Annie Coppel

Implementation Consultant, NICE Field Team

15 March 2013

NICE to know about:

Setting the standards for health and

social care

The role of NICE

• To improve quality and productivity

• To identify good clinical and public health

practice using the best available evidence

• To help resolve uncertainty for the public,

patients and professionals

• To reduce variation in the availability and

quality of practice and care.

• April 2013

• Adults and children

• Non-departmental public health body

• Still NICE, but……….“care excellence”

“… an expanded role for NICE

extending its remit into social care”

Guidance and standards

and

legal status for implementation

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

– dabigatran for stroke prevention

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

– stable angina, COPD

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

– skin cancer prevention, walking and cycling

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

– SonoVue

Types of guidance

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

– Laparoscopic insertion of a magnetic bead band for gastro-oesophageal reflux disease

• Medical technologies guidance - on new or novel medical technologies

– Cardio Q ODM

• Cancer service guidance

• ….Social care guidance

Types of guidance

SoS funding direction: NHS is required

to provide funding and resources for

medicines and treatments recommended

by NICE through its technology appraisal

programme, normally within 3 months from

date of publication

Technology appraisals

You have the right to drugs and treatments that

have been recommended by NICE for use in the

NHS, if your doctor says they are clinically

appropriate for you

Quality Standards – continuous quality

improvement

Evidence Guidance Quality

Standards

‘Sentinel markers’

A prioritised set of concise, measureable

statements designed to drive quality

improvements across a pathway of care

A comprehensive set of

recommendations for a particular

disease or condition

An example: chronic kidney disease

Underpinned by

10 source

guidelines, three

from NICE and

seven from the

Renal Association,

both accredited

sources.

Published March 2011

The CKD quality standard

A set of 15 statements

– sentinel markers of

high quality care for

patients with chronic

kidney disease.

Covers the whole

pathway of care.

Associated with

process and outcome

measures.

180 healthcare quality standard topics

NICE quality standards: helping to

manage the interfaces

Social care

Public health

NHS

Referred social care topics and timelines

Topic Guidance Quality Standard

Mental wellbeing in older

people

Already available Late 2013

Autism in adults and children Already available Late 2013

Medicines management in

care homes

2014 2015

Transition between health and

social care

2015 2016

Older people with multiple co-

morbidities

2015 2016

Domiciliary care 2015 2016

Child maltreatment 2015 2016

Transition between child adult

services

2015 2016

Where the quality standards fit in

How quality standards can be used?

Health and social care

professionals and public

health professionals to make

decisions about care based on

the latest evidence and best

practice.

People receiving health and social

care services, their families and

carers and the public to find

information about the quality of

services and care they should expect

from their health and social care

provider.

Service providers to examine

the performance of their

organisation and assess

improvement in standards of

care they provide

Commissioners to be confident that

the services they are purchasing are

evidenced-based and cost effective

care which aims to drive up quality

Why using NICE guidance and

standards to support practice and

quality improvement is important

The importance to patients, service

users and carers

• “Confidence in the clinical system”

• “Confidence in staff looking after me”

• “Understand what treatment to expect”

• Better patient experience and outcomes

• Empowers peoples to make choices

about their own care

• A constitutional right to receive

treatment and medicines.

The importance for health/social care

professionals

• Guides practice

• “Brings together what the research tells us

in the context of what is already known”

• “Pragmatic approach to problems seen

every day”

• “Helps me to keep my practice up to date”

• Healthcare professionals should take

NICE guidance into account when

deciding what treatments to give people

The importance for organisations

• Helps us to commission and deliver the best care and services

we can and to use the resources we have wisely

• Proves we are offering safe and high standards of care/services

giving everyone (population, commissioners, regulators)

confidence that we are a high performing organisation

• Helps us to improve quality and outcomes for our

patients/service users

• Supports our workforce to be up to date and competent

• Helps us to become a learning organisation – adopting new

innovations that bring benefits to our patients/service users

• Helps us to look after the physical and mental wellbeing of our

staff

How does NICE work?

Core principles of all NICE guidance

• Independent advisory committees

• Comprehensive evidence base

• Expert input

• Patient and carer involvement

• Genuine consultation

• Regular review

• Open and transparent process

Who is involved

in developing

guidelines?

