Getting the best out of NICE

Dr Stephen Stericker, Implementation Consultant North

NICE Field Team

• Implementation Consultants

• Team of 7 aligned to NHS CB regions

• 1 in Northern Ireland

• Responsible for a geographical territory

• Field based

• Provide local connectivity

Core principles of all NICE guidance

• Based on the best evidence available• Expert input• Patient and carer involvement• Independent advisory committees• Genuine consultation• Regular review• Open and transparent process• Social values and equity considerations

Why use NICE guidance?

• Based on the best available research– Effectiveness: what works and in what population– Cost-effectiveness: value for money approaches to national

and local priorities

• Reduce variation and inequalities• Improve local services and accountability• Improve health and wellbeing outcomes• Supports the case for investment • Supports local integration, investment and

prioritisation discussions with partners• Fit with broader policy agenda.

• Technology appraisals - on the use of new and existing medicines and treatments

• Clinical guidelines - on the appropriate treatment and care of people with specific diseases and conditions within the NHS

• Public health guidance - on the promotion of good health and the prevention of ill health

• Diagnostic guidance - on measurements and tests used to evaluate or monitor a patient’s condition

• Interventional procedures guidance - on safety and efficacy (can it work) of processes or treatments

• Medical technologies guidance - on new or novel medical technologies (value proposition)

• Social care guidance (new!)

Types of guidance

EFFECTIVE (how well they work)

COST-EFFECTIVE (value for money)

Recent public health guidance

Public health guidance in development

• A concise set of quality statementso designed to drive priority quality improvements within a

particular area of careo offering key markers of high-quality cost-effective careo derived from best available evidence - NICE guidance

and other accredited sources.• Accompanied by recommended indicators that aim to

measure improvements in both the processes and outcomes of care

Designed to drive quality improvement in a defined care or service area

What are NICE Quality Standards?

A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements.

A set of systematically developed recommendations to guide decisions for a particular area of care or health issue

NICE Quality Standards

Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies

Published quality standardsQS1 Dementia

QS2 Stroke

QS3 VTE prevention

QS4 Specialist neonatal care

QS5 Chronic kidney disease

QS6 Diabetes in adults)

QS7 Glaucoma

QS8 Depression in adults

QS9 Chronic heart failure

QS10 COPD

QS11 Alcohol dependencyQS12 Breast cancerQS13 End of life careQS14 Service user experience adult mental health

QS15 Patient experience in adult NHS services

QS16 Hip fracture

QS17 Lung cancer

QS18 Ovarian cancer

QS19 Bacterial meningitis

QS20 Colorectal cancerSee the full list of referred topics:www.nice.org.uk/guidance/qualitystandards

QS21 Stable angina

QS22 Antenatal care

QS23 Drug use disorders

QS24 Nutrition support in adults

QS25 Asthma

QS26 The epilepsies in adults

QS27 The epilepsies in children & young people

QS28 Hypertension

QS29 Diagnosis & management of VTE

QS30 Supporting people to live well with dementia

QS31 Health & wellbeing of looked after children

QS32 Caesarean section

QS33 Rheumatoid arthritis

QS34 Self harm

QS35 Hypertension in pregnancy

QS36 UTI in infants, children and young people

QS37 Postnatal care

QS38 Acute upper gastrointestinal bleeding

QS40 Psoriasis

QS41 Familial hypercholesterolaemia

. The first topics are:

Reducing tobacco use in the community-Smoking is currently the leading cause of preventable death in England

Preventing harmful alcohol use-An estimated 1.5 million people currently show signs of alcohol dependence. Diseases related to alcohol accounting for 1 in 8 NHS bed days.

Strategies to prevent obesity in adults and children-The majority of people in England are either overweight or obese, which increases the risk of type 2 diabetes heart disease and certain cancers, and costs the NHS more than £5 billion per year.

The new standards will be based on existing NICE public health guidance , and designed to drive and measure improvements in healthcare.

