Shared learning database

Shire Pharmaceuticals
Published date:
October 2010

A series of practical tools to help NHS stakeholders identify development areas in local ADHD service provision with reference to NICE guidelines. The flexible framework of tools can be scaled up or down to give individuals of all roles and statuses the confidence and support to propose specific opportunities for the improved experience of service users.

This example was originally submitted demonstrating implementation of NICE guideline CG72. It has been reviewed and the approach outlined continues to align with the updated NICE guideline NG87.

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

  • Help NHS stakeholders to identify local opportunities for developing better services in line with the standards of NICE ADHD guidelines for young people.
  • Provide NHS stakeholders with a series of practical tools that can help them to identify development areas in current ADHD service provision and opportunities to enhance local support. The tools offer an easy-to-use method of benchmarking current practice before moving on to preparing the case for future development through structured tools and targeted workshops. The tools are also flexible and can be scaled up or down according to local requirements.
  • Empower NHS stakeholders to involve a wide range of relevant stakeholders, including parents and young people with ADHD, in structured discussions about future service provision.
  • Enable effective multi-agency and multi-disciplinary team-working for ADHD through the creation of a stakeholder network which brings together previously untapped resources and can continue to develop in the future.
  • Empower NHS stakeholders to feel confident about proposing their business cases and influencing local developments in ADHD local care pathways in order to quickly and effectively roll out implementation of the NICE guidelines.
  • Provide a phased approach to the implementation of improved ADHD service provision with an emphasis on small steps leading to outstanding service provision, as follows:
  • -Phase 1 - the use of the 'Making Sense of NICE' tools to benchmark current practice and to identify and involve relevant stakeholders so that they can develop a business case for improved service.
  • -Phase 2 - the launch of the improved service provision, such as integrated care pathways, for example.
  • -Phase 3 - ongoing benchmarking and monitoring of the improved service provision via a multi-agency stakeholder team. - Provide a basis for enhanced and ongoing cohesiveness across education, social care and healthcare in terms of local ADHD service provision.

The campaign's objectives are:

  • To help NHS stakeholders to progress their local ADHD services towards meeting the recommended ADHD NICE guidelines.
  • To provide a framework for helping NHS stakeholders to achieve this through easy-to-use practical tools that offer a step-by-step approach, with support at each stage, from benchmarking current provision through to implementing a case for development.
  • To remove the sense of isolation for people working in ADHD and people who support patients and carers, through providing a structure for change and development that meets local ADHD needs.
  • To facilitate and improve multi-agency working through providing a forum for the exchange of ideas with the aim of developing improved local ADHD services.
  • To facilitate and improve multi-disciplinary working across primary and secondary care teams to utilise resources more effectively.
  • To strengthen the belief that best practice within ADHD can be achieved through sharing existing skills and acquiring new ones by taking small steps at a local level.
  • To enable NHS stakeholders to provide enhanced patient care through the implementation of improved multi-disciplinary working alongside more efficient ADHD service provision.

Reasons for implementing your project

The context for the campaign is based around the development areas in service provision that have been identified and documented in the NICE guidelines, specifically:

  • Consistency in the approach to recognising and diagnosing ADHD (full guidelines, p29)
  • Simplification of referral pathways (full guidelines, p30)
  • Aligned provision of treatments and interventions (full guidelines, p29)
  • Effectiveness of multi-agency working (full guidelines, p31-32).
  • Case study: as an example, a Community Consultant Paediatrician, who leads an ADHD Joint Working Group across North Hertfordshire, used the tools. It helped her to bring together stakeholders from different multi-agency backgrounds to discuss and implement an integrated care pathway focussed around efficient referrals.

The challenges faced were:

- Of 60,000 children in the East and North Hertfordshire NHS Trust area, 800-850 had been diagnosed as having ADHD in North Hertfordshire. The Community Consultant Paediatrician was part of a small team dealing with this workload.

- A disparity had been identified between specialist ADHD nursing provision in North Hertfordshire and what was provided in East Hertfordshire. Both areas had an ADHD nurse offering the same number of hours per week (22.5) but in East Hertfordshire, the numbers of children with ADHD totalled less than half that of North Hertfordshire (250-300). East Hertfordshire had therefore been able to provide a standard of care that was not available to children in the north of the county.

