Disclaimer: This document was developed specifically for a workshop and is not a resource formally endorsed by NICE. 1

Using NICE guidance and quality standards to improve practice

RECOMMENDATION PRIORITY CURRENT ACTIVITY/

EVIDENCE POSSIBLE ACTIONS

NEEDED DEADLINE ACTION

LEAD

WHAT YOUR ORGANISATION NEEDS TO HAVE IN PLACE

High-level support and clear leadership

Top-level commitment to evidence-based practice is essential to implementing NICE guidance and using NICE quality standards, as well as developing a culture of evidence-based practice

Clear leadership will help to promote a positive culture of continuous improvement in health and social care organisations.

Ensuring clear delegation of responsibility for ensuring the organisation is implementing NICE guidance and using quality standards, such as board members , medical directors, directors of public health, elected member committees or senior officers in local authorities.

Directors and senior level stakeholders should receive regular internal reports on the local use of NICE guidance, including audit reports, highlighting areas where the organisation does not provide its services in line with NICE recommendations or there are weaknesses identified in service provision. Any risks identified should be recorded.

They may also like to receive reports on the extent to which services are currently in line with relevant quality standards, because they can be used to identify key areas for improvement.

Disclaimer: This document was developed specifically for a workshop and is not a resource formally endorsed by NICE. 2

A nominated lead for the organisation

Identifying a person to coordinate local activities around NICE guidance and quality standards as they are published is vital for effective implementation. The responsibilities of this person could include: • coordinating an organisational response to NICE consultations • monitoring guidance and quality standards as they are published, and ensuring they are assessed for relevance to the organisation's services • disseminating guidance and quality standards to key groups and identifying nominated leads to implement the guidance or coordinate quality improvement activities (either in their own organisation or in an organisation commissioned to provide the services covered by the guidance) • horizon scanning and guiding forward planning, including preparing briefings on the potential impact (such as financial) of implementing the guidance • ensuring an effective documented process for monitoring and providing feedback is in place and adhered to • producing regular senior-level reports • ensuring deviations from NICE recommendations are recorded on a risk register or equivalent • arranging educational events

It may be possible to incorporate these responsibilities into an existing post – for example, clinical-effectiveness coordinator, clinical governance manager, public health lead, local authority policy lead, chief pharmacist or head of prescribing and pharmacy – rather than creating a new post.

In a local authority, a policy manager, a local strategic partnership manager responsible for quality assurance or a senior knowledge officer could take responsibility for coordinating the use of NICE guidance and quality standards.

N/A

Key attributes a nominated lead will need to have (and which may be included in a job description) are: • a thorough knowledge of relevant policy drivers • a thorough knowledge of service delivery in the organisation • ability to analyse, challenge and improve current practices • a record of achievement in managing projects and change • strong interpersonal and leadership skills • credibility.

Disclaimer: This document was developed specifically for a workshop and is not a resource formally endorsed by NICE. 3

A multidisciplinary forum

Strategic decisions on the use of NICE guidance and quality standards should be made in a multidisciplinary forum. To be most effective, this forum should be a decision-making body that reports to the highest-level group in the organisation (for example, in an NHS trust, this would be the board). It could be an existing forum that already serves other functions in the organisation - for example a quality forum in a local authority or CCG.

The forum should provide overall management, planning and monitoring of the implementation of NICE guidance. It should look at all new guidance and quality standards shortly after they are published, and consider their relevance to the organisation. It should identify named leads and networks or planning groups to lead on specific recommendations. The forum should:

• ensure that effective forward planning and engagement occurs • assess the relevance of NICE guidance and quality standards for the organisation as they are published • ensure guidance and quality standards are disseminated to the appropriate people • identify named leads for each piece of guidance or quality standard • ensure that the organisation knows its current position regarding all relevant guidance and quality standards • record deviation from NICE guidance recommendations, and ensure strategies for achieving it in the future are agreed if appropriate • ensure delivery against local action plans • review local audit and action plans as necessary • check that appropriate financial implications

It is important to consider ways of coordinating work across organisations, especially where guidance and quality standards cross the primary and secondary care interface, or across health and social care. Collaboration reduces duplication of effort and ensures a coordinated, standardised response to each piece of guidance across health and social care services locally. This will help to ensure seamless, integrated care.

Below are some suggestions for group membership, but there may be other people you want to consider. Implementation is most effective if a wide range of disciplines are represented. E.g. • Clinicians/ practitioners/ • Pharmacists • Patient and public representatives • Finance/ Governance and audit leads • Public health professionals • Commissioning leads • Service managers/ Policy leads The group should be chaired by a senior person in the organisation who can act as a champion for evidence based practice, quality improvement and has strong leadership skills and credibility.

A local policy

Organisations should have a clear policy for implementing NICE guidance and using NICE quality standards, which is endorsed at the highest level of the organisation.

Disclaimer: This document was developed specifically for a workshop and is not a resource formally endorsed by NICE. 4

WHAT YOUR ORGANISATION NEEDS TO DO

Raise local awareness

Raise local awareness of NICE guidance and quality standards that are in development or newly published.

Sign up to the NICE e-newsletter to receive the monthly bulletin, showing guidance that NICE has published each month. You can disseminate the newsletter or incorporate information into your own, and you can refer people to the relevant NICE pathways. NICE pathways are simple-to-use interactive tools that bring together all NICE products on a topic.

To look ahead and see what guidance and quality standards are due to be published in the near future you can use the forward planner, which has a list of all current guidance and quality standards as well as those in development.

