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 integrated, person-centred care and support for people growing older with learning disabilities, and their families and carers. This will mean health and social care practitioners and providers involving and listening to the person and their family and carers, and agreeing a care plan that reflects their needs and aspirations. Offering an annual health check, including explaining what it will involve and how to arrange it, is an important part of this. It will also mean challenging assumptions and looking beyond the person's learning disability to provide the support needed to help them live an active, community-involved life.
Ensuring a well-trained and supported workforce, with the knowledge needed to support people growing older with learning disabilities. Health and social care services are structured in a way that tends to mean practitioners work in either learning disability or older people's services, and their training and support reflects this. Moving to a workforce with expertise from across both disciplines may be challenging to achieve.
Planning and commissioning local health, social care and housing services to meet the needs of the local population. Commissioners need to know the size of their local population of adults with learning disabilities, and any likely future growth in this population. Learning disability services are often seen as separate from other services, but all pathways of care and support need to consider the needs of people with learning disabilities in order to improve access and funding.
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.