NICE - helping more people to be more active Deborah O’Callaghan - Implementation Consultant 30 th June 2015
Overview • Brief reminder of the role of NICE • Highlight resources to support the uptake of physical activity • Overview of how these NICE resources can be used to: – Ensure and provide assurance that services are safe, effective and value for money – Inform scrutiny and service review – Identify high impact areas for improvement – Develop a clear case for investment (or funding bid) • A quick guide to accessing NICE guidance and resources
The role of NICE • To identify good practice using the best available evidence • To help resolve uncertainty for the public, patients and professionals • To reduce variation in the availability and quality of practice and care April 2013 – social care guidance and standards
NICE guidelines • recommendations based on the best available evidence to help you plan, deliver and evaluate successful programmes • an objective and authoritative summary of the research and evidence, reviewed by independent experts from a range of backgrounds and disciplines • an assessment of the effectiveness and cost effectiveness of public health interventions “Following NICE's recommendations on physical activity will help you make the best and most efficient use of resources to improve the health of people in your area”
Physical activity guidance • Exercise referral schemes to promote physical activity (PH54) (September 2014) • Four commonly used methods to increase physical activity (PH2) (March 2006) • Maintaining a healthy weight and preventing excess weight gain among adults and children(NG7) (March 2015) • Maternal and child nutrition (PH11) (March 2008) • Obesity (CG43) (December 2006) • Physical activity and the environment (PH8) (January 2008) • Physical activity: brief advice for adults in primary care (PH44) (May 2013)
Physical activity guidance cont. • Prevention of cardiovascular disease (PH25) (June 2010) • Promoting physical activity for children and young people (PH17) (January 2009) • Promoting physical activity in the workplace(PH13) (May 2008) • Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation (PH41) (November 2012) • Weight management before, during and after pregnancy (PH27) (July 2010)
Maintaining a healthy weight and preventing excess weight gain among adults and children – March 2015 1 Encourage people to make changes in line with existing advice 2 Encourage physical activity habits to avoid low energy expenditure 3 Encourage dietary habits that reduce the risk of excess energy intake 4 Further advice for parents and carers of children and young people 5 Encourage adults to limit the amount of alcohol they drink 6 Encourage self-monitoring 7 Clearly communicate the benefits of maintaining a healthy weight 8 Clearly communicate the benefits of gradual improvements to physical activity and dietary habits 9 Tailor messages for specific groups 10 Ensure activities are integrated with the local strategic approach to obesity
NICE pathways
NICE Pathways NICE Pathways • present all NICE guidance for a specific subject • include NICE guidance and NICE quality standards • Link to NICE implementation resources (e.g. costing and commissioning resources, training resources) • offer an easy and intuitive way to access NICE guidance
Quality standards
Physical Activity Quality Standards • Physical activity: encouraging activity in all people in contact with the NHS (March 2015) • Mental wellbeing of older people in care homes (Dec 2013) • Falls in older people – Assessment and prevention (March 2015) • Antenatal Care (Sept 2012) • Postnatal Care (July 2013) • Diabetes in adults (March 2011)
What are NICE guidance and quality standards? A set of systematically developed recommendations to guide decisions for a particular area of care or health issue Quality Evidence Guidance Standards A NICE quality standard is a Research studies - experimental concise set of statements and observational, quantitative designed to drive and and qualitative, process measure priority quality evaluations, descriptions of improvements. experience, case studies
Source guidance • Behaviour change: individual approaches (2014) NICE guideline PH49 • Physical activity: brief advice for adults in primary care (2013) NICE guideline PH44 • Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation (2012) NICE guideline PH41 • Promoting physical activity for children and young people (2009) NICE guideline PH17 • Promoting physical activity in the workplace (2008) NICE guideline PH13
Domain Objectives and indicators 1 Improving the wider Objective determinants of health Improvements against wider factors which affect health and wellbeing and health inequalities Indicators 1.9 Sickness absence rate 1.16 Utilisation of outdoor space for exercise/health reasons 1.18 Social isolation* (ASCOF 1I) 2 Health improvement Objective People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities Indicators 2.5 Child development at 2 – 2½ years 2.6 Excess weight in 4 – 5 and 10 – 11 year olds 2.8 Emotional wellbeing of looked after children 2.12 Excess weight in adults 2.13 Proportion of physically active and inactive adults 2.17 Recorded diabetes 2.22 Take up of the NHS Health Check programme – by those eligible 2.23 Self-reported wellbeing 2.24 Injuries due to falls in people aged 65 and over 4 Healthcare public health Objective and preventing premature Reduced numbers of people living with preventable ill health and people dying prematurely, mortality while reducing the gap between communities Indicators 4.4 Under 75 mortality rate from all cardiovascular diseases (including heart disease and stroke)** (NHSOF 1.1) 4.5 Under 75 mortality rate from cancer** (NHSOF 1.4i) 4.7 Under 75 mortality rate from respiratory diseases** (NHSOF 1.2) 4.11 Emergency readmissions within 30 days of discharge from hospital** (NHSOF 3b)
Driving quality improvement work
What are NICE guidance and quality standards? A set of systematically developed recommendations to guide decisions for a particular area of care or health issue Quality Evidence Guidance Standards Research studies - experimental A NICE quality standard is a and observational, quantitative concise set of statements and qualitative, process designed to drive and evaluations, descriptions of measure priority quality experience, case studies improvements.
How to use NICE quality standards Help to identify local priorities for quality improvement • NICE quality standards can highlight key areas for improvement. An initial assessment should consider: – relevance to the organisation – how services compare – what evidence is available – actions to improve – risks of not improving
Sources of information to support initial assessment could include: • baseline assessments/actions plans for NICE clinical guidelines • new or existing service user feedback • complaints or Serious Untoward Incidents (SUIs) • audit information (including national audit data) • prescribing or activity data • views of the service/team • process maps • service user experience interviews
The initial assessment • A positive assessment can: – provide assurance – could be included in the trust’s quality account or organisation’s quality profile • An assessment indicating areas requiring quality improvement can: – inform local quality improvement work/programme planning – support discussions with commissioners • Inform the organisation’s annual audit programme (by identifying priority areas for audit) and business planning • Inform local risk management, in collaboration with the service’s commissioners
Do we require our service providers to include advice about physical activity in the feedback that we give to parents? Is this reflected in the service specification? What is the content of the advice – does it include information about local opportunities to be physically active? What format is this advice in and at what stage is it given?
Endorsement statement for Living well through activity in care homes “This toolkit supports statements on participating in meaningful activity and personal identity in the NICE quality standard for mental wellbeing of older people in care homes . In addition, it also supports the recommendations relating to occupational therapy interventions and training within the NICE guideline on mental wellbeing in over 65s: occupational therapy and physical activity interventions ” National Institute for Health and Care Excellence June 2015
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