Ensuring Equitable Newborn Hearing Screening for Refugee Families

Surrey and Sussex Healthcare NHS Trust partnered with NEC Health to remove barriers to newborn hearing screening for refugee families. Together, they created an inclusive, sustainable approach that ensures every baby receives timely, equitable care.

Overview

Surrey and Sussex Healthcare NHS Trust (SASH) identified a critical health inequality affecting newborn hearing screening for migrant and refugee families near Gatwick Airport. Barriers including language, transport, cultural unfamiliarity, and financial constraints were causing babies to miss essential hearing checks – checks that are vital for identifying hearing loss early and preventing long-term developmental challenges.

Partnering with NEC Software Solutions, SASH embarked on a multi-year improvement programme to embed inclusion, redesign protocols and ensure that every baby, regardless of background, received timely, equitable screening.

The Challenge

Hearing screening must take place within set national timeframes to ensure early intervention. However, families seeking asylum or recently resettled face complex barriers:

• Language and literacy challenges make screening letters and processes difficult to understand

• Transport and financial pressures prevent travel to outpatient appointments

• Cultural uncertainty and traumatic experiences can make engaging with unfamiliar services daunting

• Frequent moves between temporary accommodations cause missed communications and lost appointment details

The 2024 MBRRACE report highlighted significant inequalities in maternity healthcare nationally, and SASH recognised how easily these disparities could extend into newborn screening. SASH was already awarded the Maternity Service of Sanctuary Award – and wanted to ensure the same standard applied to the hearing screening pathway.

The Approach

Working collaboratively, SASH and NEC transformed the newborn hearing screening process using a multifactorial, culturally aware, data-driven strategy.

1. Data Audit and Insight Generation: NEC analysed all ‘Was Not Brought’ cases and identified two clear risk factors – babies living in local hotels and babies whose families required translators.
2. Protocol Redesign: Completing all screening before discharge, even when repeat tests were needed. This removed the need for outpatient visits, eliminating transport, translation and logistical barriers.
3. Cultural Competency and Inclusion Training: NEC delivered workshops featuring roleplay of a refugee family navigating services; Inclusion Lead Midwife lectures on health inequalities; Introductions to the ‘Wheel of Privilege’ framework; and Guidance on using interpreters effectively. Screeners described the training as ‘eye-opening’ and ‘transformational’.
4. Better Language Support: Translator needs were recorded at each screen and NHSP materials were sourced and provided in Pashto and other languages.
5. Joined-Up Working Across Services: Midwives supporting hotel-accommodated families coordinated with screeners to ensure babies weren’t missed, and audiology teams were updated to ensure continuity after screening.

Impact

• Zero ‘Was Not Brought (WNB)’ cases for refugee babies in five consecutive years

• 95%+ screening coverage, meeting national NHSP standards

• Faster diagnosis and no delays to early intervention

• Reduced administrative costs and fewer booked appointments

Screeners also reported significantly improved confidence when working with families from diverse backgrounds, thanks to the cultural awareness training and practical tools provided.

“They have demonstrated a clear commitment to addressing health inequalities and always aim to be responsive to the needs of families from diverse communities.”
-Mary Clare Chapman, Consultant Midwife & Maternity Service of Sanctuary Award Winner

This initiative ensures that refugee families – who statistically face greater health inequalities – receive equitable access to essential screening at a critical moment in their baby’s development. By removing system-level barriers, SASH and NEC have created a model where inclusion is built into the core of everyday practice and have redefined what inclusive community care looks like.