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 an integrated approach to intermediate care. Currently, the 4 service models of intermediate care tend to operate separately, delivered by different staff and funded from different budgets. Moving to a more integrated approach for planning, funding and delivery of all 4 models, including transferable assessments that are accepted across all services, would improve the experience for people using the services. However, such changes may be difficult to achieve.
Starting bed-based intermediate care services within 2 days (and crisis response within 2 hours) of receiving an appropriate referral. Rapid provision of the right intermediate care service will benefit people using the services, and may help reduce pressure on hospital beds. However, this approach will prove challenging in light of the current financial pressures and demands on the services.
Making sure the aims, objectives and purpose of intermediate care are understood by people using the services, their families, and professionals from the wider health and social care system. There is currently a lack of understanding that the term 'intermediate care' includes intermediate care services funded by the healthcare system and reablement services funded by social care. In addition, there is low awareness that active rehabilitation or reablement is quite different from ongoing care and support.
Developing leadership that promotes clarity of purpose and good communication within each service, and provides guidance and support to staff. This leadership will help staff working in intermediate care services to deliver a service focused on enabling and supporting independence, and optimising wellbeing.
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. Taking part in the National Audit of Intermediate Care (NAIC) will help to provide a benchmark for measuring progress and will add to the national data on intermediate care.
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.