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:
Children, young people and adults with a learning disability and behaviour that challenges are likely to use both health and care services throughout their lives. However, a lack of integration across services, including children's and adults' services, can impact on quality of care. Local authorities, working together with clinical commissioning groups, can provide a more joined‑up and person-centred approach by designating a lead commissioner who is responsible for commissioning health, social care and education services for both adults and children with a learning disability, including for people whose behaviour is described as challenging. For some services, creating this role may involve a significant change in practice.
Family members and carers often play a significant role in supporting people with a learning disability and behaviour that challenges, but they can find it difficult to access information, guidance and support. Many families need ongoing training and support for their caring role from specialist services, including positive behaviour support services. Families may also benefit from services such as peer support. Local authorities and health services need to provide this information and support, and tell families how to get it. For areas that do not currently provide comprehensive support for families, this will involve a significant change in practice.
Developing good general and specialist community services is important for supporting children, young people and adults with a learning disability and behaviour that challenges to live how and where they want, and to avoid the need for hospital admission or residential placements. Developing capacity in services and housing to support people in the community is likely to be a challenge in areas where resources are focused on inpatient care. Clear plans will need to be developed, agreed and put in place to make this change.
Children, young people and adults with a learning disability and behaviour that challenges should not be admitted to inpatient units unless all other possible options have been considered and exhausted. Similarly, children and young people should only be provided with a residential placement if all other possibilities have been considered. Where inpatient care or residential placements are used, planning should begin immediately for the person to return to their family or community. The plan should be reviewed regularly. Where this is not current practice, significant change will be needed.
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.