Local Support - making best use of guidance and quality standards

NICE has a field team of 8 implementation consultants who are regionally based and who work with local health and social care organisations.   Broadly speaking they:

  • raise awareness of the guidance, quality standards and supporting products that NICE produces
  • help local organisations put guidance and quality standards into practice – and to make best use of NICE
  • support people to share their work with each other and spread good practice
  • encourage people to work with NICE to ensure that local views and expertise inform the development of national guidance

Interview with Jane Moore, NICE Implementation Consultant for London

1) What kind of organisations have you met with in the past year?

The field team have met with a really broad range of organisations in the last year, from Health, Social care and the voluntary sector, at a strategic and at an operational level. At a strategic level we have engaged with regional representatives of NHS England, Public Health England and SCIE, supporting them with local engagement work. I have worked with Academic Health Science Networks, advising on how NICE guidance can support and drive their work. For example the South London Health Improvement Network Communities of Practice have brought clinicians together to look at aspects of patient safety, and I have helped identify where NICE has guidance and resources to drive local improvement.

At a more operational level I have spent some time attending the team meetings of Local Authority social care commissioners and showing them our guidance and resources. Often they know about the guidance, but once I show them all that we have got and explain how they can use it in a practical way they are impressed and want to find out more. I delivered a workshop to Principal Social Workers from every Borough in London which was valuable as they have a role in taking a professional lead within their councils for supporting and advising on quality and influencing strategic decision making.

With the Five Year Forward View signalling further investment in primary care and new models of care, and the introduction of co-commissioning enabling CCGs to commission and specify the quality of primary medical services, I have been meeting CCG leads to discuss how NICE guidance and resources can support the delivery of primary care services. This has often meant helping them develop a systematic process for ensuring relevant guidance is understood and used across all their practices, including by nurses and allied health professionals, and ensuring NICE quality standards are being used to drive quality improvement activities across groups of practices. They have found the “Primary Care Checklist”, developed by the Field Team, very helpful.

2) What examples have you seen of organisations putting NICE guidance into practice?

I was asked to join the steering group of one of NICE’s sponsored Vanguards (the Enhancing Health in Care Homes Vanguard based in Sutton in South London) and I introduced them to our guideline on “Transition between Inpatient Hospital Settings and Community or Care Home Settings”. They used this to develop a Hospital Transfer Pathway, also known as the Red Bag Pathway. There were a number of issues locally with paperwork and possessions being handed over appropriately when residents went from a care home into hospital and back again. In this instance the NICE guidance provided a neutral ground to enable a framework to be developed locally. The team involved have now written this up as a shared learning example, which we share with others via the NICE local practice collection.

In the bag: improving the move between hospital and social care

3) How are organisations finding ways of using resources efficiently amidst a climate of financial pressures?

The current financial climate means that delivering care in line with evidence based guidance is more important than ever. Commissioners want to ensure that what they are commissioning is good value, and providers want to ensure that their staff are delivering care in the most effective way. The Five Year Forward View talks about closing the three gaps (health and wellbeing, care and quality, and funding and efficiency) and NICE guidance can contribute to all of these. I have found that organisations are becoming more willing to work together across a patch to identify efficient and effective patient pathways and agree how they organise themselves around them. For example Accountable Care Organisations (ACO’s) being developed in several areas are bringing providers together to collaborate and save money, but they still want to know what the evidence says is effective, and they want ways of measuring the success of long term outcomes based contracts, so NICE quality standards are proving very helpful to them.

4) What projects are you looking forward to taking on in the coming year?

We are offering to engage with leads from the Sustainability and Transformation footprints, and with all of the new care model (vanguard) sites, to advise on how NICE guidance and quality standards can contribute to the design and evaluation of their local plans, which are a key element to deliver the Five Year Forward View vision. At the current time there is still a lack of clarity about exactly how these will proceed, but it is a real opportunity to embed NICE guidance and standards into services of the future.

At a more local level the field team will be meeting with Medical Directors or Directors of Nursing of all Acute and specialist trusts this year, encouraging a systematic approach to the use of guidelines and quality standards to help address the requirements of the NHS planning guidance, to make improvements in quality and reduce avoidable mortality rates. We will offer support and advice on the implementation of NICE guidelines, for example, the suite of NICE trauma guidelines to inform the quality and avoidable mortality ‘must dos’ in the NHS planning guidance, and our guideline on Sepsis to help them meet the national CQUIN for this year on this subject.

We are also planning something a little different for mental health trusts. Mental health trusts are working hard to ensure they look after the physical health of people with severe mental illness, to support the parity of esteem agenda, giving equal priority to mental health and physical health, which was enshrined in law by the Health and Social Care Act. NICE has a great deal of guidance and resources which can support this, and as this is a national CQUIN for mental health trusts this year, they are keen to find out what we have to support their work. We are hoping to deliver a webinar on this topic.