Jan Williams Chief Executive, Bro Taf Health Authority Implementing National Guidance - The Perspective of a Welsh Health Authority Chief Executive Clinical Excellence, December, 2001

Dr Keith Baker Director for Public Health Barnet, Enfield and Haringey Health Authority

National Guidance - Welsh Context n n National Assembly for Wales (NAfW): – –NICE Accountability n n Application of National Guidance: – –DoH, NAfW, Joint Planning Group – –NSFs

Bro Taf Health Authority - An Integrated Approach (i) n n Integrated with existing Bro Taf mechanisms – –HA-wide prescribing formulary – –High Cost Drugs Panel – –Clinical Governance Committee – –Chief Executives Group n n Integral part of HA processes - HIP, LTAs

Bro Taf Health Authority - An Integrated Approach (ii) n n 4 stage approach to technology appraisals n n Clinical Guidelines/Referral Practice Guides n n Primary Care: – –LHGs/Prescribing Advisors – –Primary Care Audit Group – –Prescribing Indicators – –Practice Based Audits

Learning over the last 18 Months - Organisational Issues (i) n n Lack of clarity within organisations about roles and responsibilities n n Progress greater where integrated into clinical governance/performance development arrangements n n Significant variations in baseline positions both in Trusts and across Primary Care

Learning over the last 18 Months - Organisational Issues (ii) n n Disconnection between managerial and clinical leadership n n Variable capability to absorb multiple service changes in short timeframe n n Whole systems issues n n Need to develop monitoring and evaluation methods

Learning over the last 18 Months - Cultural Issues n n Variable approach towards clinical audit n n Professional resistance n n Variable investment in training and development of audit staff n n Primary care culture

Learning over the last 18 Months - Contextual Issues n n Contractual position - Primary Care n n Plurality of guidelines n n Information systems n n Resource implications/prioritisation n n Ownership of NICE work programme n n Welsh policy context

Challenges (i) n n Clinical and managerial leadership n n One source of clinical standards n n Prioritisation n n Investment in skills training n n Cultural change

Challenges (ii) n n Public involvement n n Publication of information n n Whole systems accountability n n Organisational change

The view from North London n n skewing n n affordability n n local expertise and slow national timescales n n relative cost effectiveness