Supporting Commissioning for Value Stephen Judge, Implementation Consultant, South West.
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Transcript of Supporting Commissioning for Value Stephen Judge, Implementation Consultant, South West.
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 . . . )