NICE guidance / Quality Standards are pivotal to Greater Manchester's Sector-Led Improvement approach to driving improvements in public health. This programme of work aims to enable local authorities (LAs) to take responsibility for their own performance and improvement and for leading the delivery of improved outcomes using benchmarking data alongside a robust evidence base which NICE guidance / Quality Standards underpins.
The approach we have developed is based on the principles of mutual support and assistance and involves a discrete process of self-assessment and peer review using NICE guidance / Quality Standards as the driver for improving performance.
Local Action Plans are developed and reviewed regularly by LA peers to ensure that NICE guidance / Quality Standards are being implemented and that performance against PHOF (Public Health Outcomes Framework) measures improves in the long-term.
Aims and objectives
1. Smoking prevalence and smoking at time of delivery (SATOD)
2. Take up of NHS Health Check programme by those eligible - Take-up and Offer
3. Injuries from Falls in people aged 65 and over
4. Excess weight in 4-5 year olds and 10-11 year olds
The programme adopts a bottom up approach to improving performance and efficiencies within the public health and social care system to ensure the delivery of best possible interventions for people who use services.
1. Identification of evidence based best practice using NICE guidance / Quality Standards.
2. Benchmarking performance against comparative LAs.
3. Self-assessment to highlight gaps in provision.
4. Engagement with wider partners such as Clinical Commissioning Groups and Public Health England.
5. Peer challenge and support.
6. Monitoring of improvement through local and GM actions.
The programme uses NICE guidance / Quality Standards to benchmark current provision across GM and drive improvements in public health within individual local authorities and on a GM footprint. It enables local authorities to take responsibility for their own performance and improvement and for leading the delivery of improved outcomes for local people in their area.
Reasons for implementing your project
Following the transition of public health from NHS into Local Authority GMPHN has adopted a Sector-Led approach to performance management. Rather than adopting a top down approach GMPHN has taken a bottom up approach. Many local authority departments have taken this approach which they have found it to be more successful in engaging partners than other traditional approaches that rely on objectives set by 'external' agencies such as the government or NHS England. Public Health teams in each LA completed self-assessment for each PHOF measure in order to demonstrate that they undertake evidence based commissioning and regularly monitor providers' practice. GMPHN sourced NICE guidance / Quality Standards and extracted the relevant sections within the guidance to support LAs to review the interventions and services they commission. GMPHN highlighted areas within the self-assessment that evidenced use of NICE guidance / Quality Standards and highlighted areas where there was no evidence that NICE guidance had been implemented. The template provided links to NICE guidance and supporting evidence and allowed LAs to share details of innovative or creative practice operating in their local area.
Using NICE guidance/Quality Standards as a benchmark, Peer Review Teams identified opportunities for improving efficiencies and increasing productivity within each LA and at a GM level. GMPHN has facilitated the formation of a number of working groups to develop GM actions. Such as the following:
-GM Obesity Group has undertaken analysis and benchmarked costs for the National Child Measurement Programme (NCMP) and has developed a collaborative commissioning framework that allows each LA to have local additions.
-GM Tobacco Commissioners Group has produced an analytical document that benchmarks costs for stop smoking services provided by GPs and Pharmacies at a GM level. This has led to a collaborative commissioning framework for 2015 and onwards.
-GM Health Check Group has formed to benchmark costs and develop a consistent approach to data systems across GM.
How did you implement the project
The GMPHN provided sector-led improvement / peer review training to over 40 GM Public Health staff to increase their knowledge and understanding of the principles of sector-led improvement and the process / procedures for self-assessment and peer review. Summarising the evidence was a key task to ensure accuracy and to allow public health teams to mobilise their teams against the set evidence.
GMPHN condensed the evidence presented in the self-assessments into a summary document for Peer Review Teams in preparation for discussion at peer review panels. GMPHN facilitated eight peer review panels which reviewed the self-assessment and associated NICE guidance and highlighted areas that did not adopt evidence based practice. Peer Review Teams used their knowledge and experience to identify interventions / approaches and provide an objective evaluation of the key strengths and areas of development for each local authority. GMPHN provided Peer Review Teams with the relevant NICE guidance and identified areas were NICE best practice was not in place and actions were agreed to develop this.
The Peer Review Teams and GMPHN have then developed in partnership with each LA a set of local recommendations which have been built into Local Action Plans to be developed by LA. Peer Review Teams will reconvene to review the progress of Local Action Plans and to provide further support to ensure that best practice is being maintained in accordance with NICE guidance. A set of GM recommendations were also identified which were presented to the DsPH and PH Leadership Group. GMPHN formed several sub-groups to take ownership of a number of GM priority actions such as benchmarking costs and commissioning frameworks and, where possible, collaborative commissioning. De-commissioning and re-commissioning of provider services were also priority actions for these sub-groups. GMPHN is a subscription based organisation and therefore there are no additional costs were incurred.
Accountability of the development of these Local Action Plans lies with peers. Peer Review Panels will reconvene 6, 9 and 12 months to further the development of Local Action Plans. This supportive session will allow LAs to feedback their challenges and achievements in implementing NICE guidance and subsequently help and/or learn from colleagues.
GMPHN has facilitated a number of workshops in order for LAs to share how NICE guidance has been implemented in their area. These workshops include a Healthy Weight Tackling Childhood Obesity workshop which aims to enable commissioners to purchase services that are high quality and cost effective and focussed on driving up quality.
GMPHN will also be facilitating a Return On Investment workshop which will focus on return on investment within physical activity but also explore how different return on investment methodologies could be utilised across other agendas. The event will be jointly facilitated by GMPHN, University of Manchester and NICE.
The formation of a GM Health Checks Group tasked with reviewing existing services and developing a collaborative commissioning framework for GM to create efficiencies and improve outcomes. A number of local improvements have been realised. One GM local authority has embedded local actions and report to their Health and Well Being Board and have agreed a local system to ensure there is accountability for development of local action plans. The programme has also highlighted various areas for local improvements and has led to contract reviews to search for efficiencies.
Key learning points
In order to deliver this programme of work effectively it was essential that GMPHN engaged with relevant partners from the beginning to illustrate the process involved and to agree roles and responsibilities. Peer review training was delivered to increase colleagues' knowledge and understanding of the principles of sector-led improvement and to gain their trust and dedication. GMPHN emphasised to colleagues the benefits of peer support and the opportunities that it presented to local authorities to improve their outcomes. It was essential that colleagues felt that they had control and ownership of this programme of work.
Training provided colleagues with practical guidance and illustrated all the processes involved in the programme. GMPHN took every opportunity to engage with partners at various local public health meetings and on a one to one basis to illustrate the process involved. Partners involved in the programme received regular communications in order maintain agreed timeframes and had access to relevant NICE guidance / Quality Standards. The DsPH and PHLG were given regular progress updates - again communication was key.
Local action plans were developed and the ownership of actions agreed. Partnership agreements and MOUs (Memorandum of Understanding) were developed when required.