1. London Ambulance Service Patients’ Forum 13th October 2014
agenda item 3
London Ambulance Service
Patients’ Forum
13th October 2014
Jane Moore
Implementation Consultant (London)
Lead to tailor title slide accordingly.

2. Objectives About NICE NICE Guidance
New Quality standards – how to use them
Making it easier to access the evidence
Getting involved

3. What is NICE?
The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and advice to improve health and social care.

4. What we do
Produce evidence-based guidance and advice for health, public health and social care practitioners
Develop quality standards and performance metrics for those providing and commissioning health, public health and social care services
Provide a range of information services for commissioners, practitioners and managers across health and social care

5. 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 local services and accountability
Improve health and wellbeing outcomes
Supports the case for investment
Supports local integration discussions and decisions with partners on investment and prioritisation
Fit with broader policy agenda.
Why use?
- Provides support for decision making at all levels – local policy making, strategic decision making (JSNA) to implementation of action plans (JHWBS)
- 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in planning how the health and wellbeing board members want to take action to meet the agreed priorities” JSNA/JHWBS draft guidance Jan 12]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 (immunisation – inequals from poor record keeping, can’t call children in for immunisation, off sick= reduced education outcomes, parents finding it had to hold own job to look after child. Often outcomes other than health need to be considered)
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 – transport
Preventing Unintentional Injuries – example
Simple and cheap measures that have been proven can save lives and prevent children from serious disfigurement or disability. Several studies using ‘before’ and ‘after’ data have shown that 20 mph zones reduce casualties by around 40 %, so reliable estimates can be made of the costs and benefits of investing in 20 mph zones. A cost–benefit analysis of local road safety engineering schemes, including 20 mph zones, often give 1st year rates of return of about 100 per cent; that is the costs are recovered in the first 12 months.

6. How NICE is set up Previously a Special Health Authority from 1999
NDPB from April 2013
Funded by Department of Health
Staff of around 600
Many more people are involved part time in developing our guidance (around 1000)
Current budget – around £60 million
Money to implement NICE recommendations comes out of local budgets.

7. 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

8. EFFECTIVE (how well they work) COST-EFFECTIVE (value for money)
Types of guidance
Technology appraisals - on the use of new and existing medicines and treatments
Interventional procedures guidance - on safety and efficacy (can it work) of processes or treatments
Clinical guidelines - on the appropriate treatment and care of people with specific diseases and conditions within the NHS
Public health guidance - on the promotion of good health and the prevention of ill health
Medical technologies guidance - on new or novel medical technologies (value proposition)
Diagnostic guidance - on measurements and tests used to evaluate or monitor a patient’s condition
Social care guidance (new!)
EFFECTIVE (how well they work)
COST-EFFECTIVE (value for money)

9. Statutory status - for Technology Appraisals (drugs) only
NICE Regulations
NHS Constitution
Under the NICE Regulations, where NHS England is the appropriate health body, it must comply with a NICE technology recommendation. This includes providing funding usually within 3 months of the date of publication for any patient who meets the clinical criteria. In some circumstances, the guidance will state a longer period for providing funding. The NHS Constitution sets out patients’ rights for access to such medicines and treatments. This is to ensure there is equality in access irrespective of where patients live or are being cared for.
For England

10. Levers and mechanisms to support uptake of other NICE guidance
Inspection – Care Quality Commission
Performance measures & incentives (financial)
National and local guidance (JRCALC)
Education, accreditation & Continuing Professional Development (CPD) eg. via professional bodies
Workforce development at organisational and national levels
Participation with NICE (stakeholders, comment on drafts) and to promote evidence into practice

11. Thinking more about the needs of ambulance services
2013 Winner - Harmonising pre-hospital care across South West England

14. Guidance in development - Trauma
NICE is developing five pieces of guidance relating to trauma, Each piece of guidance will focus on a different aspect of trauma care. Due February 2016.
Complex fractures: assessment and management of complex fractures (including pelvic fractures and open fractures of limbs)
Fractures: diagnosis, management and follow up of fractures (excluding head and hip, pelvis, open and spinal)
Major trauma: assessment and management of airway, breathing and ventilation, circulation, haemorrhage and temperature control.
Spinal injury assessment: assessment and imaging, and early management for spinal injury (spinal column or spinal cord injury)
Major trauma services: service delivery of major trauma services

15. Guidance in development
Safe staffing guideline: Accident and emergency settings due May 2015
Acute medical emergencies – due November 2016
consultation on scope 16 October November 2014, recruiting lay member now
Acute heart failure (guideline & quality standard) guideline published Oct 2014
Acute kidney injury (quality standard) published Oct 2014
Complex fractures (guideline and quality standard) guideline due April 2016
Excess winter deaths and illness (guideline) due March 2015
Fractures (guideline and quality standard) guideline due April 2016
Intrapartum care (updated guideline) due December 2014
Pneumonia (guideline) due December 2014
Pre-term labour and birth (guideline & quality standard) due Nov 2015
Sepsis (guideline and quality standard) guideline due July 2016
Transfusion (guideline and quality standard) guideline due May 2015
Tuberculosis (updated guideline and quality standard) due October 2015
Type 1 Diabetes (updated guideline & quality standard) due August 2015
Type 2 Diabetes (guideline & quality standard) guideline due August 2015
Guidance currently in development and potentially relevant to urgent care

