Supporting Commissioning for Value
Stephen Judge, Implementation Consultant , South West
A&E
Infections
Vitamins
Preventable
Injury
Diet
Tooth
Decay
Infant
Mortality
Low Birth
Weight
LRTI
Admissions
It’s not the type of
guidance that matters,
but its content.
So consider TAGs,
CGs, PH guidelines
and advice and tools
Prevention &
Public Health
Contraception
Diet
Smoking and Drinking
Secondary Care
Primary &
Community Care
Management of low
birth weight babies
GP, Sexual Advice
Lower respiratory tract
infections
Smoking cessation
Flu vaccination
Breastfeeding advice
NGx
NICE
guidelines
will be
numbered
in this way
in future
Do you know your guidance from your
quality standards?
10 minutes. Fastest group wins!
Lay out the pieces of paper as follows:
Type of
guidance
Description
Example
Types of guidance
• 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!)
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, costeffective patient care;
are derived from the best available
evidence; and
are 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)
NICE Evidence Services
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
www.evidence.nhs.uk
And also available via the NICE website main menu
• Bulletins, Alerts and Evidence
Awareness Service
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
Are you aiming to improve the quality of
healthcare?
Identify the best available evidence-based
guidance
Check whether services are currently in line
with best practice
Develop an initial plan to overcome any
barriers to change
Check if the plan can be delivered within
existing resources
Finalise the action plan and implement
Evaluate ongoing success through systematic
measurement
NICE Into Practice Guide
• 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.
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)
Local Government Briefings
• Concise information on cost-effective and evidencebased 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
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/Intopractice/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
NICE Guidance
NICE Evidence
NICE
Pathways
Costing, Return on
Investment and Quality
and Productivity
collection
Quality Standards
Health, Public Health,
Social Care
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 . . . )