Monitoring performance in the NHS. The district neural tube defect screening service.

A small medical school team has developed a six item system (SIS) for monitoring the neural tube defect (NTD) screening service. SIS is discussed in relation to possible alternative monitoring systems and the advantages which led to its implementation are described. In July 1982 the system was introduced in three districts in South Wales and the first year's results are presented. These permit the local provision, written policies and clinical and management responsibility of the service to be examined and deficiencies in the relevant information systems to be identified. Of particular concern is the discovery that districts have no way of knowing the number of terminations for NTD, and thus their current NTD incidence. In view of these findings, it would seem advisable for all districts providing NTD screening to monitor their service. SIS provides a simple, cheap and effective monitoring system which could be easily implemented throughout England and Wales.