NICE - in evidence based commissioning Gateshead Council Gillian Mathews, Implementation Consultant - North 9 September 2011

Overview Using NICE guidance in the commissioning cycle Using NICE Quality Standards in evidence based commissioning The advantages of an evidence- based approach

More than just guidelines... Advice on new and existing treatments Clinical guidelines, QOF and quality standards Health promotion and disease prevention Comprehensiv e evidence service NICE and NHS Evidence Evidence – guidance – shared learning

Technology Appraisals - guidance on the use of new and existing medicines and treatments. Interventional Procedures Guidance Clinical guidelines - guidance on the appropriate treatment and care of people with specific diseases and conditions. Cancer Service guidance Public health guidance Medical technologies guidance Diagnostics guidance Types of guidance Evidence based – clinically and cost effective

Finding guidance from NICE Pathways

JSNA JSNA and strategic plans What are we doing now? Is it working? Evidence for what works Indicators and data to measure progress The commissioning cycle

New system relationships Economic regulation Registration and assurance Evidence, guidance and Standards Commissioning and system integration NHS CB NICE Monitor CQC

Outcomes Framework and Standards

Quality Standards A set of specific, concise statements that are markers of high-quality, clinical and cost- effective patient care across a pathway or clinical area Topics sequenced by National Quality Board (NQB) – will be the NHS CB in future Aim: to offer clarity about what high quality care looks like across the 3 dimensions of quality ensuring: –care is effective –care considers service user’s experience –care is safe Over time - building to a library of around150 topics

Dementia Quality Standard

Dementia: quality statement 2 Quality statement Carers of people with dementia are offered an assessment of emotional, psychological and social needs and, if accepted, receive tailored interventions identified by a care plan to address those needs.

Related quality measures - structure Evidence that those carrying out a carers' assessment identify any emotional and psychological needs and the social impact on the carer and offer the carer psychological therapy, including cognitive behavioural therapy (CBT), if clinically appropriate. Evidence that this is an ongoing process and includes any period after the person with dementia has entered residential care. Evidence that care plans for carers of people with dementia involve a range of tailored interventions, which consist of multiple components including: –individual or group psychoeducation –peer-support groups with other carers, tailored to the needs of individuals depending on the stage of dementia of the person being cared for and other characteristics.

Quality measure - process a) Proportion of carers of people with dementia who are offered an assessment of their needs. Numerator: the number of carers offered an assessment of their needs. Denominator: the number of carers of people with dementia. b) Proportion of carers of people with dementia receiving interventions tailored to their needs. Numerator: the number of carers receiving interventions tailored to their needs Denominator: the number of carers of people with dementia who have an agreed care plan.

Quality Standards and Commissioners Framework for provider discussions Potential to include elements in contracts Obtaining and monitoring outcomes data Potential use by Regulators Impact on payment mechanisms

NICE Guides for commissioners On a topic-specific basis : support the commissioning of evidence-based care for patients assist financial modelling through a tool to calculate local service costs provide a framework for investment decisions highlight and support relevant national priorities signpost NICE guidance and other relevant supporting information.

Key features: Simple search Accredited sources of guidance Browse functions in key topic areas My Evidence Healthcare databases via Athens

UnsafeSubstandardAdequateGoodExcellent Provider Payment Mechanisms Commissioning Outcomes Framework Development of commissioning guidance (NHS CB) NICE quality standards Standard of services Proportion of services Registration requirements Regulation ( Enforcement against Registration Requirements) There is no statutory provision allowing NICE Quality Standards to impact upon registration requirements Quality Standards are advice from NICE to the NHS CB on high quality care. Standards and high quality care

Why use the best available evidence? To reduce variation To reduce inequalities To improve quality of service provision To reduce waste To ensure the best use of resources

This is what we do Evidence assessment and interpretation Economic evaluation and resource impact assessment Pathways, guidance and standards Web access for decision support and e-learning NICE and NHS Evidence Evidence – guidance – shared learning

Summary We set out to cover: Using NICE guidance in the commissioning cycle Using NICE Quality Standards in evidence based commissioning The advantages of an evidence- based approach