Transcript Document
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 . . . )