Jane Moore Implementation Consultant (London region) National Institute for Health and Care Excellence NICE guidance for social care Jane Moore Implementation Consultant (London region)

What is NICE? The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. Name change and rebranding to support the social care sector.

The role of NICE To improve quality and productivity To identify good clinical, public health and social care practice using the best available evidence To help resolve uncertainty for the public, and professionals To reduce variation in the availability and quality of practice and care.

Our guidance Guidelines: health public health social care medicines practice Health technologies: medicines interventional procedures medical technologies This slide – 2 points – breadth of guidance and effectiveness/ Cost effectiveness I usually note that at this stage – our “ology” guidance is less relevant – but health, PH and social care directly relevant Health – pressure ulcers ; Delirium, end of life care, falls, Public health – infection prevention and control Social Care –Home care for older people, MWOP, dementia Medicines practice – managing medicines in care homes Guidelines on health topics recommend how healthcare professionals should care for people with specific conditions. Example - Delirium, pressure ulcers, dementia. Cover any aspect of a condition and may include recommendations about providing information and advice, prevention, diagnosis, treatment and longer-term management. Guidelines on public health topics make recommendations on local interventions that can help prevent disease or improve health. The guidance may focus on a particular topic (such as smoking), a particular population (such as schoolchildren) or a particular setting (such as the workplace). Guidelines on social care topics aim to improve outcomes for people who use social care support by making recommendations about social care services and interventions that are effective and cost-efficient Based on the best available evidence, they describe what works and is value for money

Regulation - CQC Andrea Sutcliffe, Chief Inspector for Adult Social Care CQC “At the CQC we are asking the questions that matter to people. We’re asking whether services are safe, caring, effective, responsive to people’s needs, and well led. “And the way that we can do this is by identifying key lines of enquiry – so the questions that we will ask when we go out on inspections. We will also identify what the characteristics are of the services that we see, so whether they are good, outstanding, require improvement or are inadequate. “This quality standard will inform the questions that we ask, and help us to provide the understanding of what ‘good’ and ‘outstanding’ practice looks like in this area.” https://www.youtube.com/watch?v=RxwHM0JsdyI And for information, this quote is taken from a video (hyperlinked) of Andrea Sutcliffe talking about how CQC use NICE quality standards to inform review questions.

Relevant guidance Residential care: Supporting people to live well with dementia Mental wellbeing of older people in residential care Managing medicines in care homes Older people with social care needs and multiple long-term conditions Transition between inpatient hospital settings & community or care home settings Dementia: independence and wellbeing Falls in older people Oral health for adults in care homes Nursing care: End of life care for adults Delirium in adults Pressure ulcers Nutrition Infection prevention and control Learning disability: Challenging behaviour in people with learning disability Home Care: Delivering personal care to older people in their own homes Drug & Alcohol services: Mental illness and substance misuse Drug misuse in over 16s Alcohol use disorders Alcohol: preventing harmful use Department of Health and Department for Education refers topics Initial set of 9 topics Exploratory discussions to clarify the remit and key issues for each topic in Jan – April 2013 DH consultation on possible future topics, with input from NICE’s External Reference Group

Relevant guidance in development Adult social care: improving people’s experience (Feb 18) Adults with complex needs (including LD) and mental health needs; social work interventions (TBC) Advocacy for adults with health and social care needs (TBC) Care and support of older people with learning disabilities (May 18) Decision making and mental capacity (July 18) Independent living: supporting independence & preventing isolation (TBC) Intermediate care including re-ablement (July 17) Learning disabilities and behaviour that challenges (March 18) Safeguarding adults in care homes (TBC) Supporting adult carers (July 19) Department of Health and Department for Education refers topics Initial set of 9 topics Exploratory discussions to clarify the remit and key issues for each topic in Jan – April 2013 DH consultation on possible future topics, with input from NICE’s External Reference Group

