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

2. 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.

3. 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.

4. 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

5. 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.”
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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. Example: Pathway NG27 Transition between health & social care

12. 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)

13. 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

14. 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

15. 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

16. 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

17. 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!

18. 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

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

20. 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’)

21. Population groups
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.

23. NICE Pathways

24. Staying up to date with NICE
Website
NICE News - monthly e-newsletter
Social Care Stakeholder Update – monthly bulletin
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