Weathering the Storm: How NICE products and services can improve quality and productivity

Keith Dickinson, Associate Director NICE

Outline

• Introduction

• What NICE does

• How NICE can help identify cost savings productivity gains

• Savings and productivity collection

• Summary

Introduction

• Unprecedented challenges

• Quality and efficiency gains required, but reduced funding, and increased demands

• Monitor highlighted potential £30bn funding gap by 2021 - see Closing the NHS funding gap: how to get better value healthcare for patients - October 2013)

• But there is support out there….

The role of NICE

• To identify good clinical, public

health and social care practice using the best available evidence

• To help resolve uncertainty for

the public, service users,

professionals and practitioners• To reduce variation in the availability

and quality of practice and care

Core principles of all NICE guidance

• Comprehensive evidence base• Cost effectiveness reviews included • Expert input• Patient and carer involvement• Independent advisory committees• Genuine consultation• Regular review• Open and transparent process

NICE guidance• Clinical guidelines• Medicines practice guidelines• Public health guidelines• Social care guidelines• Safe staffing guidelines• Interventional procedures guidance• Technology appraisals (medicines)• Medical technologies guidance• Diagnostic guidance• In addition, Quality Standards are produced for

Clinical/Medicines/Public Health/Social Care

Savings and productivity collection

• Costing saving guidance

• Cost saving support

• Public health ROI tool

• Quality and productivity case studies

• Do not do recommendations

• Key therapeutics topics

• http://www.nice.org.uk/About/What-we-do/Into-practice/Commissioning-support

Cost saving guidance

• Implementation of NICE guidance can deliver savings

• Lists where savings can be made

• Forward planning tool

• Quantifiable and non quantifiable savings

Cost saving guidance exam[;esFilter Cost Saving Guidance Published High

Inditherm Mattress for the prevention of inadvertent perioperative hypothermia

Cost saving guidance

August 2011

High

CardioQ-ODM (oesophageal Doppler monitor) to guide intravenous fluid management in patients

undergoing surgery, or in critical care

Cost saving guidance

March 2011 Very High

Constipation (women) - prucalopride

Cost saving guidance

December 2010

Very High

MoorLDI2 Burns Imager a laser Doppler blood flow imager for the assessment of burn wounds

Cost saving guidance

March 2011 High

Hypertension (update)

Cost saving guidance

August 2011

High

Vascular disease - clopidogrel and dipyridamole (review)

Cost saving guidance

December 2010

Very High

Hypertension (partial update of CG18)

Cost saving guidance

June 2006 Very High

Cost saving support

• Aimed at organisations responsible for implementing guidance and standards

• Tools can be used to estimate local costs

• Informs implementation plans and business cases

• Wide range of tools available

Public health ROI tool example

Return on investment toolv1.01 (June 2014)

NICE Return on Investment (ROI) tool for interventions and strategies to increase Physical Activity

Click to Begin

Quality and productivity case studies • Provides practical case studies• Can include case studies wider than NICE guidance• All examples submitted to NICE are evaluated• Evaluation based on meeting the q&p criteria:

1. Savings

2. Quality

3. Evidence

4. Implementation• First 3 criteria are scored, then combined• Overall score used to identify ‘recommended’

NICE Quality and Productivity collection: Avoiding unnecessary referral for glaucoma

Quality and productivity case studies examples

Filter QP Case Study Published Very High

Service redesign: early identification of pati ents at risk of developing end-stage kidney disease

QP Case Study August

2014 Very High

Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care

QP Case Study May 2014 Very High

Peer-reviewed referral management: saving money and increasing quality by improving

referral practice

QP Case Study October

2013 Very High

Stratified cancer pathways: redesigning services for those living with or beyond cancer

QP Case Study October

2013 Very High

Safety Express: a national pilot to deliver harm free care

QP Case Study June 2013 Very High

Management of patients with Stroke: REDS (Reach Early Discharge Scheme)

QP Case Study October

2012 Very High

Prevention of inpatient falls: systematic risk assessment and reduction programme

QP Case Study December

2011 Very High

Service redevelopment: Integrated whole system QP Case Study May 2012 Very High

‘Do not do’ recommendations• Database approach • Contains practices (identified during

guidance development) that should be:– Discontinued– Not used routinely

• Each recommendation contains information on:– Healthcare setting– Links to relevant NICE guidance or Quality

Standard

‘Do not do’ example - View all NICE do not do from this Guidance

• Some ‘do not do’ examples from Pressure Ulcers (CG179):– Do not routinely offer adults, neonates, infants, children and young

people negative pressure wound therapy to treat a pressure ulcer, unless it is necessary to reduce the number of dressing changes (for example, in a wound with a large amount of exudate).

– Do not offer gauze dressings to treat a pressure ulcer in adults, neonates, infants, children and young people.

– Do not use hyperbaric oxygen therapy to treat a pressure ulcer in neonates, infants, children or young people

– Do not routinely offer enzymatic debridement to adults with a pressure ulcer.

Key therapeutic topics

• Not formal NICE guidance

• Summarise evidence-base

• Topics identified to support QIPP medicines use and procurement work-stream

• Example: Wound care products (NICE advice KTT14) published January 2013

Forward Planner

Status Guidance short titleType of guidance

Anticipated publication

date

Programme budgeting category

Impact on PbR

Commissioner(s) Provider(s) Potential cost impact areas (costs or savings)Potential cost impact

In progress

Self-monitoring coagulometers (CoaguChek XS system, INRatio2 PT/INR monitor and ProTime Microcoagulation system)

Diagnostic Technology

Aug-14 10C CCGs and NHS England

Primary care, Community health care, Secondary care - acute and tertiary care

The initial procurement of coagulometers incurs a cost of around £300 per person, while there will also be costs around training people to use them. In the longer-term it may decrease the demand for anti-coag clinics and outpatient services. Additional information will be published when available.

Cost saving

In progress Drug allergyClinical

GuidelineSep-14 20A ? CCGs

Secondary care - acute

Implementing the recommendations may increase the number of referrals to specialist allergy clinics for any given locality. Potential benefits and savings include: reduced hospital admissions; reduced length of inpatient stay from drugs administered during hospital stay; reduced recurrence of allergic reactions and anaphylaxis; and reduced inappropriate referrals to specialist allergy services.

Cost saving

In progress QS_Acute kidney injuryQuality

StandardsOct-14 17B ? CCGs

Primary care and secondary care -

acute

Additional costs are likely to be incurred due to increased rates of serum creatinine and urine testing. However both of these are low cost (typically around 25p and 10p respectively per person) while improved identification of AKI is believed to avoid degeneration and treatment of the consequences of AKI.

Cost saving

Summary• Recognised that the challenge is unprecedented• NICE has a range of products and services that

don’t cost but do save• Includes tools, webinars, models • If you haven’t got at least one ‘NICE product or

service linked to your CIP…. Just type in ‘savings’!• NICE is always looking for individuals and

organisations to contribute to the development of recommendations….