Why use NICE guidance? Based on the best available research Effectiveness: what works and in what population Cost-effectiveness: value for money approaches to national and local priorities Reduce variation and inequalities Improve health and wellbeing outcomes Supports quality improvement activities (good news stories) Can help address incidents (action plans) Supports the case for investment (value for money) Demonstrates quality to commissioners (tenders, contract, quality monitoring) Help answer questions around quality from CQC Staff can understand and explain care delivery (CPD) Demonstrate quality to service users & families Why use? Provides support for decision making at all levels – local policy making, strategic decision making , implementation of local action plans To underpin actions in the Joint Health and Wellbeing Strategy (JHWBS) – provides evidence base to ensure you are doing the right thing ( i.e. what works) and are using public money wisely to give your local population the best chance of having the best outcomes. [“Evidence of cost-effective and efficient interventions may also be useful in planning how the health and wellbeing board members want to take action to meet the agreed priorities” JSNA/JHWBS draft guidance Jan 12] Reduce variation and inequalities – helping to understand how to meet the needs of the most vulnerable and the most in need. Guidance recognises these groups Provides local accountability – helps you define what you expect from services in terms of outcomes – so you know what you are getting. That is, easier to hold providers to account and also to account to the general public (because services commissioned have sound research to support cost and outcomes) Provides a framework for discussion with your partners about what is the best and right thing to do

Core principles of all NICE guidance Comprehensive evidence base Expert input Patient and carer involvement Independent advisory committees Genuine consultation Regular review Open and transparent process

Example: Guideline Usually say – not very exciting slide but this is what a guideline looks like – drill down into recs for detail BUT whole host of support to help people use this in the real world – see tab

Example: Pathway NG27 Transition between health & social care

What are NICE quality standards? Evidence Guidance Quality Standards A set of systematically developed recommendations to guide decisions for a particular area of care or health issue Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements. Guidance – aim is to improve individual or population wellbeing and health – for social care aim is to improve independence and wellbeing Evidence - these are examples to show the breadth of evidence that will be considered depending on the question and the types of evidence available Also have the option of inviting expert witnesses to provide expert advice in the absence of published evidence, and the option to call for evidence (ie ask stakeholders if they are aware of anything)

NICE quality standards Include measures to help inform local quality improvement work Typically 6 – 8 statements Based on best available evidence such as NICE guidance and other evidence sources accredited by NICE Define priority areas for quality improvement

How to use NICE quality standards Help to identify local priorities for quality improvement NICE quality standards can highlight key areas for improvement. An initial assessment should consider: relevance to the organisation, how services compare, what evidence is available, actions to improve, risks of not improving Driving quality improvement Once you have identified gaps and priorities, use quality standard measures to improve quality of services: establish a project team, develop an action plan, assess cost and service impact, develop a business case, measure a baseline, deliver actions and evaluate success See Into Practice Guide www.nice.org.uk/intopracticeguide

EG. Ensure wellbeing and safeguarding responsibilities are met NICE Quality Standards can help organisations to: Provide meaningful, person-centred activities Supporting people to live well with dementia Mental wellbeing of older people in residential care Reduce medication errors Medicines management in care homes Monitor for malnutrition Nutrition support in adults Prevent falls Falls guideline and quality standard Reduce healthcare-related infections Infection prevention and control Avoid delirium and monitor for depression Delirium

Tools and Resources to save you effort We provide a range of resources to help maximise uptake and use of evidence and guidance. Into Practice Guide Online learning resources Clinical case scenarios Local practice collection NICE and BNF apps Field team Baseline assessment/ tools Costing reports and templates Medicines Information www.nice.org.uk/about/what-we-do/into-practice

Tips to help staff conduct oral health assessment Includes: Tips to help staff conduct oral health assessment Handy assessment tool Understanding how dental pain can affect residents’ general wellbeing Very practical support!

For service users: What to expect from a good homecare service Importance of a home care plan What to do if you’re unhappy with the standard of care you’re receiving

Accessing the guidance www.nice.org.uk Accessing the guidance Search bar for free text Or, try NICE Pathways Search by categories, dates, state of development

You can then search for a word or phrase, or by category (e. g You can then search for a word or phrase, or by category (e.g. ‘settings’ or ‘conditions and diseases’)

Population groups http://www.nice.org.uk/guidance/population-groups/older-people However, I advise you to also check the topic landing page for ‘older people’ (under population groups) as you will find potentially useful guidelines and quality standards focusing on independence and wellbeing.

NICE Pathways

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