16. NICE Quality Standards
Define high-quality, cost-effective care across a disease, condition or clinical area
Presented as a set of specific, concise statements that:
act as markers of high-quality, cost-effective patient care;
are derived from the best available evidence; and
are produced collaboratively with the NHS and social care, along with their partners and service users.
QS will form an integral suite of support and guidance from NICE –all derived from same evidence base – to help commissioners and providers of health and social care to achieve the best outcomes for the patients or clients, with the resources they have available.

17. Quality Standards and quality improvement
Evidence
Guidance
Quality
Standards
A comprehensive set of recommendations for a particular condition or service area
The Health and Social Care Act (2012) sets out a new responsibility for NICE to develop quality standards and other guidance for social care in England. The Act outlines a vision for establishing quality as the defining factor for health and social care, through the use of quality standards. The use of quality standards for health and social care can allow people to hold their local commissioners to account, can help guide the commissioning of efficient and effective services and can assist service providers and users to assess the quality of the services they are involved in.
The primary purpose of NICE quality standards is to describe high-priority areas for quality improvement, which are aspirational but achievable, in a defined care or service area. NICE quality standards do not provide a comprehensive service specification. They define priority areas for quality improvement based on consideration of the topic area.
H&SC Act – duty as a commissioner or provider of NHS services to consider these
A prioritised set of concise, measureable statements designed to drive quality improvements within a particular area of care

18. Quality standards – Urgent care
Cardiovascular
ACS including MI
Venous thromboembolic diseases
Stroke
VTE prevention
Gastrointestinal
Acute upper GP bleeding
Respiratory
Asthma (including children)
COPD
Neonates and children
Bacterial meningitis and
meningococcal septicaemia
Constipation
Feverish illness in childhood
Neonatal jaundice
Specialist neonatal care
Urinary tract infection
Mental health
Alcohol dependence and harmful alcohol use
Dementia
Self harm
Neurological
Delirium
Epilepsy
Endocrine, nutritional and metabolic
Diabetes in adults
Blood disorders
Sickle cell acute painful episode
Infectious diseases
Infection prevention and control
Trauma and injuries
Hip fractures
Service delivery topics
Cross cutting topics
Quality standards that are either published (P), in development (ID) or on our work programme, potentially relevent to urgent care.

19. Scrutiny and service review
NICE guidance & quality standards can provide a useful reference tool for those scrutinising services
Ask services:
whether they have a systematic approach to NICE guidance and quality standards, and what it is
how they are using NICE quality standards to improve quality of care provided or commissioned
specific questions developed from quality standard statements

20. Quality standards - scrutiny

21. NICE pathways
Bring together related guidance, between and within topics
Link other products – Quality Standards, implementation support tools etc
Provide a useful format in a network of recommendations
Improve digital formatting for easier access
To find out everything that NICE recommends on a topic without having to know what type of guidance was published
To help you review local pathways
For service redesign
As an educational/teaching resource
For access to patient information resources
For access to relevant Quality Standards

23. Information at your fingertips -apps
Android smartphone and tablets
iPhone and iPads
Browse
Rapid searches
Bookmark for offline use
Receive automatic updates
BNF - For health and social care professionals who work for or who are contracted by NHS England.
Users will need to enter their NHS Athens user name and password to activate the app and download the content. Eligible professionals who do not yet have an NHS Athens password can register for free online or directly from their smartphone by following the instructions displayed in the Apple App Store and Google Play Store, or the app itself.
Available via:
NICE website
Apple App Store
Google Play Store

24. NICE resources to overcome barriers to implementation
Clinician distrust = horizon scanning
Forward planner
Stakeholder consultation
Slide sets
Podcasts
Lack of organisational support =
develop systematic approach
How to guide
Implementation advice
Local policy templates
Educational tools
Online learning modules
Lack of knowledge = measurement
Audit support
Baseline assessment
Implementation database
Shared learning
Lack of resources = build business case
Commissioning guides
Costing tools
Do not do database
QIPP database
> into practice

25. Get involved in developing evidence based guidance
Current NICE consultations
Comment on our draft guidance and quality standards
Stakeholder registration
Ensure your organisation is registered so you can be alerted about consultations and submit comments
Join a NICE committee or working group
NICE committees consist of a wide range of healthcare professionals and vacancies are listed on our website
Patient and public involvement
There is a range of opportunities for service users to get involved, with full support from our PPI team
Fellows and Scholars
Opportunities for healthcare professionals’ personal development by becoming ambassadors for NICE, recruiting March

26. How to find out more Website www.nice.org.uk
Sign up to receive monthly NICE News
Queries
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