positive from NIPE, and outcomes recorded on the national IT system | 1, 2, 11 | 6 months | Standard | Local guidelines (that are signed off) |
Newborn blood spot screening – no recommendations in this section
Next steps
The screening service is responsible for developing an action plan in collaboration with the commissioners to complete the recommendations contained within this report.
SQAS will work with commissioners to monitor activity and progress of the recommendations for 12 months after the report is published. After this point SQAS will send a letter to the provider and commissioners summarising progress made and will outline any further action(s) needed.
Appendix: References
- NHS Section 7a screening service schedules 2 and 4 2024-25
- NHS population screening: pathway requirements specifications and learning from screening incidents
- NHS population screening standards
- NHS population screening: reporting data definitions for key performance indicators
- NHS Managing Safety Incidents in NHS Screening Programmes https://www.gov.uk/government/publications/managing-safety-incidents-in-nhs-screening-programmes(last updated 2024)
- NHS England (2022) Patient Safety Incident Response Framework
- NHS Sickle cell and thalassaemia screening programme handbooks (last updated 2022)
- NHS Infectious diseases in pregnancy screening programme clinical guidance (last updated 2023)
- NHS Fetal anomaly screening programme handbook (last updated 2024)
- NHS Newborn hearing screening programme operational guidance (last updated 2024)
- NHS Newborn and infant physical examination: programme handbook (last updated 2024)
- NHS Newborn blood spot screening guidance (last updated 2023)
- NHS England population screening: pathway requirements specification Diabetic eye screening pathway requirements specification
- NHS Screening inequalities strategy
- Department of Health and Social Care Public Health Profiles
- The Society and College of Radiographers and The Royal Collage of Radiologists (2017) Standards for the provision of an ultrasound service
- UK Health Security Agency Immunisation against infectious disease (last updated 2024) https://fingertips.phe.org.uk
- Hinton et al (2023). A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy
- Hinton et al (2022) Quality framework for remote antenatal care
There is more detailed information on individual screening programmes that can be accessed via Population screening programmes: detailed information