Shared learning database

Type and Title of Submission


Measuring Success: An audit process for guideline No.8; The management of multiple sclerosis in primary and secondary care. (Updated 2008)


The MS Society developed, piloted and then rolled out an audit tool and process for measuring the success of service providers in implementing the NICE Guideline No8 that put the voice of service users in the centre of the process. Service user's views from focus groups were combined with the results of the audit and synthesized into prioritised action plans for service improvement/developments for people with MS. The MS Society works in partnership with the service provider through the whole process and can reward or 'pump prime' developments.



Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG8 - Multiple sclerosis

Category(s) that most closely reflects the nature of the submission:

Audit tool

Is the submission industry-sponsored in any way?


Description of submission


To provide a comprehensive audit tool that allows service providers to evaluate their service against the guideline. To cross reference the guideline to the National service Framework for Long term conditions. To support service providers to gain patients views by facilitating focus groups and feeding the results back into action planning and reward service improvements / developments.


1. To provide a comprehensive audit tool that allows service providers to audit their services against the six key priorities of the NICE guideline and provide evidence of compliance with the NSF. 2. To include the patient voice in the process, allowing for better prioritisation for service development 3. To encourage prioritised action planning and implementation of service improvement/ development plans


The MSS developed its own standards of care for MS in 1997 in the absence of anything else and introduced a scheme called 'Measuring Success' to reward those services that met the standards. With the publication of the NICE guidance in 2003, the society recognised there was not incentive to implement the guidelines or way of auditing that this was being done. In 2004 the MSS launched its 'Measuring Success' Toolkit, a comprehensive box containing all the materials needed to understand the guideline and the audit process and an audit tool. The programme would support service providers with the running of focus groups of service users to feed back into action planning. In 2005, 7 pilot sites were established to undertake the whole process supported by the MSS (and over 1,000 toolkits have been sent to NHS service providers for them to be able to undertake the audit process in isolation to date). The toolkit was evaluated by a web survey of everyone who had received one up to mid 2006 and as a result re-designed into the 2007 edition with the audit tool broken down into sections to reflect the changes in NHS configuration and the loss of the rest of the materials which were not valued by those who had received the full box. The toolkit was also cross referenced against the NSF for long term conditions, as service providers were abrogating their intentions to implement NICE guidelines in preference to the NSF, thus allowing service providers to prove compliance with both. An interactive excel version of the audit tool was produced in response to requests from service providers. A total of 12 new sites have registered for the full audit process and have undertaken it or are in the process of doing so in 2007/8 and new sites are coming forward for 2009.


1. A comprehensive audit tool was produced and revised following evaluation and updates to reflect changes in NHS configuration and take into account the similarities between the six key priorities of the guideline and the 11 quality requirements of the NSF for long term conditions. 2. Focus groups were run in six of the seven of the pilot sites and result fed back into action planning. One site chose to use a patient questionnaire due to the large geographical spread of its audit and the cost to the MSS of running multiple focus groups to obtain a fair evaluation. 3. Action plans have resulted in improved access to services for people with MS, better equipment and education sessions for both service users and service providers.

Results and evaluation

The toolkit was evaluated by a web based survey of all who received a toolkit and the results analysed. The results from a 44% response rate showed that over 90% of those who received the kit and responded wanted the audit tool only and made little use of the other materials included. Most adapted the audit tool to fit their local situations and thought it should reflect more the emerging configurations of the NHS into primary, secondary, rehabilitation care. The MSS also thought a section should be included for commissioners. Sites that completed the tool have used the action planning results to: - Improve services by access to bladder scanning by the MS nurse - Introduce a multidisciplinary clinics 'one stop shop' for assessing people with MS - Pilot patient held records - Blitz the backlog of assessments to get services back up to speed. - Improve the equipment available for assessment and rehabilitation sessions. - Develop a support group for women with MS and with continence issues. - Provide a service user continence study day. - Introduce an emergency wheelchair scheme for acute relapse needs.

Key learning points

In the development process, to include as many professionals from as wide a geographical spread as possible in the process to try and address localisation issues early on. To advertise the process more explicitly (new flyer attached), so that PCTs/Trusts understand the process they are asking for support with. To contract with the PCTs/Trusts on a more formal basis (sample contract attached), so as to make clear the expectations and responsibilities and timescales on both sides. To ensure there is a clinical 'champion' for the audit and to have a key contact in the PCT/Trust with whom to liaise. To ensure that audit will be manageable in terms of geographical spread and ability to support the running of focus groups that will be representative.

View the supporting material

Contact Details

Name:Alun Davies
Job Title:Lead for Audit and Evaluation
Organisation:Multiple Sclerosis Society
Address:MS National Centre 372 Edgware Road
Postcode:NW2 6ND
Phone:0208438 0700


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This page was last updated: 11 September 2008

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.