NICE has joined forces with the Social Care Institute for Excellence (SCIE) and its partner organisations to create its new social care guidance and quality standards in a £5.4 million deal.

SCIE will be paid £1.8m per year over the next three years to help NICE develop the guidance and quality standards as part of the Institute’s new responsibilities from April 1 2013 onwards.

The partnership will work together as part of the NICE Collaborating Centre for Social Care.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said SCIE’s “track record” will “support us in the new and important area of work.”

The NICE Collaborating Centre for Social Care will use the methods and processes currently used by SCIE to develop the social care guidance on the behalf of the Institute. NICE will then use the guidance as a basis for its quality standards for social care.

SCIE works closely with various supporting organisations and research units to develop work relevant to the social care sector.

The first quality standards produced under the partnership – care of people with dementia and health and wellbeing of looked-after children – will be published in April, as part of a pilot scheme to test the Centre’s methods and processes.

A new draft quality standard for evidence-based patient care of hypertension has been published by NICE.

The Institute has opened a consultation on its updated guidelines for the treatment of high blood pressure, which includes six statements to help improve care and outcomes.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the new quality standard provides “measures markers” to drive improvements.

Reduction of high blood pressure is one of the most common interventions in primary care. In 2006, hypertension cost the NHS around £1bn to treat in drugs alone. It’s now estimated there are around 12 million people in the UK with the condition – plus an additional 5.7 million people yet to be diagnosed.

The six updated statements include ensuring people with resistant hypertension who have received four anti-hypertensive drugs and whose blood pressure remains uncontrolled are referred for specialist assessment. Also, NICE advises that people who are newly diagnosed and at a 10 year cardiovascular disease risk of 20% or higher should be offered statin therapy.

NICE aims for the revised quality standard to ensure accurate diagnosis, with treatments provided and their adherence and efficacy monitored appropriately and referrals to specialists made when necessary.

The final quality standard for high blood pressure is expected in March 2013.

NICE has devised six key statements for the management of people with a suspected or confirmed venous thromboembolic (VTE) disease in a draft quality standard.

Statements include: people with suspected VTE have diagnostic investigations within 24 hours of initial clinical suspicion and those with unprovoked VTE are offered cancer tests.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the draft quality standard “will contribute to improving the diagnosis and treatment” of people with VTE.

VTE diseases range from asymptomatic deep vein thrombosis (DVT) to fatal pulmonary embolism (PE). Latest figures estimate that around 1,000 per week are diagnosed with blood clots in their legs or lungs.

Additional statements advise that people with suspected DVT – where diagnostic investigations take longer than four hours – are offered interim therapeutic dose anticoagulation therapy. If an individual is suspected to have PE, they should be offered the same therapy when investigations take longer than an hour.

NICE is now inviting comments from stakeholders on the suggested statements. A final decision on the quality standard is expected in April next year.

The Department of Health has asked NICE to develop several additional integrated health and social care quality standards.

NICE will begin work on quality standards on the care and wellbeing of both adults and children with autism and on the mental wellbeing of older people in residential care.

The DH has also requested that the Institute develop similar standards of care where no existing guidance on a topic exists.

Earl Howe, Parliamentary Under-Secretary of State for Quality said NICE’s quality standards “help define what good care looks like”.

The topics where no guidance exist and requires development are:

• Autism in adults
• Autism in children
• Child maltreatment
• Domiciliary care
• The transition between child and adult services
• The transition between health and social care, including discharge planning, admission avoidance, reducing readmissions and reducing unnecessary bed occupancy
• Mental wellbeing of older people in residential care
• Management of physical and mental co-morbidities of older people in community and residential care settings
• Medicines management in care homes

Work on two pilot health and social care quality standards is already being undertaken by NICE. Guidelines for the standard of care of people with dementia and the health and wellbeing of children in care will be published in April next year.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the Institute welcomed the request by the DH to develop the quality standards as part of its new role.

“It’s important for health and social care services to work in tandem and the standards we develop will play a vital role in ensuring services are closely aligned to ensure effective, high quality patient care is consistently achieved.”

NICE has identified 12 key priority areas in a new quality standard on antenatal care.

New guidelines include women being cared for by a named midwife throughout their pregnancy and offered foetal anomaly screening in accordance with current UK programmes.

Jane Munro, Quality and Audit Development Advisor at the Royal College of Midwives, said the standard “will contribute to safer and healthier pregnancies for women”.

The quality standard represents the first component NICE is creating in a series of maternity quality standards which will eventually form the care pathway.

The key priority areas have been identified in aspects of high-quality, cost-effective care which NICE says will improve the “effectiveness, safety and experience of care for pregnant women”.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the quality standard “firmly places women at the centre of decision making about their care, ensuring they are provided with up to date information to enable them to make informed decisions in partnership with healthcare professionals about their care and treatment.”

