1. NICE - supporting quality in social care Stephen Judge Implementation Consultant July 2015

2. Areas to cover Part 1 Who we are and what we do Guidance – what and why Quality standards Managing medicines in care homes – key points Home care – key points Part 2 Finding what you need Practical help Staying up to date and opportunities for getting involved

3. What is NICE? World leader in producing guidance and setting standards for high quality care and for promoting healthy living From April 2013 new remit for social care – renamed National Institute for Health and Care Excellence Evidence-based guidance and other products from NICE help resolve uncertainty about best quality care and what represents value for money www.nice.org.uk

4. Health technologies: –technology appraisals –interventional procedures –medical technologies Guidelines and quality standards: - clinical practice -public health -social care topics We produce national guidance covering

5. TopicGuidanceQS Health and wellbeing of looked after childrenPublished Supporting people to live well with dementiaPublished Autism in children and adultsPublished Mental wellbeing of older people in residential carePublished Managing medicines in care homesPublished Challenging behaviour in people with learning disabilityPublishedOct 2015 Home careSep 20152016/17 Older people with multiple long-term conditionsSept 20152016/17 Children’s attachmentOct 20152016/17 Transition between health and social careNov 20152016/17 Transition from children’s to adults’ servicesMar 20162017/18 Child abuse and neglectMay 20162017/18 Mental health problems in people with learning disabilityOct 20162017/18 Social Care Guidance

6. Our position in the social care sector Evidence, Guidance, Standards.

7. Quality standards

8. Quality Standards EvidenceGuidance Quality Standards A prioritised set of concise, measureable statements designed to drive quality improvements across a pathway of care A comprehensive set of recommendations for a particular disease or condition

9. NICE Quality Standards 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 Include measures to help inform local quality improvement work

10. "As a user of care services, they support me in my choices about who provides care for me, and in knowing what to expect from a good quality care service." "Commissioning services using NICE quality standards allows me to meet my duties as a local authority commissioner to promote integration of health and social care, and support me in ensuring the services I commission are high quality, and value for money” “As a provider of care services, I can use NICE guidance and quality standards to ensure, and therefore demonstrate, that I provide high quality care, based on the best available evidence.” How can quality standards be used ?

11. For example QS 50 Mental Wellbeing of older people in care homes - about staff being trained to recognise signs of mental health conditions - about staff being able to recognise physical ill health issues and sensory impairment limitations QS 63 Delirium - about care homes assessing newly admitted adults who are at risk of delirium

12. NICE QS relate to good and outstanding ratings, and have been used by CQC in developing their forthcoming framework. NICE and the CQC

13. NICE Advice https://www.nice.org.uk/advice/lgb25 http:// www.nice.org.uk/guidance/qs50/resources/using-quality- standards-to-improve-practice-in-care-homes-for-older-people

14. Part 2 Finding what you want quickly and easily

15. Accessing the guidance Improved search returning more relevant results Prominent ‘feature’ section promoting NICE’s latest developments

16. An easy and intuitive way of accessing a range of information from NICE about health, public health and social care. They include up-to-date NICE guidance, quality standards and related information Features: Pathway information Information for the public Implementation support tools Quality standards Source guidance Related guidance Save and print http://pathways.nice.org.uk/pathways.nice.org.uk NICE Pathways

18. Android smartphone and tablets iPhone and iPads Browse function Rapid searches Bookmark for offline use Receive automatic updates Available via:  NICE website  Apple App Store  Google Play Store www.nice.org.uk/apps NICE Apps – Information at your fingertips

19. Practical Support

20. Implementation – practical support Into Practice Guide Self assessment/Audit tools Costing reports and templates Online learning resources Clinical case scenarios Shared learning database Medicines Information NICE and BNF apps Field team We provide a range of resources to help maximise uptake and use of evidence and guidance. www.nice.org.uk/about/what-we-do/into-practice

22. NICE Savings and Productivity and Local Practice Collections www.nice.org.uk/sharedlearning

23. Shared learning Patient information leaflets about preventing falls in hospital and the use of bedrailsPatient information leaflets about preventing falls in hospital and the use of bedrails Portsmouth Hospitals Multifactorial interventions can reduce harm from falls in Acute Hospital settingsMultifactorial interventions can reduce harm from falls in Acute Hospital settings University Hospitals Birmingham NHS Foundation Trust Care Home Support Team (CHST) - Reducing Falls Derbyshire Community Health Services Community based Falls Prevention in Older People Anglesey County Council

24. Quality and productivity case studies Crisis response falls team: reducing admissions and repeat fallsCrisis response falls team: reducing admissions and repeat falls Fall and bone health management assessment proforma: Improving care across primary and secondary careFall and bone health management assessment proforma: Improving care across primary and secondary care Prevention of inpatient falls: systematic risk assessment and reduction programmePrevention of inpatient falls: systematic risk assessment and reduction programme Safety Express: a national pilot to deliver harm free care Fragility fractures - prevention Microfibre mops: saving money and reducing risk Decreasing missed doses: To improve patient safety and outcomesDecreasing missed doses: To improve patient safety and outcomes

25. Keeping up to date and getting involved

26. NICE News- monthly e- newsletter on consultations, published and forthcoming guidance. Social care stakeholder update :- socialcaresh@nice.org.uk socialcaresh@nice.org.uk Stephen.judge@nice.org.uk Staying up to date with NICE http://www.nice.org.uk/News/NICE-newsletters-and-alerts

