nice - in evidence based commissioning gateshead council gillian mathews, implementation consultant...
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NICE - in evidence based commissioning
Gateshead Council
Gillian Mathews, Implementation Consultant - North
9 September 2011
Overview
• Using NICE guidance in the commissioning cycle
• Using NICE Quality Standards in evidence based commissioning
• The advantages of an evidence- based approach
More than just guidelines...
NICE and NHS Evidence
Evidence – guidance – shared learning
• Technology Appraisals - guidance on the use of new and existing medicines and treatments.
• Interventional Procedures Guidance
• Clinical guidelines - guidance on the appropriate treatment and care of people with specific diseases and conditions.
• Cancer Service guidance
• Public health guidance
• Medical technologies guidance
• Diagnostics guidance
Types of guidance
Evidence based – clinically
and cost effe
ctive
Finding guidance from NICE Pathways
JSNA JSNA and strategic plans
What are we doing now?Is it working?
Evidence for what works
Indicators and data to measure progress
The commissioning cycle
New system relationships
Outcomes Framework and Standards
NHS OUTCOMES FRAMEWORKDomain 1
Preventing people from
dying prematurely
Domain 2Enhancing the quality of life for
people with LTCs
Domain 3Recovery
from episodes of ill health /
injury
Domain 4Ensuring a
positive patient
experience
Domain 5Safe
environment free from avoidable
harm
NICE Quality Standards (Building a library of approx 150 over 5 years)
Commissioning Outcomes Framework
Commissioning Guidance
Provider payment mechanisms
Commissioning / ContractingNHS Commissioning Board - Specialist services and primary care
GP Consortia – all other services
1
2
3 4
7
Duty of quality
Du
ty o
f qu
ality
Du
ty o
f qu
ality
tariffstandard contract
CQUIN QOF
5
6
Duty of quality
NHS OUTCOMES FRAMEWORKDomain 1
Preventing people from
dying prematurely
Domain 2Enhancing the quality of life for
people with LTCs
Domain 3Recovery
from episodes of ill health /
injury
Domain 4Ensuring a
positive patient
experience
Domain 5Safe
environment free from avoidable
harm
NICE Quality Standards (Building a library of approx 150 over 5 years)
Commissioning Outcomes Framework
Commissioning Guidance
Provider payment mechanisms
Commissioning / ContractingNHS Commissioning Board - Specialist services and primary care
GP Consortia – all other services
1
2
3 4
7
Duty of quality
Du
ty o
f qu
ality
Du
ty o
f qu
ality
tariffstandard contract
CQUIN QOF
5
6
Duty of quality
Quality Standards
• A set of 10-15 specific, concise statements that are markers of high-quality, clinical and cost-effective patient care across a pathway or clinical area
• Topics sequenced by National Quality Board (NQB) – will be the NHS CB in future
• Aim: to offer clarity about what high quality care looks like across the 3 dimensions of quality ensuring:– care is effective– care considers service user’s experience– care is safe
• Over time - building to a library of around150 topics
Dementia Quality Standard
Dementia: quality statement 2
Quality statement• Carers of people with dementia
are offered an assessment of emotional, psychological and social needs and, if accepted, receive tailored interventions identified by a care plan to address those needs.
Related quality measures - structure
• Evidence that those carrying out a carers' assessment identify any emotional and psychological needs and the social impact on the carer and offer the carer psychological therapy, including cognitive behavioural therapy (CBT), if clinically appropriate.
• Evidence that this is an ongoing process and includes any period after the person with dementia has entered residential care.
• Evidence that care plans for carers of people with dementia involve a range of tailored interventions, which consist of multiple components including: – individual or group psychoeducation – peer-support groups with other carers, tailored to
the needs of individuals depending on the stage of dementia of the person being cared for and other characteristics.
Quality measure - process
a) Proportion of carers of people with dementia who are offered an assessment of their needs.
• Numerator: the number of carers offered an assessment of their needs.
• Denominator: the number of carers of people with dementia.
b) Proportion of carers of people with dementia receiving interventions tailored to their needs.
• Numerator: the number of carers receiving interventions tailored to their needs
• Denominator: the number of carers of people with dementia who have an agreed care plan.
Quality Standards and Commissioners
• Framework for provider discussions
• Potential to include elements in contracts
• Obtaining and monitoring outcomes data
• Potential use by Regulators
• Impact on payment mechanisms
NICE Guides for commissioners
On a topic-specific basis :
• support the commissioning of evidence-based care for patients
• assist financial modelling through a tool to calculate local service costs
• provide a framework for investment decisions
• highlight and support relevant national priorities
• signpost NICE guidance and other relevant supporting information.
www.evidence.nhs.uk
Key features:• Simple search• Accredited sources of guidance• Browse functions in key topic areas• My Evidence• Healthcare databases via Athens
Unsafe Substandard Adequate Good Excellent
Provider Payment Mechanisms
Commissioning Outcomes Framework
Development of commissioning guidance (NHS CB)
NICE quality standardsStandard of services
Proportion of services
Registration requirements
Regulation ( Enforcement against Registration Requirements)
There is no statutory provision allowing NICE Quality Standards to impact upon
registration requirements
Quality Standards are advice from NICE to the NHS CB on high quality care.
Standards and high quality care
Why use the best available evidence?
• To reduce variation• To reduce inequalities• To improve quality of
service provision• To reduce waste• To ensure the best
use of resources
This is what we do
NICE and NHS Evidence
Evidence – guidance – shared learning
Summary
We set out to cover:• Using NICE guidance in the
commissioning cycle• Using NICE Quality Standards in
evidence based commissioning • The advantages of an evidence-
based approach