Plan ahead – NICE guidance and quality standards in development People in your organisation can help to shape the recommendations that NICE makes in several ways: • By registering as a stakeholder, you can coordinate an organisational response to a consultation. • Health and social care professionals can join a NICE committee or working group, or contribute to one of NICE's external reference groups. • Patients, service users and the public can also get involved in commenting on consultations via representative groups or by joining a NICE committee or working group.

Consider the financial and service planning impact The financial implications of implementing NICE guidance need to be an integral part of your organisation's financial and business plans. Once you have seen the draft guidance, you could consider starting some preparatory work, looking at local services and processes.

For NHS organisations, if the activity is within tariff, then the tariff will normally include the costs of implementing NICE guidance and commissioners will expect providers to deliver accordingly without additional funding. For activity that is outside the tariff, organisations should specify the process for negotiating funding between commissioners and providers.

Disclaimer: This document was developed specifically for a workshop and is not a resource formally endorsed by NICE. 5

Consider the financial and service planning impact

NICE quality standards set out high-priority areas for quality improvement that are aspirational but achievable. Commissioners will use them to be confident that services they purchase are striving to deliver high-quality and effective care. Providers and commissioners should take account of quality standards when commissioning, planning and delivering services.

In a local authority, any bids for resources or resource re-alignment should be expressed in light of the organisation's statutory duty to promote people's wellbeing and its need to comply with national priorities, and the resulting benefits for local people and the economy. NICE guidance can help local authorities demonstrate that a value-for-money, evidence-based approach is being used to improve health and wellbeing and reduce health inequalities.

Assess the relevance of published NICE guidance and quality standards

When NICE guidance or quality standards are published, discuss their relevance at your organisation's multidisciplinary forum. Record any actions, including whether the topics are relevant to your organisation and whether there are likely to be any deviations from the published guidance in the way the organisation implements it.

You should record the relevance on a local database or register.

If guidance is not relevant, agree and record decision

If the high-level group decides that the NICE guidance or quality standard is not applicable to your organisation, record your decision in formal minutes and on a local database or register, linked to a risk register.

It is good practice to review this decision periodically if services change or the organisation takes on new services. Record a risk around conducting a periodic review of NICE guidance previously considered not to be relevant, if service provision changes.

If guidance is relevant, identify a named lead for it

Identify a lead for each piece of NICE guidance or quality standard, who can make people aware of its content and lead change if required. The lead is likely to be a prominent figure who will champion the guidance and inspire others. Enable them to share the guidance with other relevant professionals in a prompt and effective way.

If the guidance covers more than 1 organisation (such as primary and secondary care, or local authorities and the NHS), establish contact with the identified leads in partner organisations to work collaboratively to develop a coordinated action plan.

To ensure everyone knows about relevant NICE guidance:

• include information about guidance in induction training for all staff • liaise with your education/ training team to make use of educational forums • link with existing networks • develop newsletters, leaflets, updates or info packs for different audiences • incorporate guidance into local policies and protocols

Disclaimer: This document was developed specifically for a workshop and is not a resource formally endorsed by NICE. 6

ACCESS SERVICES AGAINST NICE GUIDANCE OR QUALITY STANDARDS

When guidance is published, you might not know if you provide services in the way that NICE recommends, whether this is current practice and the extent to which you might need to change what you do. The person named as the lead for implementing the piece of guidance should work with colleagues to compare current practice with the recommendations. NICE has developed baseline assessment tools to support this activity

NICE quality standards can highlight key areas for improvement. When they are published, you may want to identify whether they broadly reflect current practice in the organisation. Any tools to support local use and measurement will be found alongside the quality standard on the NICE website. If there is associated NICE guidance, implementing it will contribute to the organisation's practice, in line with the quality standard.

It is also a good idea to identify data sources for quality standard measures so that you can respond to requests for a statement of current provision against the quality standard. These may come from within the organisation or from commissioners. Tools to prepare action plans for meeting quality standards, and data collection tools for the process measures are also available. NICE has also developed audit tools to make the process of auditing practice easier.

PERIODICALLY REVIEW SERVICES ALREADY IN LINE WITH NICE GUIDANCE OR QUALITY STANDARDS

Review services periodically to ensure best practice is maintained. If there are quality standards in the area of service you wish to review you could use those standards and measures, and the action and reporting table. Where improvement is slow it is useful to go back to past guidance periodically to ensure services are still in line with detailed information in the NICE guidance.

Disclaimer: This document was developed specifically for a workshop and is not a resource formally endorsed by NICE. 7

SUPPORT CHANGES IN SERVICES NOT IN LINE WITH NICE GUIDANCE OR QUALITY STANDARDS

Develop an action plan

If your organisation is not providing services currently in line with NICE guidance, work with the appropriate colleagues to develop an action plan, which should detail the steps needed to put the guidance into practice. Look at the recommendations that the baseline assessment identified as not currently being carried out, and assign actions to each one.

Assess cost and service impact, and develop a business case

Organisations should assess how much it will cost (or save) to implement the action plan developed from your baseline assessment. It might be possible to make some of the changes using existing resources, or it might be possible to make savings, or free up capacity for other activities.

Your organisation might need to consider capital needs (such as equipment), staffing and training needs, and capacity issues. These will need to be addressed by local delivery and planning processes. You should also consider whether any longer-term savings can be made as a result of early actions to promote health and wellbeing. It is important that organisations have a process for working together with local partners to implement NICE guidance because it can help to even out the costs and savings.

Evaluate your actions, provide high-level assurance and share your success

Make sure you evaluate your action plans to analyse how effective they have been, and review the impact of the overall implementation process. Make any necessary changes to the process to ensure continual improvements.

Implementation of NICE guidance and the use of quality standards should be included in quality, performance and commissioning reports, to assure the organisation and the public that statements of high-quality care are being used to measure the organisation's services and make improvements.