With the health service in a state of flux, the National Institute of Health and Clinical Excellence (NICE) wants to reassure community health professionals that they are there to offer advice and help, as well as produce in-depth guidance and quality of care documents.Jayne Rowneyexplains how NICE tools and principles can guide and support you through your working day
Jayne Rowney,Implementation Adviser National Institute for Health and Clinical Excellence
Many health professionals are aware that the National Institute for Health and Clinical Excellence (NICE) provides guidance that helps to shape the daily practice of their daily working lives. However, with the NHS currently being asked to focus on ensuring quality care, while at the same time planning for a challenging financial situation, where does NICE fit in, and how can it help practitioners to maintain best practice?
The principles of NICE
NICE is responsible for producing guidance and standards to support those treating or caring for people with specific diseases or conditions, and also makes recommendations on new and existing drugs, devices, diagnostics, treatments and procedures1. NICE also makes recommendations to the NHS, local authorities and other organisations in the public, private, voluntary and community sectors on how to improve people's health and prevent illness and disease. NHS Evidence,is a free service provided by NICE, enabling access to authoritative clinical and non-clinical evidence and best practice through a web-based portal. All NICE guidance is produced through open and transparent processes, by independent committees, and is subject to genuine consultation at key points in the guidance development. There are opportunities for practitioners to contribute to the guidance development process, as part of a stakeholder organisation or as a member of a guideline development group.
Putting guidance into practice
NICE guidelines take into account cost effectiveness as well as clinical effectiveness. For each piece ofguidance that is published, an accompanying costing tool is produced to support implementation. The costing tools highlight particular recommendations within the guidance that may have a cost impact or an opportunity to make savings and allow NHS organisations to plan at a local level. This may be useful for practitioners who wish to develop business cases or bid for funding.
For example, implementing the NICE guidance on postnatal care can be expected to deliver net annual savings of between £5000 and £9000 per average unit experiencing around 2500 births a year. The savings arise from a reduction in the incidence of childhood disease due to the protective effects of breastfeeding assuming following the recommendations will lead to an increase in the numbers of mothers who breastfeed.
The NICE website contains a section dedicated to cost savings5. This includes information on planning service delivery and spending to save, as well as efficient use of services and reducing inefficiency. NICE guidelines often contain recommendations on practices that should be discontinued or should not be used routinely, due to a lack of supporting evidence. These have been highlighted in a searchable database6
Support tools for health professionals
Along with costing tools and information, NICE also produces a range of support tools to help practitioners to put recommendations into practice. Each piece of guidance is accompanied by an educational slide set which highlights the "Key Priorities for Implementation" (as defined by the Guideline Development Group responsible for producing the guidance). These slide sets include discussion prompts and sometimes case studies to facilitate local discussion of the guidance. They can be adapted for use at a local level.
In addition to the slide set presentations, many pieces of guidance are accompanied by targeted support resources and tools. The type of resources available depends upon the content of the guidance, and any barriers to implementation that have been identified. For example, NICE has recently published a training package to support health professionals to raise sensitive issues with service users. Working with a team from the University of Leeds, NICE produced an online programme for self directed study, along with a resource pack for trainers to use to plan and provide interactive, reflective sessions for healthcare professionals. Further information and links to access the package are available online7. NICE also produces tools that can be used in day-to-day practice, such as graphs for monitoring neonatal jaundice, a fact sheet on constipation in children and young people, and a history taking questionnaire. This is only a selection of tools that are available and a full list can be found on the NICE website8. Alternatively, a list of related support tools can be found on the main landing page of each piece of guidance.
To support implementation of the recent guidance on Pregnancy and Complex Social Factors9, NICE published an accompanying resource, which showcases examples from practice10. The examples from practice are presented to allow those responsible for implementing the recommendations in the NICE guideline to gain an understanding of what services for pregnant women with complex social factors could look like.Shared learning for good practiceThe NICE website hosts a shared learning database, with examples from practice of how previously published NICE guidance has been implemented. This can be useful for practitioners who are planning change within their own organisation or service. The shared learning database is also a forum for sharing and demonstrating good practice. Submissions are automatically entered for consideration for the prestigious NICE Shared Learning Awards, which are held annually at the NICE conference11. NICE guidance on antenatal and postnatal mental health12 has been used to help to develop new specialist services and improve health outcomes for women living in Sheffield13. The guidance was used alongside local health needs analysis to support the implementation of a care pathway, clarifying professional roles and the patient journey. It also helped staff to identify and respond to maternal mental health problems, which led to improved patient experience, as well as cost savings and a reduction in inpatient stays.
Amongst other examples, NICE guidance14 has also been utilised to create risk assessment tools for venous thromboembolism (VTE) in pregnancy and the weeks following childbirth15. The guideline was used by a multidisciplinary team from Musgrove Park Hospital to develop two implementation tools for planning and recording care, and improving patient safety through consistent care and recording.
Quality standards to achieve excellence
Recent additions to the work undertaken by NICE includes the development of quality standards, which are central to the Government's vision of an NHS focussed on delivering the best possible outcomes for patients16.
