Supporting Commissioning for Value

Stephen Judge, Implementation Consultant , South West

Preventable Injury

Low Birth Weight

Vitamins

Infections

Diet

It’s not the type of guidance that matters, but its content.

So consider TAGs, CGs, PH guidelines and advice and tools

NGxNICE guidelineswill be numbered in this way in future

10 minutes. Fastest group wins!

Lay out the pieces of paper as follows:

Do you know your guidance from your quality standards?

Type of guidance

Description Example

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

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

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

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

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

• Medical technologies guidance - on new or novel medical technologies (value proposition)

• Social care guidance

• Safe Staffing guidance (new!)

Types of guidance

EFFECTIVE (how well they work)

COST-EFFECTIVE (value for money)

Maternal and Child nutrition guideline PH11

• Training and skills development of staff• Folic acid and Vitamin D recommended supplements• Promote and assist entry to Healthy Start scheme• Discuss diet with mother• Encourage weight loss in pregnancy where BMI >30• Encouraging breastfeeding (inc ability in public spaces)• Discuss pros and cons of infant formula• Monitor baby’s weight• Advise on allergies and oral health

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; andare produced collaboratively with the

NHS and social care, along with their partners and service users.

 

Postnatal Care QS57

• Postnatal care plan is regularly reviewed and updated• Mothers are advised within 24 hrs of birth of potentially

life threatening conditions• Discuss infant sleeping to avoid SIDS• Support for breastfeeding is received from a structured

programme• Use of infant formula is discussed with mother• Babies have physical check at 6-8 weeks• Postnatal checks include assessment of mother’s

emotional wellbeing (and if baby blues not resolved within 14 days assess for mental health problems)

A suite of services that provide internet access to high quality authoritative evidence and best practice.

•Evidence Search

•Journals and Databases including access to Health Database Advance Search (HDAS)

•Clinical Knowledge Summaries (CKS)

•BNF

•UK DUETs

•Bulletins, Alerts and Evidence Awareness Service

NICE Evidence Services

www.evidence.nhs.uk And also available via the NICE website main menu

Group exercise

What are the 3 biggest challenges you face when implementing NICE guidance ?

Feedback

Challenges of implementing NICE guidance 2011 survey of 683 clinicians and managers

A systematic approach

• Ensure organisational structures and processes are in

place

Board level leadership Day-to-day operational lead for

quality appointed Multi-disciplinary forum for

strategic decisions Nominated lead for each new

development System in place for ongoing

monitoring and reporting to the board

.

• Web based guide to help health and social care organisations use NICE guidance & quality standards to achieve a high quality of care in local settings

• Suggests what an organisation can put in place, and what staff can do, to use NICE guidance & quality standards to improve outcomes and get the best value for money

• Includes helpful tips, links to other resources and shared learning examples of how other people have used NICE guidance and quality standards

Who is it for?

This guide is for anyone who is …•a commissioner or provider of health or social care•responsible for ensuring that evidence-based guidance is put into practice by their organisation•involved in quality improvement•involved in planning, delivering and scrutinising care services•leading on implementing a specific piece of guidance•using a quality standard to improve quality across a team or service.

NICE Into Practice Guide

Practical support

• Routine guidance support tools: baseline assessment, costing and resource impact tools, audit criteria

• Other discretionary guidance support tools: Support for commissioning using the quality standard, online learning modules 4x per year

• Endorsement programme: statement from NICE in the guidance support tool about its alignment to the relevant guidance or quality standard(s)

• Concise information on cost-effective and evidence-based solutions for local government, public health and, from April 2014 social care

• For local authorities and their partner organisations in the health and voluntary sectors, in particular those involved in Health and Wellbeing Boards

• Demonstrate potential role of NICE guidance as the basis of solutions to public health issues and problems at a local level

• Derived from existing guidance

• Web-based format with links to other sources of information – but also printable

www.nice.org.uk/lgb

• Introduction

• Key messages

• What can local authorities achieve

• What is effective

• Examples of good practice

• Developing an action plan

• Costs and savings

• Background to recommendations

• Support

• Other useful resources

Local Government Briefings

Health Visiting – Local Gov. Briefing 22

• Healthy Child Programme- review and health checks- screening- immunisation (eg MMR)- parenting support- behaviour change (mostly of parents)

• Provide additional support for vulnerable families• Consider wider factors, such as poverty and housing• Reduce infections and preventable injury (home safety,

suspicion of maltreatment)• Promote healthy lifestyles (vitamins, passive smoking,

breastfeeding, diet etc.)

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

Quality and productivity 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

Support for Commissioners (feverish illness <5s)

• Assess using Traffic Light System • Record vital signs• Take urine test if high temperature• Provide a safety net of advice

• Clinical audit tools can help demonstrate and monitor services

• Support document estimates cost impacts• Links to details of recommendations (e.g. TLS)

NICE Pathways . . . guidance at your fingertips

Pathways brings together all NICE guidance, quality standards and support in easy-to-navigate flowcharts

pathways.nice.org.uk

Using NICE guidance to support C4V

C4V Elements of value

Getting involved . . .

• 8 strong field team, plus medicine associates, NICE fellows and scholars

• NICE Enquiries desk• Online information, education tools, blogs,

tweets etc.• Apps !• Many opportunities to get involved (registered

stakeholders, joining a committee . . . )