1. Supporting Commissioning for Value
What
Stephen Judge, Implementation Consultant , South West

3. A & E Tooth Decay Infant Mortality LRTI Admissions Infections Vitamins
Preventable Injury
Diet
Low Birth Weight

4. Prevention & Public Health
Contraception
Diet
Smoking and Drinking
Primary & Community Care
GP, Sexual Advice
Flu vaccination
Smoking cessation
Breastfeeding advice
Secondary Care
Management of low birth weight babies
Lower respiratory tract infections
It’s not the type of guidance that matters, but its content.
So consider TAGs, CGs, PH guidelines and advice and tools
NGx
NICE guidelineswill be numbered in this way in future

5. Do you know your guidance from your quality standards?
10 minutes. Fastest group wins! Lay out the pieces of paper as follows:
Type of guidance
Description
Example

6. 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
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
Diagnostic guidance - on measurements and tests used to evaluate or monitor a patient’s condition
Interventional procedures guidance - on safety and efficacy (can it work) of processes or treatments
Medical technologies guidance - on new or novel medical technologies (value proposition)
Social care guidance
Safe Staffing guidance (new!)
EFFECTIVE (how well they work)
COST-EFFECTIVE (value for money)

7. Maternal and Child nutrition guideline PH11
Training and skills development of staff
Folic acid and Vitamin D recommended supplements
Promote and assist entry to Healthy Start scheme
Discuss diet with mother
Encourage weight loss in pregnancy where BMI >30
Encouraging breastfeeding (inc ability in public spaces)
Discuss pros and cons of infant formula
Monitor baby’s weight
Advise on allergies and oral health
Bedwetting Pathway, Under 5 box
Bedwetting Pathway, 5-19 Yr box
Bedwetting Pathway, About, Sources, CG111

8. 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.
NICE is required to regularly review the QS, making revisions as appropriate.
The NHSE and SoS, in carrying out their duties must have regard to the standards prepared by NICE, as should organisations improving the quality of services.

9. Postnatal Care QS57
Postnatal care plan is regularly reviewed and updated
Mothers are advised within 24 hrs of birth of potentially life threatening conditions
Discuss infant sleeping to avoid SIDS
Support for breastfeeding is received from a structured programme
Use of infant formula is discussed with mother
Babies have physical check at 6-8 weeks
Postnatal checks include assessment of mother’s emotional wellbeing (and if baby blues not resolved within 14 days assess for mental health problems)
4. Bedwetting Pathway, QS tab, (click link to get number QS70)
5. Quality Standards, statement 5 – refer !
6. Clinical Guidlline CG111, KPIs

10. And also available via the NICE website main menu
NICE Evidence Services
A suite of services that provide internet access to high quality authoritative evidence and best practice.
Evidence Search
Journals and Databases including access to Health Database Advance Search (HDAS)
Clinical Knowledge Summaries (CKS)
BNF
UK DUETs
Bulletins, Alerts and Evidence Awareness Service
And also available via the NICE website main menu

11. Group exercise
What are the 3 biggest challenges you face when implementing NICE guidance ?

12. Feedback
Challenges of implementing NICE guidance survey of 683 clinicians and managers

13. Ensure organisational structures and processes are in place
A systematic approach
Ensure organisational structures and processes are in place
Board level leadership
Day-to-day operational lead for quality appointed
Multi-disciplinary forum for strategic decisions
Nominated lead for each new development
System in place for ongoing monitoring and reporting to the board
Are you aiming to improve the quality of healthcare?
Identify the best available evidence-based guidance
Check whether services are currently in line with best practice
Develop an initial plan to overcome any barriers to change
Check if the plan can be delivered within existing resources
Finalise the action plan and implement
Evaluate ongoing success through systematic measurement

14. NICE Into Practice Guide
Web based guide to help health and social care organisations use NICE guidance & quality standards to achieve a high quality of care in local settings
Suggests what an organisation can put in place, and what staff can do, to use NICE guidance & quality standards to improve outcomes and get the best value for money
Includes helpful tips, links to other resources and shared learning examples of how other people have used NICE guidance and quality standards
Who is it for?
This guide is for anyone who is …
a commissioner or provider of health or social care
responsible for ensuring that evidence-based guidance is put into practice by their organisation
involved in quality improvement
involved in planning, delivering and scrutinising care services
leading on implementing a specific piece of guidance
using a quality standard to improve quality across a team or service. .

15. Practical support
Routine guidance support tools: baseline assessment, costing and resource impact tools, audit criteria
Other discretionary guidance support tools: Support for commissioning using the quality standard, online learning modules 4x per year
Endorsement programme: statement from NICE in the guidance support tool about its alignment to the relevant guidance or quality standard(s)

16. Local Government Briefings
Concise information on cost-effective and evidence- based solutions for local government, public health and, from April 2014 social care
For local authorities and their partner organisations in the health and voluntary sectors, in particular those involved in Health and Wellbeing Boards
Demonstrate potential role of NICE guidance as the basis of solutions to public health issues and problems at a local level
Derived from existing guidance
Web-based format with links to other sources of information – but also printable
Introduction
Key messages
What can local authorities achieve
What is effective
Examples of good practice
Developing an action plan
Costs and savings
Background to recommendations
Support
Other useful resources

17. Health Visiting – Local Gov. Briefing 22
Healthy Child Programme - review and health checks - screening - immunisation (eg MMR) - parenting support - behaviour change (mostly of parents)
Provide additional support for vulnerable families
Consider wider factors, such as poverty and housing
Reduce infections and preventable injury (home safety, suspicion of maltreatment)
Promote healthy lifestyles (vitamins, passive smoking, breastfeeding, diet etc.)

18. Savings and productivity collection
Costing saving guidance
Cost saving support
Public health ROI tool
Quality and productivity case studies
Do not do recommendations
Key therapeutics topics

19. Quality and productivity examples

20. Support for Commissioners (feverish illness <5s)
Assess using Traffic Light System
Record vital signs
Take urine test if high temperature
Provide a safety net of advice
Clinical audit tools can help demonstrate and monitor services
Support document estimates cost impacts
Links to details of recommendations (e.g. TLS)

21. NICE Pathways . . . guidance at your fingertips
Pathways brings together all NICE guidance, quality standards and support in easy-to-navigate flowcharts
pathways.nice.org.uk

24. Using NICE guidance to support C4V
NICE Pathways
NICE Guidance
NICE Evidence
Quality Standards
Health, Public Health, Social Care
Costing, Return on Investment and Quality and Productivity collection
C4V Elements of value

25. Getting involved . . .
8 strong field team, plus medicine associates, NICE fellows and scholars
NICE Enquiries desk
Online information, education tools, blogs, tweets etc.
Apps !
Many opportunities to get involved (registered stakeholders, joining a committee )