This NICE guidance represents a very interesting challenge for two key reasons:
(1) On Wirral it is the NHS who mostly lead on baselining and action planning around NICE yet this particular guideline is largely non-clinical with many of the recommendations it makes requiring LA action.
(2) The scope of the guidance (52 recommendations compared to a typical 6 -10) renders some of the normal local templates and procedures used in baselining not fit for purpose.
Therefore a creative approach has been taken to baselining and action planning whereby a large number of stakeholders could feel genuinely engaged with the work on all 52 recommendations without attending an unrealistic amount of meetings.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Aims and objectives
To effectively baseline and begin to implement NICE PH 28 by involving all stakeholders in a meaningful and effective way.
To establish a clear picture of the current situation in relation to this guidance by carrying out a comprehensive baselining exercise.
To produce an agreed action plan built upon the above baseline information.
To trial a new approach to NICE baselining and action planning whereby a large number of stakeholders can feel genuinely engaged with the work on all 52 recommendations without attending an unrealistic amount of meetings.
Reasons for implementing your project
The start point was a baseline assessment to establish how much of the recommended practice was already in place and what the implications would be of beginning to implement recommendations not currently being addressed.
This NICE guidance represents a very interesting challenge in that whilst it is the NHS who are most used to baselining and action planning around NICE, this particular guidance is very non-clinical with many of the recommendations it makes requiring LA action.
The scope of the guidance (52 recommendations compared to a typical 6 -10) is equally challenging and rendered some of the normal local templates and procedures used in baselining not fit for purpose.
Generally, on Wirral, when new NICE public health guidance is published an NHS Wirral lead is identified who pulls together a baselining group who review and plan together over a short series of meetings. Given the size and scope of PH NICE 28, to mount an effective approach, a large group of stakeholders, many from outside the NHS (and therefore generally less familiar with NICE) would need to be involved in a potentially long series of meetings in order to give full consideration to all 52 recommendations. Realistically, this approach was not going to be possible.
How did you implement the project
A new approach was struck whereby a broad range of professionals were interviewed (one to one) about specific sets of recommendations; each recommendation being considered by at least two different professionals to provide a check and balance. A small team helped the lead worker allocate sets of recommendations to appropriate professionals.
The key stakeholders interviewed included:
1) LAC Nurses and Lead School Nurse Manager
2) Health Visitor Managers
3) Service Manager Quality Assurance/Safeguarding (IROs)
4) Strategic Lead for Safeguarding Children and Young People.
5) Children and Families Commissioning Manager
6) Head of Health and Wellbeing, Children and Young People
7) Strategic Service Manager (Children's Resources)
8) LACES Team Manager
9) Consultant Psychologist (CAMHS)
10) Designated Nurse Safegauring Children
11) Team Manager and Operational Support Manager Fostering Service
12) Pathways Team Manager
13) Service Manager CYPP
All responses, whether statements, opinions, ideas, frustrations or whatever, were faithfully recorded without judgement. Several contradictions were noted but this in itself proved valuable as it showed different levels of awareness and understanding of others work.
An extensive final report was scrutinized and a manageable number of recurring issues and concerns identified which became the focus of action and financial plans put together jointly by NHS Wirral and Wirral LA.
As a result of this work jointly owned action and financial plans for NICE PH 28 were produced. All 6 recommendations in the action plan were assigned to responsible leads (individuals or groups) with sufficient powers to carry them forward. Actions, deadlines and monitoring systems were all made clear. The 6 recommendations were;
1. Support and drive efforts to raise the profile of the JSNA and embed its use in key decision making and commissioning by Wirral NHS and LA workers.
2. Ensure consent is always secured so Looked After Children can have scheduled vaccinations along with their classmates.
3. Establish a wider sense of responsibility (beyond just LAC nurses) for ensuring the elements of health care plans are carried out.
4. Ensure Child and Adolescent Mental Health Services advice is available for children in danger of becoming looked after.
5. Develop and monitor a charging system for specific services provided for LAC from beyond Wirral and invest income in services for Wirral YP.
6. Support improved transition between CAMHS and Adult Mental Health Services.
Key learning points
It seems possible for large numbers of stakeholders to be meaningfully involved with implementing very large pieces of new NICE guidance if the guidance is broken down and not reviewed by every single stakeholder as a whole.
The responsible leads and monitoring and feedback systems built into the action plan produced will be vital in demonstrating the success of this approach.
Policy and Curriculum Lead -Lifestyle
Is the example industry-sponsored in any way?