Naomi McVey Commissioning Adviser, NICE

March 2013

Quality standards- NICE and the new NHS

Overview

• NICE in the new NHS – focus on NICE quality standards

• How the quality standards relates to physiotherapy services, where we are and where we need to be

• NICE guidance can support physiotherapists to ensure the services they provide are of the best possible quality and offer the best value for money, and to demonstrate this to patients, the public, other professions and commissioners

• Perspectives on influencing commissioners

NICE and the new NHS

New system relationships

NICE and the new NHS

NICE Quality Standards

“Progress on outcomes will be supported by quality standards.

These will be developed for the NHS Commissioning Board by NICE, who will develop authoritative standards setting out each part of the patient pathway, and indicators for each step. …

The standards will cover areas that span health and social care.”

NICE Quality Standards

• Define high-quality, cost-effective care across a disease, condition or clinical area

• Presented as a set of specific, concise statements that:– act as markers of high-quality, cost-effective

patient care;– are derived from the best available evidence;

and 

Developing 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

Where the quality standards fit in

Preventing people from dying prematurely

Enhancing quality of life for people with long

term conditions

Helping people to recover from episodes of ill health

or following injury

Ensuring that people have a positive

experience of care

Treating and caring for people in a safe environment and protecting them from harm

180 healthcare quality standard topics

Key quality standards for physiotherapists – published

• Stroke (QS2)• Chronic heart failure (QS9)• COPD (QS10)• End of life care for adults (QS13)• Patient experience in adult NHS services (QS15)• Service user experience in mental health

services(QS14)• Hip fracture in adults (QS16)• Asthma (QS25)

(See here for more information)

Key quality standards for physiotherapists – in development

• Supporting people to live well with dementia• Autism• Faecal incontinence• Lower urinary tract symptoms• Metastatic spinal cord compression• Peripheral arterial disease• Rheumatoid arthritis• Smoking cessation

(See here for more information)

Stroke quality standard

Quality standard for stroke

• Quality statement 3: ‘Patients with stroke are assessed and managed by stroke nursing staff and at least one member of the specialist rehabilitation team within 24 hours of admission to hospital, and by all relevant members of the specialist rehabilitation team within 72 hours, with documented multidisciplinary goals agreed within 5 days.’

• Quality statement 7: ‘Patients with stroke are offered a minimum of 45 minutes of each active therapy that is required, for a minimum of 5 days a week, at a level that enables the patient to meet their rehabilitation goals for as long as they are continuing to benefit from the therapy and are able to tolerate it.’

• Quality statement 10: ‘All patients discharged from hospital who have residual stroke-related problems are followed-up within 72 hours by specialist stroke rehabilitation services for assessment and ongoing management.’

Hip fracture

• A walk through the hip fracture QS on NICE website…

Smoking cessation - draft QS

Currently available for consultation, statements include:

1.People are asked if they smoke by their healthcare professional, and those who smoke are offered brief advice on how to stop.

2.People who smoke are referred to an evidence-based stop smoking service.

•Potential to impact on interaction of all healthcare professionals with each of their patients, and therefore on skills and competencies in behaviour change etc•? CSP registered as a stakeholder

CCG Outcomes Indicator Set

CCG Outcomes and indicators

• Provide clear, comparative information for CCGs, HWBs and LAs about the quality of services & health outcomes

• NICE's role is to develop indicators for the CCGOIS, in particular from quality standards

• Origins in Liberating the NHS: Commissioning for Patients as the Commissioning Outcomes Framework, renamed as the CCG Outcomes Indicator Set

• Chosen on the basis that they contribute to the overarching aims of the five domains in the NHS Outcomes Framework

• It does not set thresholds or targets for CCGs, it is a tool for CCGs to drive local improvement & set priorities

Quality standards and physiotherapy

• Physios have a good track record using NICE guidance• Now need to get to grips with the quality standards• Process within your organisations for implementing

NICE guidance? Does this include the QS? Implement NICE guidance to achieve the

standard/statement• Use NICE implementation tools• If no relevant QS and no NICE guidance use other or

recognised national guidance • Important that physios have the opportunity to

contribute to the consultation process for the QS

Influencing commissioners and key organisations in the new NHS

Influencing local commissioners

Get your ducks in a row…•Plan – what are you planning to achieve?•Research – know your local population, commissioners, local plans and priorities, local leads•Know your service •Be integrated and patient focused•Use the evidence-base•Demonstrate outcomes & quality improvement•Get marketing!

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Also available – the app for the British National Formulary and the British National Formulary for Children

Keeping up to date

• Sign up for the NICE News• Twitter @NICEcomms • Log on to the website and register

your details at www.nice.org.uk• Email naomi.mcvey@nice.org.uk