Improving access to care in a remote and rural area; local introduction of screening for newborn developmental hip dysplasia (Green Maternity Challenge)

Project completed as part of the National Green Maternity Challenge 2024-25 by the NHS Orkney team.

Team members:

• Lauren Flett, Senior Charge Midwife
• Michelle Mackie, Lead Midwife
• Monique Sterrenburg, Consultant Obstetrician & Gynaecologist

Setting / patient group: Paediatrics/Maternity Services

Issue: 

Due to geographical limitations and relatively small nature of NHS Scotland, access to advanced equipment and specialist care and skills are limited. Presently, families need to travel to Aberdeen with their newborns for the Ultrasound Newborn Screening for Hip Dysplasia. This setting has the potential to negatively affect clinical outcomes for patients, particularly those from peripheral areas such as Orkney Island, due to increased travel time and delay in travel owing to unpredictable weather, longer waiting periods and inconvenience to families.

In contrast, offering screening programme on the island would reduce waiting times, and increase access to healthcare. It can also allow for early management and intervention in newborns. This can further lead to a stronger local social support networks and an increase in local skills in sustainable resource management.

Intervention: 

Setting up a newborn hip ultrasound screening service in Orkney Island, by partnering with Aberdeen Maternity Hospital (AMH) and Royal Aberdeen Children’s Hospital (RACH), can eliminate the need for families to travel to Aberdeen. This can make sure that the care is sustainable and equitable, benefitting the environment and the families.

This was kept in mind and families were engaged firstly to estimate the impact of change and to confirm if families would like to have a screening programme locally. After confirming their agreement for the same, the key approach was to enable the existing sonographers on the island to extend their expertise so that these scans can be performed locally. There were 3 experienced sonographers already on the island, who were ready to extend their expertise and skillset to be able to perform these scans, which meant that no additional staffing was required.

This task was carried out by engaging various members of the multidisciplinary team and stakeholders including but not limited to the board at RACH, local sonography and radiology team, local training and development team and local governance teams.

The project began in January 2025, and involves planning, training sonographers, ordering necessary equipment and developing local Standard Operating Procedures and Guidelines. The project is still in effect, with a goal to fully implement the service locally by December 2025, while remaining in constant contact and support from RACH.

Outcomes:

Environmental

Emissions associated with family travel can be reduced as the carbon emissions caused by families travelling to Aberdeen for the scan will be much lower as compared to staff travel for training purposes to the mainland. According to calculations, there will be a savings of 7,073

kgCO2e in the first year (accounting for staff training), which will increase to 7,615 kgCO2e in the next year.

Social

Based on the result of 55 completed surveys by families, 80% of them experienced a degree of stress while travelling with a newborn and 22% of them experienced some form of weather or travel related delays. 25% of them stated that they faced financial impact as a result of having taken time off of work to attend the appointments. Interestingly, only 1 out of the 55 patients required treatment. Therefore 98% of scans could have been delivered locally without a need for travel to RACH for further diagnosis. 98% of them also stated that access to a screening appointment locally would have been helpful for them and their families, which shows a strong support in favour of service change.

The impact of this change will be positively on families, in terms of improved health outcomes and community wellbeing, and on the staff, in terms of increased opportunities for staff development and job satisfaction. Since the scan numbers will be small, it is expected that the staff well-being will not be affected negatively.

Clinical

Following full implementation of the programme, patient satisfaction can be compared with the current situation to measure the impact of intervention in terms of accessibility, convenience, and overall experience. A locally available screening programme will make sure that scans are done within the first 2 weeks of life, preventing any delays in screening caused by inability to access screening, be it due to travel or other reasons. Measuring sonographer competence through clinical competency reviews will maintain patient safety and quality of scans.

Financial

It costs approximately £1085.00 for one staff member to attend a two-day training course, including return flights and one night accommodation in Cardiff. There will be no additional costs for conducting the screening on the island as ultrasound machines and probes are already available. Currently, it costs the NHS an average of £800 per family for travel to Aberdeen and an average of £50 per family for food expenses.

With the implementation of the programme, a reduction of £15,915 in costs is expected in the first year. As staff training will not be required for the same staff after the first year, the annual savings are expected to increase to £17,000.

Key learning point:

Introducing a new healthcare service, especially in remote locations, requires patience, dedication, and ongoing adaptation to various obstacles. A variety of barriers including staff training, logistical challenges and public engagement need to be dealt with for effective planning and implementation of the programme. Setting out goals in the form of ‘Next/Immediate Steps’ is necessary to stay motivated and serves as a constant reminder of current situation and ultimate desired outcome.