Professor Gillian Leng CBE, Deputy Chief Executive and Director of Health and Social Care, NICE

Enhancing the quality of care: supporting the use of evidence within social careProfessor Gillian Leng Deputy Chief Executive, NICE, March 2015

An overview of NICE

– Scientific evidence is explicit (codified and propositional), systematic (uses transparent and explicit methods for codifying), and replicable (using the same methods with the same samples will lead to the same results).

– It can be context-free (universal truths) or context-sensitive (specific circumstances)

Lomas et al 2005

Scientific evidence

“Evidence is inherently uncertain, dynamic, complex,

contestable, and rarely complete”

Lomas, J; Culyer T et. al

Conceptualizing & Combining Evidence For Health System Guidance; CHSRF, May 2005

Scientific and colloquial evidence

Guideline development

• Six internationally agreed

domains of guideline

production:• Scope and purpose

• Stakeholder involvement

• Rigour of development

• Clarity and presentation

• Applicability

• Editorial independence

Publication

Validation

Consultation

Development

Scoping

Topic referral

Guidance and quality standards

A comprehensive set of recommendations for a particular condition or service area

‘Sentinel markers’A prioritised set of concise, measureable statements designed to drive quality improvements across a pathway of care.

NICE, CQC & service quality

Products to publish in 2015Guidelines

Home care

Social care of older people with multiple long term conditions

Transition between inpatient hospital settings and community or care home settings

Challenging behaviour of people with learning disability

Children’s attachment

Quality standards

Managing medicines in care homes

Pressure ulcers

Challenging behaviour of people with learning disability

Home care guideline

• Draft guideline out for consultation until April 16

• Focusses on older people receiving home care and their carers

• For commissioners, providers, care workers and home care managers

• While the Care Act and other legislation describe what organisations need to do, this guideline is focussed on “what works” in terms of how they fulfil those duties

Recommendations – delivering care• Ensure home care visits are long enough for home care

workers to complete their work without compromising the quality of their work or the dignity of the person, including scheduling sufficient travel time between visits.

• Take into account that people with cognitive impairments, communication difficulties or sensory loss may need workers to spend more time with them.

• Home care visits shorter than half an hour should be made only if: – the home care worker is known to the person, and – the visit is part of a wider package of support, and – it allows enough time to complete specific, time limited tasks or to

check if someone is safe and well.

Living well with dementia

A set of 10 statements

Provide a clear focus on the priority areas for continuous improvement in quality and outcomes

To be read alongside the healthcare standard for dementia

Associated with outcome and process measures.

Quality statement 4People with dementia are enabled, with the involvement of their carers, to take part in leisure activities during their day based on individual interest and choice.

‘Enabled’ refers to actions taken by care providers to ensure that people with dementia can take part in leisure activities during their day. This includes, but is not limited to, finding out people's individual interests and preferences, providing daily activities and providing transport.

Shared learning example

A lifestyle matters approach with a group of older people in warden controlled accommodation Mental wellbeing and older people – PH16•A joint initiative between Gateshead Council and Gateshead PCT looking at overcoming barriers which prevent people engaging in meaningful activities. The group focuses on the well elderly in warden controlled accommodation and is held on these premises. The group looks at the link between activity and wellbeing by using goal setting graded for individual needs to enable them to overcome their barriers in order to be fit and active.

Shared learning awards

Challenges of implementationResults from 683 clinicians and managers

“Change is not made without inconvenience, even from

worse to better”

Richard Hooker,1554-1600

The Act and quality standardsQuality standards

‘The relevant commissioner may direct NICE to prepare statements of standards in relation to the provision of:

a) NHS service b) Public health services, orc) Social care in England.

NICE must keep a quality standard under review and may revise it as it considers appropriate.

In discharging its duty, the Board/Secretary of State must have regard to the quality standards prepared by NICE’.

CQC & NICE Quality StandardsAndrea Sutcliffe, Chief Inspector for Adult Social Care at the CQC, says that “Using NICE products will help underpin the characteristics of good and outstanding social care services. The CQC will use the quality standard to train its inspectors to ensure consistency in judgments over the services that it is regulating.”

https://www.nice.org.uk/news/article/use-nice-quality-standards-to-guide-good-quality-social-care-says-cqc

The inspection processEach inspection seeks to answer five questions about services. Are they:

– Safe– Caring– Effective – links with NICE guidance– Well-led – links with NICE guidance– Responsive to people’s needs

Care will be rated as:– Outstanding – developmental statements– Good – enhanced quality statements– Requiring improvement– inadequate

Measuring progress

Quality Standard

Outcomes

Uptake data: dementia QS

Summary• NICE guidelines – recommendations on ‘what works’, for

organisations that provide, commission and provide services to ensure services are safe, effective and value for money.

• Quality standards – a concise set of statements designed to drive and measure improvement in quality.

• Tools to help put guidance and quality standards into practice.

• Local practice examples – case studies showing how organisations have used NICE guidelines or quality standards.