27. Managing medicines in care homes

28. Rationale More than 350,000 people in England and Wales live in a care home. This includes people of any age with learning disabilities or other disabilities, and the elderly.350,000 people in England and Wales live in a care home A 2011 study showed that 9 in 10 care home residents were exposed to at least 1 potential medication administration error over a 3-month period.2011 study The new NICE quality standard for managing medicines in care homes highlights this as a key issue in need of urgent improvement. It lists actions that should be taken to ensure that all health and social care practitioners are aware of residents’ needs and can administer the right medicines to the right person at the right time.NICE quality standard for managing medicines in care homes

29. Managing medicines in care homes key points People in care homes have the same rights and responsibilities in relation to NHS care as the rest of us - the NHS Constitution. Residents should have the opportunity to make informed decisions about their care and treatment. Person-centred care is important. Helping residents to look after and take their own medicines helps them retain their independence. When a person moves into a care home, staff should assume they can manage their own medicines, unless indicated otherwise. Each resident should have an individual risk assessment to determine the support they need to manage their own medicines. Care home providers should have a medicines policy which includes written processes for the safe and effective use of medicines.

30. Care Home Policy Assessing mental capacity (legislation) Storing and sharing information (inc. transfers) Keeping accurate records Problem identification and reporting Safeguarding residents Medicines reconciliation and review Ordering and disposing of medicines Stock control of medicines Administration of medicines (by resident, staff and covertly) Staff training and competency Non-prescription medicines NICE have published a ‘checklist’ to help you put a local policy in place

31. Improvement priorities Health or social care service providers to send a discharge summary, including details of the person’s current medicines, with a person who transfers to or from a care home Prescribers who are responsible for people who live in care homes to provide comprehensive instructions for using and monitoring all newly prescribed medicines. A multidisciplinary team should undertake medication reviews for people who live in care homes Residents who wish to self-administer their own medicines should be supported to do so as long as it does not put them or others at risk.

32. List of statements Statement 1 People who transfer to a care home have their medicines listed by the home on the day of transfer. Statement 2 Providers of health or social care services send a discharge summary, with details of current medicines, with a person who transfers to or from a home. Statement 3 People in care homes are supported to self-administer medicines if they wish to and it does not put them or others at risk. Statement 4 Prescribers responsible for those in care homes provide comprehensive instructions for using and monitoring all newly prescribed medicines. Statement 5 People in care homes have medication reviews by a multidisciplinary team. Statement 6 Adults in care homes who have been assessed as lacking capacity are only administered medicine covertly if a management plan is agreed after a best interests meeting.

33. List of statements Statement 1 People who transfer into a care home have their medicines listed by the care home on the day that they transfer. Statement 2 Providers of health or social care services send a discharge summary, including details of the person’s current medicines, with a person who transfers to or from a care home. Statement 3 People who live in care homes are supported to self-administer their medicines if they wish to and it does not put them or others at risk. Statement 4 Prescribers responsible for people who live in care homes provide comprehensive instructions for using and monitoring all newly prescribed medicines.

34. Statement 2 Rationale Quality measures –Structure “Evidence of local arrangements to ensure that a discharge summary, including details of a person’s current medicines, is sent with a person when they transfer to or from a care home”. What the quality statement means for service providers, health and social care practitioners, commissioners and service users and carers Source guidance Definition of terms

35. Definition of terms – Discharge summary A discharge summary should contain the following information as a minimum:  the person’s details, including full name, date of birth, NHS number, address and weight (for those aged under 16 or where appropriate, for example, frail older residents)  GP’s details  details of other relevant contacts defined by the resident and/or their family members or carers (for example, the consultant, regular pharmacist, specialist nurse)  known allergies and reactions to medicines or ingredients, and the type of reaction experienced  medicines the resident is currently taking, including name, strength, form, dose, timing and frequency, how the medicine is taken (route of administration) and what for (indication), if known  changes to medicines, including medicines started, stopped or dosage changed, and reason for change  date and time the last dose of any ‘when required’ medicine was taken or any medicine given less often than once a day (weekly or monthly medicines)  other related information, including when the medicine should be reviewed or monitored, and any support the person needs to carry on taking the medicine  what information has been given to the resident and/or family members or carers. [Managing medicines in care homes (NICE guideline SC1), recommendation 1.7.3]

36. Table discussion – how could you use the NICE quality standard for medicines management in care homes?

37. Home Care

38. Draft Guideline Rationale Focus on older adults Considers personal care (support for daily living, essential domestic tasks) Responds to CQC report “Not Just a Number” Should be read in conjunction with the Care Act 2014, Mental Capacity Act and Code of Practice on the Deprivation of Liberty Care and support should take into account individual needs and preferences Whether commissioned or bought by individuals

39. Key points for Home Care Providers Ensure care is person-centred (e.g. services are not simply one size fits all) Care and support should be delivered through a MDT where required Check which services are user priorities – can they be used flexibly ? Consider telecare (but not as simply a replacement for personal contact) Ensure contracts allow time to give a good quality service (inc travel). Workers should have enough time to do their job without being rushed. Only make <30min visits in certain circumstances (e.g. as part of a wider support package) Ensure safety by liaising over medication and safeguarding concerns Have a robust recruitment process and ensure staff have the right skills Ensure staff can recognise common health conditions and care needs (e.g. dementia, nutrition, skin integrity... )

40. Key points for Local Authorities / Commissioners Local Authorities must arrange to provide comprehensive information about care and support services (e.g. how to access, funding models etc) Home care should be considered as one component of a care package. Provision of home care to those with low to moderate needs may avoid the need for more intensive support later on Consider telecare (but not as simply a replacement for personal contact) Ensure contracts allow time to give a good quality service (inc travel). Workers should have enough time to do their job without being rushed.

41. Table discussion – how could you use the NICE guideline for Home Care ?