  • A large number of incorrect referrals had occurred because the existing pathway was fragmented and unclear, with healthcare professionals uncertain about who to refer to.
  • A clear need therefore existed to improve ADHD service provision through the creation and implementation of an integrated referral pathway.

How did you implement the project

The first stage assists:

- stakeholders identify development priorities through the use of an interactive benchmarking tool which:

  • asks a series of questions to assess current practice against core elements of the NICE guidelines and:
  • generates a highly visual summary which clearly identifies key areas for improvement. The second stage deploys a set of tools to identify:

- current resources;

- additional stakeholders;

- further resources required to target those stakeholders and:

- the evidence required to support the case for development.

The third stage acts to present the information gathered to the additional stakeholders in the context of current resource constraints by staging two workshop-style meetings at which next steps and plans are produced to facilitate implementation. In the North Hertfordshire example, the Consultant Paediatrician led a core steering group that drove this development. It brought together a wide mix of ADHD knowledge and included:

- Clinical representation, including child psychiatrists

- ADHD specialist nurses - A school nurse

- A representative from the education sector

- A mental health nurse

- Commissioners

These were joined by a wider group which included:

- GPs

- The NHS Trust General Manager

- A clinical psychologist

- Representatives from the voluntary and education sector

- Parents

- A young person with ADHD

The tools were used to bring together the service users to explore development areas in local ADHD service provision and gain endorsement on how to implement an integrated referral pathway. Development areas in local ADHD service provision were already being considered by the NHS Trust and therefore the emphasis was on the formation of the core steering group and how it could achieve that end. The group's activity at this stage has led to the development of a flowchart with criteria to determine eligibility for referral and signposting to the most appropriate specialist.

Key findings

  • The Consultant Paediatrician, as the main driver of the project, found the tools to be 'clear, concise and robust' and a 'valuable experience' that enabled her to set up a network of stakeholders and structure their approach. The tools have enabled the core working group to develop an integrated referral pathway through working with appropriate healthcare professionals and commissioners at key times.
  • Ultimately this has enabled the working group to build a strong business case for the referral pathway and in the process develop a new skill set.
  • One clinician 'highly recommended' the toolkit for the parallel learning it offers which has broadened her skill range and provided her with real advantages over her clinical colleagues.
  • The clinician was inspired to personally build a successful case for an additional ADHD nurse, using business skills acquired through use of the tools. The experience enabled her to develop a strong case supported with financial and patient outcome based evidence.
  • The Consultant Paediatrician found that the toolkit provided a unique opportunity to gain a greater understanding about working in partnership with non-healthcare agencies. It provided a clear structure to enable successful and cohesive stakeholder management across diverse groups.
  • The integrated referral pathway for North Hertfordshire will be launched as a pilot in early 2011. Prior to the launch, the pathway is already improving communication across different services through the involvement of managers from the core steering group who are working with the NHS Trust communications team on branding and distribution.
  • The Consultant Paediatrician sees the integrated pathway as the first step towards launching a pathway across the whole county.
  • As part of a recommended review process, the pathway will be evaluated after its first two years to ensure that the referral criteria are still relevant.

Key learning points

The toolkit helps NHS stakeholders at all levels and roles to:

  • Identify from their own perspective priority gaps between current local practice and the NICE guidelines.
  • Identify the major stakeholders to consult and make the most effective use of their contribution.
  • Identify what is needed from each stakeholder, for example, decision-making, consultation, agreements, and that the appropriate stakeholders are involved at the correct stages.
  • Determine what kind of resources would be most useful in building their business cases.
  • Consider from where they will draw supporting evidence to strengthen their business case.
  • Explore effective ways to work in partnership with non-healthcare stakeholders and agencies.
  • Keep an open mind when working with different stakeholders and consider how to get them 'on side' by developing strong business cases.
  • Consider the need for contingency plans.
  • Consider how to continue to enhance and develop local ADHD service provision to ensure it is as efficient and effective as possible to maximise patient care.
  • Consider how to evaluate local ADHD service provision on an ongoing basis to monitor improvement of care.
  • Start small, building confidence by making small changes to improve the patient and carer experience.

Contact details

Marie Gray
Senior Healthcare Consultant
Shire Pharmaceuticals

Is the example industry-sponsored in any way?

The campaign has been produced by Transart as a non-promotional initiative supported by Shire Pharmaceuticals Ltd as a service to medicine for NHS healthcare professionals working in ADHD service provision.