Quality Standards for Public Health

Topic Guidance QS

Autism in children and adults Available 2013/14

Mental wellbeing of older people in residential care Available 2013/14

Managing medicines in care homes Feb 2014 2015/16

Domiciliary care July 2015 2016/17

Older people with long-term conditions Sept 2015 2016/17

Children’s attachment Oct 2015 2016/17

Transition between health and social care Nov 2015 2016/17

Challenging behaviour in people with learning disability

May 2015 Tbc

Transition from children’s to adults’ services Mar 2016 2017/18

Child abuse and neglect May 2016 2017/18

Mental health problems in people with learning disability

Oct 2016 Tbc

NICE Quality Standards and guidance for social care.

NICE support for local government

NICE resources supporting implementation:

Local Government Public Health Briefings• Jargon-free, easy to read summaries of

NICE evidence-based recommendations

• Raise awareness of public health issues amongst elected members and officers

• Demonstrate potential role of NICE evidence and guidance as the basis of solutions to public health issues

• Help LA meet public health responsibilities

• Contribute to the achievement of public health outcomes

• Value for money and return on investment

• Introduction

• Key messages

• What can local authorities achieve

• What is effective

• Examples of good practice

• Developing an action plan

• Costs and savings

• Background to recommendations

• Support

• Other useful

resources

Public health briefing topicsTOPIC PUBLICATIONTobacco July 2012

Workplace health July 2012

Physical activity July 2012

Health inequalities and population health October 2012

NICE guidance and Public Health Outcomes October 2012

Alcohol November 2012

Behaviour change January 2013

Walking and cycling January 2013

Obesity May 2013

Preventing and controlling TB among vulnerable groups Sept 2013

Social and emotional wellbeing in children and young people Sept 2013

Contraceptive services TBC

Return on investment TBC

Spatial planning TBC

NICE Podcasts

PH39 Smokeless tobacco cessation - South Asian communities: podcast with Bilkis Hussain

Podcast with Bilkis Hussain - the lead for a smokeless tobacco cessation project within GP practices and dental surgeries within Leicester.

An implementation podcast for GPs, dental practitioners and smoking cessation service leads that outlines the rationale for - and some of the learning from - a smokeless tobacco cessation service which ran within GP surgeries and dental practices in Leicester.

NICE tobacco return on investment tool

•evaluates a portfolio of tobacco control interventions

•models the economic returns that can be expected in different payback timescales.•different interventions, including pharmacotherapies and support and advice, can be mixed and matched

• determines which intervention portfolio or package provides the best 'value for money', compared with 'no-services' or any other specified package

NICE Pathways

View all NICE guidance and support for clinical and public health topics. View relevant guidance recommendations, implementation support and quality standards all from the same screen.

EXISTING PATHWAYS:Alcohol use disordersBreast cancerChronic heart failureChronic kidney disease COPDDementiaDepressionDiabetesDiabetes in pregnancyDietGlaucomaHIV testing & preventionHypertensionNeonatal jaundicePhysical activityPostnatal carePreventing sexually transmitted infectionsPreventing type 2 diabetesSmokingStrokeVenous thromboembolismhttp://pathways.nice.org.uk/

Table top discussion (8.5 minutes)

Implementing guidance: what works?

What can be done to ensure that NICE guidance and quality standards are used across the local authority to inform:

1.The commissioning of services?

Or

2. Quality improvement within provider services

NICE Evidence Services

Bulletins, Alerts and Evidence Awareness Service

Helps busy professionals keep up-to-date with important new evidence. You can subscribe to:

•Evidence Updates - highlights new evidence relating to published accredited guidance

•Eyes on Evidence - covers interesting new evidence. It includes an explanation about what it means for current practice

•The Public Health Awareness Bulletin - contains the latest public health evidence that has been added to the NICE Evidence Search in the last month

•Medicine Awareness Daily and Weekly - access new research, evidence and guidance on best practice relating to the commissioning, managing, prescribing, dispensing and administration of medicines

How to find out more

• Website www.nice.org.uk

• Sign up to receive monthly NICE News

• NICE Evidence Resources www.evidence.nhs.uk

• Email stephen.stericker@nice.org.uk

• Enquiries email nice@nice.org.uk