They are markers of excellence, developed using the best available evidence, including NICE guidance and other sources accredited by NHS Evidence. Quality standards are developed in collaboration with NHS and social care professionals, as appropriate, along with their partners and service users and are the only health and social care standards that apply nationally in England. As well as being an integral component of commissioning and performance management, quality standards have also been designed to be relevant to those providing and receiving care or services. For frontline practitioners, quality standards may facilitate decision making with regards to care based on the latest evidence and best practice. Quality standards may also support service users [patients?] understand what they can expect from their health and social care providers.
NICE factsNICE is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
NICE produces guidance in three areas of health:
●public health- guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
●health technologies- guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
●clinical practice- guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS. NICE produces standards for patient care:
●quality standards- these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
●Quality and Outcomes Framework- NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients. NICE provides advice and support on putting NICE guidance and standards into practice through itsimplementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care throughNHS Evidence.
Launch of NICE PathwaysNICE Pathways, a new online tool, was launched in May 2011. This visually represents all NICE guidance on particular topics to provide health and social care professionals with faster and easier access to all relevant recommendations at a glance17. Designed for people who use NICE guidance in practice, NICE Pathways bring together all of the related NICE guidance and associated products in a set of interactive topic-based diagrams. NICE Pathways have been developed as an easy way to view all that NICE have said on a particular topic. Where topics are related, the NICE Pathway makes appropriate links (such as the links between the diet pathway and the physical activity pathway), which will allow practitioners to access the appropriate information and guidance more conveniently.
Easily accessible case histories
The NHS Evidence search bar can be downloaded to your PC for direct access to NHS Evidence resources. NHS Evidence features topic pages for clinical areas, which can help busy professionals to access the resources and information that they require quickly and easily18. This can also enable practitioners to keep up to date with any significant new evidence in their area of interest or their speciality. Additionally, NHS Evidence hosts a collection of examples of how health and social care practitioners are improving quality and productivity across the NHS and in social care. The Quality, Innovation, Productivity and Prevention (QIPP) collection provides case studies that can be used to inform local practice and initiatives. The collection consists of examples that have been submitted by organisations and individual practitioners, and welcomes new additions, which are of initiatives that demonstrate improved savings, quality and/or productivity improvements. Case studies that show lessons learned in how to better implement initiatives are also welcomed.
Services and organisations are looking to make savings and ensure that care is delivered as cost- effectively as possible. Using NICE guidance and the associated tools and resources that NICE provides can help inplanning effective use of resources, providing a solid evidence base for practitioners and delivering better outcomes for patients.
NICE will continue to produce guidance and quality standards to underpin effective, and cost-effective, evidence based practice, along with a suite of support tools to help practitioners to put this into practice. However, NICE realises that this can only be done with the support of the health professionals they produce the information and guidance for. In light of this, the implementation support team at NICE are always happy to receive feedback on your experience of using NICE guidance and tools in practice, or any suggestions that you have (see information box for contact details).
For enquiries about our resources contact:firstname.lastname@example.org
For general enquiries visit the nice website atwww.nice.org.uk/ or email@example.com
1.http://www.nice.org.uk/aboutnice/howwework/how_we_work.jsp [Accessed July 2011]
2. NICE (2006) CG37 Postnatal care: Routine postnatal care of women and their babieshttp://guidance.nice.org.uk/CG37[Accessed July 2011]
3. NICE (2006) Postnatal care: national cost impact reporthttp://guidance.nice.org.uk/CG37/CostingReport/doc/English[Accessed July 2011]
4.http://www.nice.org.uk/usingguidance/commissioningguides/breastfeed/breastfeed.jsp[Accessed July 2011]
5.http://www.nice.org.uk/aboutnice/whatwedo/niceandthenhs/CostSaving.jsp[Accessed July 2011]
6.http://www.nice.org.uk/usingguidance/donotdorecommendations/index.jsp. [Accessed July 2011]
7.http://www.nice.org.uk/usingguidance/implementationtools/educationaltools/raisingsensitiveissuestrainingpack.jsp[Accessed July 2011]
8.http://www.nice.org.uk/usingguidance/implementationtools/implementation_tools.jsp[Accessed July 2011]
9.http://guidance.nice.org.uk/CG110[Accessed July 2011]
10. NICE (2010) CG110 Pregnancy and Complex Social Factors: Service Descriptionshttp://guidance.nice.org.uk/CG110/ServiceDescriptions/pdf/English[Accessed July 2011]
11.http://www.nice.org.uk/sharedlearning[Accessed July 2011]
12. NICE (2007) CG45 Antenatal and postnatal mental healthhttp://guidance.nice.org.uk/CG45[Accessed July 2011]
13.http://www.nice.org.uk/usingguidance/sharedlearningimplementingniceguidance/examplesofimplementation/eximpresults.jsp?o=456[Accessed July 2011]
15.http://www.nice.org.uk/media/F87/6C/NICESLAwardsPosterBooklet2011.pdf[Accessed July 2011]
16.http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp[Accessed July 2011]
17.http://pathways.nice.org.uk/[Accessed July 2011]
18.http://www.evidence.nhs.uk/[Accessed July 2011]