NCC Mental Health

GDG

GDG

GDG GDG

GDG

GRP

GRP

GRP

GRP

NCC Cancer

GDG

GDG GDG

GDG

GDG

GDG National Clinical

Guidelines Centre -

Acute and Chronic Conditions GDG

GDG

GDG

GDG

NCC Women & Children’s

GDG

GDG GDG

GDG

GDG GDG NICE

Appraisal Committees

Members

• Statisticians

• Health economists

• Lay members

• GPs

• Public health physicians

• Clinical pharmacists

• Nurses

• Surgeons

• Consultant physicians

• NHS management

• Clinical pharmacologists

• Psychiatrist

• Professional allied to medicine

• Paediatrician

2 in London

2 in Manchester

Supporting use of guidance and

standards

• Horizon scanning and financial planning – Forward planner

• Sharing success – Shared learning database

• Measuring quality improvement – Baseline assessment

– Audit tools

– Quality standards indicators and measures

Practical support:

finance and commissioning

• Building a business case – QIPP database

– Costing tools

– Guides for commissioners (benchmark and budgeting tools)

– Quality Standards: NICE support for commissioners and others

• Collection of assured national and local case studies

• Organised by national QIPP workstream

• Cochrane quality and productivity topics

• Links to tools and resources

• Tool to calculate potential savings of QIPP case studies

based on local population and quality gains

• Monthly alert for new additions qipp@nice.org.uk

Costing report – national estimated cost

of implementation based on assumptions

about current practice & predictions of

how it might change following

implementation (England only)

Costing template – spreadsheet to

estimate local costs taking account of

local variation from national estimates

Costing tools

Guides for commissioners

Published NICE Guides for Commissioners

Cardiovascular

Anticoagulation therapy service

Cardiac rehabilitation service

Chronic heart failure service

Diagnosis and initial management of acute stroke

Integrated commissioning for prevention of CVD

TIA service

Mental health and behavioural conditions

Alcohol services

Antenatal and postnatal mental health services

Service for diagnosis and management of adult ADHD

Service for the diagnosis and management of ADHD in children and

young people

Service for the management and treatment of schizophrenia in adults

Commissioning stepped care for common mental health disorders

Central nervous system

End of life care for people with dementia

Memory assessment service

Service for accurate diagnosis of adult epilepsies

Gynaecology, pregnancy and birth

Endometrial ablation service

Hysterectomy service

Intrauterine devices and system service

Quitting smoking in pregnancy and following childbirth

Weight Management, before during and after pregnancy

Digestive system

Faecal continence service

Upper GI endoscopy services

Public Health

Needle and syringe programme

Peer support programme for women who breast feed

Smoking cessation services pre elective surgery

Ear and nose

Service for the surgical management of OME

Eye

Service for people at risk of developing glaucoma

Endocrine, nutritional and metabolic

Bariatric surgical service

Foot care service for people with diabetes

Insulin pump therapy service

Patient education programmes for type 2 diabetes

Musculoskeletal

Biologic drugs for the treatment of inflammatory disease in

rheumatology, dermatology and gastroenterology

Service for the diagnosis and management of rheumatoid arthritis in

adults

Respiratory

Services for people with COPD

End of Life Care

End of Life care in Adults

Urogenital

The management of male lower urinary tract symptoms

Urinary continence service

Paediatric continence services

Early identification and management of chronic kidney disease in

adults

Support for commissioners using the

quality standard

Support to consider the cost of implementing the changes required to achieve the quality standard at a local level

Identifies potential savings

Highlights areas of care with potential implications for commissioners

Signposts commissioners and service providers to a package of support tools to assist implementation of NICE guidance and service redesign

Quality

Standards

40 published Guides for

Commissioners

Support for QIPP

Find what you need quickly and easily

NICE pathways

1. To bring together related

guidance, between and within

topics

2. To link other products – Quality

Standards, implementation

support tools etc

3. To provide a useful format -

network of recommendations

4. To improve digital formatting for

easier access

Easier, quicker access to the

evidence

Links to other information

Search results plus information panels

Keeping up to date

• Sign up for the NICE News

• Register your details at www.nice.org.uk

• Email annie.coppel@nice.org.uk