Putting this guideline into practice

Putting this guideline into practice

NICE has produced tools and resources to help you put this guideline into practice.

Some issues were highlighted that might need specific thought when implementing the recommendations. These were raised during the development of this guideline. They are:

  • Ensuring a greater focus on supported decision-making. Underpinned by principles 1 and 2 of the Mental Capacity Act 2005, supported decision-making is fundamental to:

    • effective implementation of the legislation

    • empowering people who have difficulties making their own decisions independently.

      Alongside local policies and training, organisations need to ensure that their procedures and forms for capacity and best interests assessments are congruent with an emphasis on supported decision-making.

  • Ensuring a workforce that is well-trained and well-developed in supporting decision-making and in implementing the Act. Practitioners need to understand the status of the person's decision-making capacity at that specific point in time and how their particular impairment of the mind or brain affects their current ability to make decisions. Training should be delivered with input from people who use services. It should start with basic training and continue throughout an individual's employment, particularly whenever legislation is updated.

  • Access to independent advocacy. This is affected by a range of factors, including:

    • a shortage of well-trained advocates

    • practitioner knowledge of the different types of advocacy

    • practitioners being unaware of the duty to refer for advocacy

    • advocacy services being under-resourced and in high demand.

      Additionally, there is consistent evidence of a lack of understanding among commissioners, public bodies, practitioners and people who use services of the critical role that independent advocacy can play in upholding rights and providing an ultimate safeguard from abuse. Consequently, ensuring the recommendations relating to independent advocacy are acted on will be a challenge of communication and persuasion beyond statutory requirements, and they will require a concerted effort to implement effectively.

Putting recommendations into practice can take time. How long may vary from guideline to guideline, and depends on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities.

Changes should be implemented as soon as possible, unless there is a good reason for not doing so (for example, if it would be better value for money if a package of recommendations were all implemented at once).

Different organisations may need different approaches to implementation, depending on their size and function. Sometimes individual practitioners may be able to respond to recommendations to improve their practice more quickly than large organisations.

Here are some pointers to help organisations put NICE guidelines into practice:

1. Raise awareness through routine communication channels, such as email or newsletters, regular meetings, internal staff briefings and other communications with all relevant partner organisations. Identify things staff can include in their own practice straight away.

2. Identify a lead with an interest in the topic to champion the guideline and motivate others to support its use and make service changes, and to find out any significant issues locally.

3. Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision.

4. Think about what data you need to measure improvement and plan how you will collect it. You may want to work with other health and social care organisations and specialist groups to compare current practice with the recommendations. This may also help identify local issues that will slow or prevent implementation.

5. Develop an action plan, with the steps needed to put the guideline into practice, and make sure it is ready as soon as possible. Big, complex changes may take longer to implement, but some may be quick and easy to do. An action plan will help in both cases.

6. For very big changes include milestones and a business case, which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan. The group might include the guideline champion, a senior organisational sponsor, staff involved in the associated services, finance and information professionals.

7. Implement the action plan with oversight from the lead and the project group. Big projects may also need project management support.

8. Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners.

NICE provides a comprehensive programme of support and resources to maximise uptake and use of evidence and guidance. See our into practice pages for more information.

Also see Leng G, Moore V, Abraham S, editors (2014) Achieving high quality care – practical experience from NICE. Chichester: Wiley.