Shared learning database

Nottinghamshire Healthcare NHS Trust
Published date:
July 2008

Developing a robust process for the review, monitoring mechanisms and implementation of guidance produced by the National Institute of Clinical Health and Excellence (NICE) in a high secure setting.

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 develop a robust process for the review, monitoring mechanisms and implementation of guidance produced by the National Institute of Clinical Health and Excellence (NICE). 1. To form a NICE Monitoring Group to oversee the implementation of NICE Guidance and to develop Forensic Division Topic Expert Groups. 2. To have responsibility for decision making in relation to the allocation of High Secure funds. 3. To monitor the progress made against successfully funded NICE projects and to ensure completion and wide dissemination of the Forensic NICE Annual Report.

Reasons for implementing your project

In order to effectively implement and monitor NICE guidelines, the Forensic Services Division formed a NICE Monitoring Group. Due to the importance that the Division places on implementing NICE guidelines the Group is co-chaired by the Associate Director of Nursing Services and the Associate Medical Director with a multi-disciplinary membership. Prior to the Group being formed, there was little evidence that could be used to substantiate the work that was being undertaken in relation to the implementation of NICE guidelines. The NICE Monitoring Group also has the responsibility for decision making in relation to the allocation of High Secure NICE funds. Topic Expert Groups It is the responsibility of the NICE Monitoring Group to identify and agree NICE Guideline priorities. Once agreed, a member of the Forensic Division with expertise in that subject area is nominated to complete an impact analysis tool to ascertain the relevance of the guidelines to the Division. If felt appropriate, in order to ensure that the Division has a timely and systematic approach to implementing applicable NICE guidelines, a Topic Expert Group is formed, chaired by the subject expert. All Clinical Directorates within the Forensic Division are represented and contribute to a final report which identifies current provision within the Division, any gaps in provision, training requirements and financial implications in terms of implementation. Following completion of the report, an action plan is formulated identifying any gaps that can be bridged. These are tabled at appropriate forums and progress is robustly monitored and reported to the NICE Monitoring Group. Where it is felt that a significant risk remains or is identified, these are referred to the Forensic Risk Monitoring Group to be considered for inclusion in the Forensic Risk Register.

How did you implement the project

1)The development of the NICE Monitoring Group which is now well established to oversee the implementation & monitoring of NICE guidelines. The setting up of the Forensic Division Topic Expert Groups which were established to identify current provision, gaps in provision, training requirements & financial implications. 2)Funding for the implementation & support of service changes recommended by NICE guidance, is allocated as part of the national tariff uplift. Directorate Managers are invited to bid for the allocated monies. The financial aspects of the process are managed by the Head of Finance who is a member of the NICE Monitoring Group. All bids must be completed on a standardised template & include information relating to measurable activity impact/changes in patterns of activity; quality impact; how it will be managed, monitored & evaluated & whether there will be any impact on other service delivery. The NICE Monitoring Group robustly reviews the bids, if a completed clinical impact analysis has highlighted that there is a gap in a provision, then any associated bid will be encouraged & looked upon favourably, subject to a robust application being submitted. All bids are approved initially on a non-recurrent basis with the proviso that progress reports are submitted, initially on a 6 monthly basis and then an annual basis. Once the NICE Monitoring Group is satisfied that the Project Leads are meeting their set objectives, the bids where initially requested, will become recurrent. 3)An annual progress report (see attached) is produced by the Forensic Division which is widely circulated across the Trust and shared with key stakeholders (see attached. The report demonstrates the considerable progress the Division has made in ensuring compliance with published NICE Guidance & has enabled a measured improvement in the provision of care & treatment for our patient population within an established evidence base.

Key findings

All successful NICE funded projects are monitored in terms of ensuring project objectives have been met. Project Leads are requested to complete detailed progress reports which are included in the annual report (see attached). The Forensic Division has additional robust monitoring systems in place and ensures that compliance is monitored against key guidelines at quarterly Executive Performance Review Meetings. A percentage compliance is calculated, based on evidence of implementation of the guidelines across the Division taking into account any gaps which have been identified. Where the target is not reached, an exception report is submitted to the Executive Director clearly articulating what the gaps are and what is being done to bridge them.

Key learning points

The importance of having systematic processes in place for the review and implementation of NICE guidelines is a key learning point. This involves a multi-disciplinary team approach and requires a lot of commitment and enthusiasm from subject champions. Excellent leadership is paramount and staff need to be encouraged to share their good practice by presenting at various forums and having their work published in annual reports. It is also important to ensure that patients are involved in the process and consulted with regard to ascertaining their views as to what changes they would like to see happen as a result of published NICE Guidance.

Contact details

Joanne Gleaden
Clinical Governance Lead (Forensic)
Nottinghamshire Healthcare NHS Trust

Tertiary care
Is the example industry-sponsored in any way?