Driving quality through the implementation of NICE guidance in a local authority

To provide excellent social care provision to the residents of Coventry with care and support needs, as defined by the Care Act.

To improve the quality and standards of social care services within Coventry by ensuring that services and practitioners in Coventry are aware of national policies and evidence informed practice.

To ensure there is robust and objective analysis of service provision; to evaluate the effectiveness of social care provision by assessing how services align with NICE recommendations and other relevant data in the council, such as the number of complaints or waiting lists for service provision.

To assess how the council should respond to unmet NICE recommendations; to consider the value of implementing recommendations, the risk from not implementing recommendations and the cost involved.

To share analysis and outcomes from the group across the council, including senior staff and practitioners.

To develop working relationships within the council by having group members who represent different sectors of the council.

To improve working relationships with health colleagues in Coventry where NICE recommendations relate to integrated responses, such as pooled budgets and named workers across social care and health.

The principal social worker at the local authority felt it was important that social care is driven by evidence informed practice and standards that define what good looks like. There was concern that there are no mandatory national requirements to measure social care and there is a lack of standards to evaluate social care in comparison to health. NICE guidance helps to fill this gap; because it is based on the best available evidence it can be used to drive quality, to measure standards of care and to improve practice.

The principal social worker made the case for an approach based on previous experience working with NICE guidance in an integrated NHS Trust. Senior level support was secured for the proposed approach from the director of social care at Coventry City Council.

Setting up the group:

• The group was set up by the principal social worker, who is also the Head of Practice Development & Safeguarding for the council. Given these roles he has working relationships with staff across the council. He felt it was important that the group had representatives from the council’s operational staff, commissioning staff, residential and provider staff and children’s social care staff. The principal social worker approached staff directly to ask if they would like to take part in the group.
• Currently the group doesn’t have any members who are service users or carers. However, the group liaises with Coventry’s stakeholder reference group, which has service user and carer members. From assessing the recommendations in the NICE guideline NG86 ‘People’s experience of adult social care services’, it has been identified that Coventry need to consider how to implement co-production. This may lead to a change in the membership of the NICE implementation group.

How the group functions:

Process stage 1 – deciding whether NICE guidance is relevant; 4 week timescale (virtual work):

1. Every month the local health Trust circulates information about guidelines which have been published. The principal social worker likes the Trust to circulate the information as it promotes integrated work between health and social care practitioners.
2. Andrew shares the information from the Trust with members of the implementation group on a monthly basis.
3. Members of the implementation group work read the title and scope of guidelines to decide which topics are relevant to their service area. Members nominate a person to lead on a baseline assessment for guidelines which apply to their service areas. Members email their advice to each other.
4. The responses from members are collated. Decisions about which guidance is relevant and who will lead on baseline assessments is communicated to members.
5. Guidance which will be reviewed is recorded on the group’s master spreadsheet.

Process stage 2: completion of baseline assessment of NICE guidance; 8 week timescale (virtual work):

 6. The lead officer for each guideline completes a base line assessment and a ‘sensor check’ to assess if Coventry social care services have been compliant with NICE recommendations. The lead officer involves others as needed. The baseline assessment identifies actions which are needed to implement unmet recommendations, with a deadline and the name of the person leading each action. The baseline assessment may also propose not to take action to meet a recommendation by considering the level of risk and the cost of implementing actions.

7. The completed baseline assessment is circulated by the lead officer to members of the group for information and comments. The lead officer prepares for the final assessment.

8. The final baseline assessment is submitted by the lead officer to the project support officer. The lead informs all relevant staff and interested parties how to document the spreadsheet. The spreadsheet for the group is saved.

9. The NICE guidance master spreadsheet is updated to record that the baseline assessment for the particular national guidance has been completed.

Process stage 3: monitoring implementation of actions to meet unmet recommendations; ongoing working on a quarterly cycle (virtual work):

 10. Recommendations are implemented by nominated leads being made responsible for completing actions and meeting the agreed deadline. The nominated lead advises when actions they have been responsible for have been completed and when Coventry meets the NICE guidance recommendation.

11. The project support officer updates the master spreadsheet. The completion of actions, the number of recommendations met and the percentage of recommendations met for the guideline is updated on the master spreadsheet.

Face to face discussion:

 12. The group meets to review progress with implementation of all NICE guidance and considers what should be included in the quarterly quality report brief.

A diagram summarising this process can be found under the supporting information. 

Since establishing the group there has been an increased awareness within Coventry council about objectively evaluating services and aligning local policies to national guidance and evidence based recommendations.

By completing baseline assessments and relating outcomes to other data in the council the group is producing a rigorous critique of local services and raising the profile of social care within the council:

• The group produces quarterly reports which include information about baseline assessments and other relevant local evidence, such as data from complaints. These reports are made available to senior staff within the council.

• The group works with commissioners to implement recommendations.
• The group also liaises with NHS colleagues when recommendations need integrated responses.
• Members of the group share information about the findings and agreed actions with colleagues in their work areas.

The dissemination of data from the group to senior management within the council has led to social care having increased organisational visibility. Social care is now considered as having equal importance to other areas in the council, such as finance and performance.

By working together members of the group are increasing their understanding of different service areas. Meeting regularly helps members to develop their working relationships.

The group recognises that they are still in an early stage of their development in terms of evaluating the impact of changing services to ensure that NICE recommendations are being followed. For example, from completing a base line assessment in relation to NG86, People’s experience in adult social care services: improving experience of care and support for people using adult social care services, Coventry is not compliant with NICE recommendations regarding co-production (the section in the guideline titled ‘Using people’s views to improve services, recommendations 1.6.2 – 1.6.11). The principal social worker has agreed for NICE to follow up the evaluation of recommendations from NG86 as a separate shared learning example in the future.

The following points may be helpful when considering how to set up a local authority NICE implementation group:

• Approach local health colleagues for support, as they will be familiar with completing base line assessments, structures within NICE, horizon scanning and how to implement recommendations.
• When setting up the group explain to potential group members how the group could help to improve services. Social care staff may not know that NICE produces guidance that could support social care services and may not be familiar with some of NICE’s terminology, such as what is meant by a baseline assessment. It may help to initially invest time in face to face discussions to explain what the benefits could be of setting up the group and to respond to any queries or concerns.
• Consider the best way of being made aware of published guidance from NICE. Local health colleagues could be asked to share communication from NICE as a way of encouraging joint working and integrated approaches.
• The group needs to reflect the whole of social care’s infrastructure. Group members should be made up of representatives from commissioners, practitioners and providers to ensure that each area of social care is considered and to understand the relationships between different parts of the sector.  
• For the group to work there needs to be agreement from group members that there will be delegation of tasks and a commitment to the group.
• Group members need to share responsibility for completing base line assessments.
• Group members are encouraged to take part if there is administrative project support, such as assistance to set up spreadsheets, inputting data and arranging meetings.
• Implementing recommendations which relate to integrated approaches across health and social care services can create joined up ways of working for local health and social care services, improve outcomes for people supported by health and social care services and save money.