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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 [email protected]
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 [email protected]