NICE - in evidence based commissioning

Gateshead Council

Gillian Mathews, Implementation Consultant - North

9 September 2011

Overview

• Using NICE guidance in the commissioning cycle

• Using NICE Quality Standards in evidence based commissioning

• The advantages of an evidence- based approach

More than just guidelines...

NICE and NHS Evidence

Evidence – guidance – shared learning

• Technology Appraisals - guidance on the use of new and existing medicines and treatments.

• Interventional Procedures Guidance

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

• Cancer Service guidance

• Public health guidance

• Medical technologies guidance

• Diagnostics guidance

Types of guidance

Evidence based – clinically

and cost effe

ctive

Finding guidance from NICE Pathways

JSNA JSNA and strategic plans

What are we doing now?Is it working?

Evidence for what works

Indicators and data to measure progress

The commissioning cycle

New system relationships

Outcomes Framework and Standards

NHS OUTCOMES FRAMEWORKDomain 1

Preventing people from

dying prematurely

Domain 2Enhancing the quality of life for

people with LTCs

Domain 3Recovery

from episodes of ill health /

injury

Domain 4Ensuring a

positive patient

experience

Domain 5Safe

environment free from avoidable

harm

NICE Quality Standards (Building a library of approx 150 over 5 years)

Commissioning Outcomes Framework

Commissioning Guidance

Provider payment mechanisms

Commissioning / ContractingNHS Commissioning Board - Specialist services and primary care

GP Consortia – all other services

1

2

3 4

7

Duty of quality

Du

ty o

f qu

ality

Du

ty o

f qu

ality

tariffstandard contract

CQUIN QOF

5

6

Duty of quality

NHS OUTCOMES FRAMEWORKDomain 1

Preventing people from

dying prematurely

Domain 2Enhancing the quality of life for

people with LTCs

Domain 3Recovery

from episodes of ill health /

injury

Domain 4Ensuring a

positive patient

experience

Domain 5Safe

environment free from avoidable

harm

NICE Quality Standards (Building a library of approx 150 over 5 years)

Commissioning Outcomes Framework

Commissioning Guidance

Provider payment mechanisms

Commissioning / ContractingNHS Commissioning Board - Specialist services and primary care

GP Consortia – all other services

1

2

3 4

7

Duty of quality

Du

ty o

f qu

ality

Du

ty o

f qu

ality

tariffstandard contract

CQUIN QOF

5

6

Duty of quality

Quality Standards

• A set of 10-15 specific, concise statements that are markers of high-quality, clinical and cost-effective patient care across a pathway or clinical area

• Topics sequenced by National Quality Board (NQB) – will be the NHS CB in future

• Aim: to offer clarity about what high quality care looks like across the 3 dimensions of quality ensuring:– care is effective– care considers service user’s experience– care is safe

• Over time - building to a library of around150 topics

Dementia Quality Standard

Dementia: quality statement 2

Quality statement• Carers of people with dementia

are offered an assessment of emotional, psychological and social needs and, if accepted, receive tailored interventions identified by a care plan to address those needs.

Related quality measures - structure

• Evidence that those carrying out a carers' assessment identify any emotional and psychological needs and the social impact on the carer and offer the carer psychological therapy, including cognitive behavioural therapy (CBT), if clinically appropriate.

• Evidence that this is an ongoing process and includes any period after the person with dementia has entered residential care.

• Evidence that care plans for carers of people with dementia involve a range of tailored interventions, which consist of multiple components including: – individual or group psychoeducation – peer-support groups with other carers, tailored to

the needs of individuals depending on the stage of dementia of the person being cared for and other characteristics.

Quality measure - process

a) Proportion of carers of people with dementia who are offered an assessment of their needs.

• Numerator: the number of carers offered an assessment of their needs.

• Denominator: the number of carers of people with dementia.

b) Proportion of carers of people with dementia receiving interventions tailored to their needs.

• Numerator: the number of carers receiving interventions tailored to their needs

• Denominator: the number of carers of people with dementia who have an agreed care plan.

Quality Standards and Commissioners

• Framework for provider discussions

• Potential to include elements in contracts

• Obtaining and monitoring outcomes data

• Potential use by Regulators

• Impact on payment mechanisms

NICE Guides for commissioners

On a topic-specific basis :

• support the commissioning of evidence-based care for patients

• assist financial modelling through a tool to calculate local service costs

• provide a framework for investment decisions

• highlight and support relevant national priorities

• signpost NICE guidance and other relevant supporting information.

www.evidence.nhs.uk

Key features:• Simple search• Accredited sources of guidance• Browse functions in key topic areas• My Evidence• Healthcare databases via Athens

Unsafe Substandard Adequate Good Excellent

Provider Payment Mechanisms

Commissioning Outcomes Framework

Development of commissioning guidance (NHS CB)

NICE quality standardsStandard of services

Proportion of services

Registration requirements

Regulation ( Enforcement against Registration Requirements)

There is no statutory provision allowing NICE Quality Standards to impact upon

registration requirements

Quality Standards are advice from NICE to the NHS CB on high quality care.

Standards and high quality care

Why use the best available evidence?

• To reduce variation• To reduce inequalities• To improve quality of

service provision• To reduce waste• To ensure the best

use of resources

This is what we do

NICE and NHS Evidence

Evidence – guidance – shared learning

Summary

We set out to cover:• Using NICE guidance in the

commissioning cycle• Using NICE Quality Standards in

evidence based commissioning • The advantages of an evidence-

based approach