How NICE quality Standards can help drive and measure quality improvement Dylan Jones Associate Director - Quality Standards Health and social care quality programme

Presentation overview Policy background What is a quality standard? What makes up a quality standard? How they help measure quality improvement. How they can drive quality improvement.

Policy Background The relevant commissioner may direct NICE to prepare statements of standards in relation to the provision of: a)NHS service b)Public health services or c)Social care In discharging its duty, the Board/Secretary of State must have regard to the quality standards prepared by NICE. Organisations improving the quality of health services must have regard to the quality standards prepared by NICE.

Quality standards – three interfaces Social care Public health NHS

What are NICE quality standards? EvidenceGuidance Quality Standards A NICE Quality Standard is a concise set of statements designed to drive and measure priority quality improvements within a particular area of care. Around 6-8 statements per standard – up to 15 in exceptional circumstances. A comprehensive set of recommendations for a particular disease or condition, particular need or service

What makes up a QS? Quality statementRationaleQuality measureAudience descriptorSource guidanceData SourceDefinitions

Quality Measures Structure Organisational characteristics Process Interactions Functions Actions Outcome Changes in individuals and populations How they help measure quality

Example – Stroke (QS2) Statement Patients with suspected stroke are admitted directly to a specialist acute stroke unit and assessed for thrombolysis, receiving it if clinically indicated Structure Evidence of local arrangements to ensure that patients with suspected stroke are admitted directly to a specialist acute stroke unit and are assessed for thrombolysis, receiving it if clinically indicated

Process a)Proportion of patients admitted directly to a specialist acute stroke unit and assessed for thrombolysis b)Proportion of patients with suspected stroke assessed for thrombolysis who receive it in accordance with NICE technology appraisal guidance 122 (2007) and NICE clinical guideline 68 (2008). Example – Stroke (QS2)

National Comparison Where they can Quality Standards will help inform future national audits The Sentinel Stroke National Audit Programme (SSNAP) is an example of this. Quality statements 3, 5 and 11 are all considered within the 2012 report

How they can drive improvement They do not restate essential standards or regulatory requirements. Where there is overlap, statements should be mutually supportive and complementary. UnsafeSubstandardAdequateGoodExcellent NICE quality standards Standard of services Proportion of services CQC- Registration requirements

How they can drive improvement Triggering a review of local performance against relevant national outcome indicators National Outcomes Framework Commissioning for Quality Improvement Initiatives (CQUIN) Quality Outcomes Framework (QOF) Local provider payment mechanisms CCG Outcomes Indicator Set (CCG OIS) Indicators for local use Local commissioning mechanisms

Commissioner and provider perspectives Meeting QS will help: Demonstrate that a high quality service is being delivered Achieve any financial incentives, eg QOF Providers Using QS will help: Inform contract specification and monitoring of contracts Set indicators for local CQUIN Achieve outcomes as part of the CCG OIS Commissioners

Professional and lay perspectives Using QS will help: Make decisions about care based on the latest evidence and practice The development of local audit and practice reports or in professional development and validation Healthcare professionals and social care practitioners Using QS will help: People decide which services to access. To holding commissioners to account To make choices between providers. People receiving health and social care services, their families and carers and the public

More information All the details regarding the background, the development process, stakeholder involvement and the standards themselves (published and in development) are available on the NICE website (