A focus on health: applying NICE guidance to a local authority led adult quality service provider framework

Hull’s older population (people aged 65+) is expected to increase significantly by 13,514 (35.1%) from 38,491 to 52,005 up to 2041.

Seeking to meet the complex health and social care needs of an increasing number of vulnerable adults, there are currently a broad range of home care providers day centres across Hull. For those with very complex needs there are also 75 nursing and care homes care homes with a total of 2196 beds.

Whilst acknowledging that Hull City Council’s measurement of its 9 core standards was robust, the CCG also believed there was need to ensure health needs were more fully reflected on the framework and ultimately measured in terms of general quality, too. Consequently, following a period of research and discussion, it was decided to approach the local authority and seek their agreement that the application of specific NICE guidance to the framework would offer value by:

• Ensuring that health priorities were fully represented and integrated in a manner that was both research and evidence-based led
• Supporting the robust monitoring and measuring of provider service performance
• Supporting joint commissioning decisions going forwards
• Promoting best practice, quality of care and ensuring the safety and wellbeing of individuals in receipt of both health and social care services
• Providing tangible evidence of better integrated care in line with legislation including The Care Act 2014, The National Service Framework: Longer Term Conditions 2005, The National Service Framework: Older People 2001, No Secrets 2000

Once agreement was reached about the benefits of applying NICE guidance to the quality framework, implementation of the project occurred in several stages over a period of months. Key stages included:

• Attendance at NICE training events to ensure a sound understanding of how best to use to use NICE standards, statements and measures
• Regular discussion between the CCG and local authority to identify the most appropriate way in which to represent health on the framework – i.e. in a manner that was research and evidence based
• Reviewing, evaluating and sharing with the local authority the specific NICE guidance that ‘fitted’ with the framework – i.e. which guidance was applicable to domiciliary and residential care; how related standards, statements and measures ‘fitted’ the 9  local authority developed core standards without, whenever possible, making additional work
• Being proactive in establishing regular monthly meetings with the local authority in order to ensure ongoing buy-in and to check on how the framework was developing.

Key findings to date.

To date the key findings are limited. This is due to the local authority only recently rolling out the quality framework to a discrete number of service providers, with a general rollout planned for later in the year. Once the quality framework is rolled out more broadly, it is intended that a joint evaluation will take place to capture its effectiveness in terms of how clients and carers feel about whether quality has improved and how, if at all, a genuine difference has been made to their lives At this time it should also be possible to identify any difficulties the service providers themselves may have faced in meeting the standards and, if so, what additional work might support a better understanding. Further, data should also be available as to how many service providers have met the core standards and whether the measurement of these standards has been achievable within the parameters of the identified methodology of measurement.

• Because the framework has been local authority led, the timescale for going live was determined solely by them. This meant that there was no discussion about launching the framework after identifying where providers here in terms of meeting the NICE guidance as might have been evidenced, for example, by an initial base assessment
• It has been critical to the general success of the project to acknowledge that the framework is local authority led and that it is the primary commissioner of all adult health and social care services under the Care Act 2014
• It has helped that the lead CCG project worker is seconded from the local authority, and, thus, has a sound understanding of how the agency ‘works’ and has an established network on which to draw on
• It has proved critical to have good buy-in from the local authority of the need for health and social care to integrate to ensure quality of service delivery and promote positive patient experience. In this sense, Hull City Council have embraced integration very positively
• Prior to starting negotiations with the local authority, it helped for the lead CCG project worker to have a good understanding of NICE guidance and know which would specifically fit with the 9 core standards developed by the local authority 

• At this point, because we are in the rollout process:

-it is not clear what difference this new approach has made to service users, therefore any improvement is currently forecasted only

-as we are awaiting data, we cannot say whether one specific piece of guidance has helped improve quality

-it is not clear whether any particular piece of guidance has proved more difficult for providers to implement