Transcript Document

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...
Advice on new
and existing
treatments
Clinical
guidelines,
QOF and
quality
standards
NICE and NHS
Evidence
Evidence – guidance – shared learning
Health
promotion and
disease
prevention
Comprehensive
evidence
service
Types of guidance
• 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
Finding guidance from NICE Pathways
What are we doing now?
Is it working?
JSNA
JSNA and
strategic
plans
The
commissioning
cycle
Evidence for
what works
Indicators and data
to measure progress
New system relationships
• Commissioning
and system
integration
• Registration and
assurance
• Evidence,
guidance and
Standards
NHS CB
NICE
CQC
Monitor
• Economic
regulation
Outcomes Framework and Standards
Duty of quality
7
NHS OUTCOMES FRAMEWORK
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Preventing
people from
dying
prematurely
Enhancing
the quality
of life for
people with
LTCs
Recovery
from
episodes of
ill health /
injury
Ensuring a
positive
patient
experience
Safe
environment
free from
avoidable
harm
2
Duty of quality
Duty of quality
1
NICE Quality Standards
(Building a library of approx 150 over 5 years)
3
Commissioning
Outcomes
Framework
6
4
Commissioning
Guidance
5
Provider payment mechanisms
tariff
standard
contract
CQUIN
Commissioning / Contracting
NHS Commissioning Board - Specialist services and primary care
GP Consortia – all other services
Duty of quality
QOF
Quality Standards
• A set of 10-15 specific, concise statements that
are markers of high-quality, clinical and costeffective 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
Standards and high quality care
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.
Regulation
( Enforcement against Registration Requirements)
Development of commissioning guidance (NHS CB)
Commissioning Outcomes Framework
Provider Payment Mechanisms
Registration
requirements
Proportion of services
Standard of services Unsafe Substandard Adequate
NICE quality standards
Good
Excellent
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
Evidence
assessment
and
interpretation
Economic
evaluation
and resource
impact
assessment
NICE and NHS
Evidence
Evidence – guidance – shared learning
Pathways,
guidance and
standards
Web access
for decision
support and
e-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 evidencebased approach