Quality Standards - setting priority areas for quality improvement

NICE quality standards help those working in the health and social care system improve the quality of care they provide. Each quality standard has around 5 statements that aim to drive measurable improvement within a particular area of health or care.

Our quality standards can help providers ensure care is based on the latest evidence and best practice. They also help service providers to quickly and easily examine the performance of their organisation and assess improvement in standards of care they deliver.

This year we issued 34 quality standards on a number of topics that range from osteoarthritis, to reducing the harm from smoking, and challenging behaviour among people with learning disabilities.

A number aimed to prevent premature death by tackling cardiovascular disease and obesity – two of the nation’s biggest health problems.

100th quality standard launched – advice on preventing CVD

In September 2015, we published our 100th quality standard on the prevention of cardiovascular disease (CVD). The quality standard aims to help health professionals prevent thousands of people from becoming ill and dying prematurely from heart attacks, strokes and peripheral arterial disease.

Although fewer people are dying as a result of CVD, it is still the leading cause of death in England and Wales. In 2010, 180,000 people died from CVD – around 80,000 of these deaths were caused by coronary heart disease and 49,000 were caused by strokes. Of the 180,000 deaths, 46,000 occurred in people aged 75 years or younger, and 70% of those were in men.

The quality standard includes 9 statements aimed at healthcare professionals caring for people in danger of developing CVD, or who already have CVD. These include:

  • Adults with a 10-year risk of CVD exceeding 10% receive advice on lifestyle changes before any offer of drug intervention.
  • Adults with a 10-year risk of CVD exceeding 10% are assessed for secondary causes before any offer of statin therapy.

Professor Anthony Wierzbicki, Consultant in Metabolic Medicine/Chemical Pathology, and specialist member of the committee that developed the standard said: “Cardiovascular disease remains the greatest cause of mortality in the UK. This quality standard highlights the need for comprehensive risk assessment to identify those individuals at risk.

“It highlights the need to intervene at an early stage on lifestyle-related factors for cardiovascular disease (e.g. smoking) and to identify and treat secondary causes of raised lipids (e.g obesity and excess alcohol intake). If these interventions are unsuccessful, healthcare professionals and patients should discuss the merits of statin therapy for reducing the risks of heart attack and stroke.”

Help with preventing premature death from strokes and heart attacks

In July 2015, we published a quality standard on a common heart disorder that can increase the risk of strokes.

Atrial fibrillation is thought to affect around 900,000 people in England. It occurs when the electrical impulses controlling the heart rhythm become disorganised, so that the heart beats irregularly and, occasionally, too fast and so cannot pump blood around the body efficiently.

People with AF have a higher risk of having a stroke because the blood can become stagnant and form blood clots. Anticoagulation therapy can help to prevent strokes by reducing the likelihood of a blood clot forming.

The quality standard includes 6 statements aimed at healthcare professionals caring for people in danger of developing, or who already have, AF.

Dr Matthew Fay, a GP and specialist member of the committee that developed the standard, said: “This quality standard brings in to sharp focus the key issue of stroke prevention. In doing so it continues to highlight the need for a change in practice so that everyone with AF is considered for anticoagulation and the quality of that anticoagulation is always kept under review by clinicians and commissioning groups.”

Preventing obesity in children and young people

Childhood obesity is seen as one the most serious global public health challenges for the 21st century. Obese children and young people are at increased risk of developing health problems such as type 2 diabetes. They are also more likely to become obese adults

For children, being overweight or obese can also result in self-esteem issues and a lower quality of life that can ultimately lead to depression.

In 2013/14 in England, more than 1 in 5 children aged 4 to 5 years at the start of primary school were overweight or obese rising to more than 1 in 3 among children aged 10 to 11 years.

Our quality standard on obesity in children and young people contains 8 statements that together aim to prevent them from becoming overweight or obese.

The standard calls for:

  • local authorities and NHS venues to use vending machines where children and
  • young people can buy healthy food and drink options
  • nutritional information to be displayed on menus at local authority and NHS venues
  • placing healthy options prominently in local authority and NHS venues

Professor Gill Leng, Deputy Chief Executive of NICE, said: “Lifestyle and weight management programmes can support parents and carers to identify changes that can be made at home to tackle obesity and maintained over the long-term. These changes include healthy eating and getting the whole family to be more active.

“Tackling obesity in children and young people also benefits their future health. Up to 79% of children who are obese in their teens are likely to be obese adults, which can lead to health problems in adulthood such as type 2 diabetes, heart disease and some cancers. The quality statements set out the effective actions that should be taken to prevent and manage obesity in children and young people.”