The quality standard on antenatal care includes:

• Pregnant women are supported to access antenatal care, ideally by 10 weeks.
• Pregnant women are cared for by a named midwife throughout their pregnancy.
• Pregnant women have a complete record of the minimum set of antenatal test results in their hand-held maternity notes.
• Pregnant women with a body mass index of 30 kg/m2 or more at the booking appointment are offered personalised advice from an appropriately trained person on healthy eating and physical activity.
• Pregnant women who smoke are referred to an evidence-based stop smoking service at the booking appointment.
• Pregnant women are offered testing for gestational diabetes if they are identified as at risk of gestational diabetes at the booking appointment.
• Pregnant women at high risk of pre-eclampsia at the booking appointment are offered a prescription of 75 mg of aspirin to take daily from 12 weeks until at least 36 weeks.
• Pregnant women at intermediate risk of venous thromboembolism at the booking appointment have specialist advice provided about their care.
• Pregnant women at high risk of venous thromboembolism at the booking appointment are referred to a specialist service.
• Pregnant women are offered foetal anomaly screening in accordance with current UK National Screening Committee programmes.
• Pregnant women with an uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) are offered external cephalic version.
• Nulliparous pregnant women are offered a vaginal examination for membrane sweeping at their 40- and 41-week antenatal appointments, and parous pregnant women are offered this at their 41-week appointment.

NICE has identified 12 key priority areas in a new quality standard on antenatal care.

New guidelines include women being cared for by a named midwife throughout their pregnancy and offered foetal anomaly screening in accordance with current UK programmes.

Jane Munro, Quality and Audit Development Advisor at the Royal College of Midwives, said the standard “will contribute to safer and healthier pregnancies for women”.

The quality standard represents the first component NICE is creating in a series of maternity quality standards which will eventually form the care pathway.

The key priority areas have been identified in aspects of high-quality, cost-effective care which NICE says will improve the “effectiveness, safety and experience of care for pregnant women”.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the quality standard “firmly places women at the centre of decision making about their care, ensuring they are provided with up to date information to enable them to make informed decisions in partnership with healthcare professionals about their care and treatment.”

The quality standard on antenatal care includes:

• Pregnant women are supported to access antenatal care, ideally by 10 weeks.
• Pregnant women are cared for by a named midwife throughout their pregnancy.
• Pregnant women have a complete record of the minimum set of antenatal test results in their hand-held maternity notes.
• Pregnant women with a body mass index of 30 kg/m2 or more at the booking appointment are offered personalised advice from an appropriately trained person on healthy eating and physical activity.
• Pregnant women who smoke are referred to an evidence-based stop smoking service at the booking appointment.
• Pregnant women are offered testing for gestational diabetes if they are identified as at risk of gestational diabetes at the booking appointment.
• Pregnant women at high risk of pre-eclampsia at the booking appointment are offered a prescription of 75 mg of aspirin to take daily from 12 weeks until at least 36 weeks.
• Pregnant women at intermediate risk of venous thromboembolism at the booking appointment have specialist advice provided about their care.
• Pregnant women at high risk of venous thromboembolism at the booking appointment are referred to a specialist service.
• Pregnant women are offered foetal anomaly screening in accordance with current UK National Screening Committee programmes.
• Pregnant women with an uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) are offered external cephalic version.
• Nulliparous pregnant women are offered a vaginal examination for membrane sweeping at their 40- and 41-week antenatal appointments, and parous pregnant women are offered this at their 41-week appointment.

NICE has identified 12 key priority areas in a new quality standard on antenatal care.

New guidelines include women being cared for by a named midwife throughout their pregnancy and offered foetal anomaly screening in accordance with current UK programmes.

Jane Munro, Quality and Audit Development Advisor at the Royal College of Midwives, said the standard “will contribute to safer and healthier pregnancies for women”.

The quality standard represents the first component NICE is creating in a series of maternity quality standards which will eventually form the care pathway.

The key priority areas have been identified in aspects of high-quality, cost-effective care which NICE says will improve the “effectiveness, safety and experience of care for pregnant women”.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the quality standard “firmly places women at the centre of decision making about their care, ensuring they are provided with up to date information to enable them to make informed decisions in partnership with healthcare professionals about their care and treatment.”

The quality standard on antenatal care includes:

• Pregnant women are supported to access antenatal care, ideally by 10 weeks.
• Pregnant women are cared for by a named midwife throughout their pregnancy.
• Pregnant women have a complete record of the minimum set of antenatal test results in their hand-held maternity notes.
• Pregnant women with a body mass index of 30 kg/m2 or more at the booking appointment are offered personalised advice from an appropriately trained person on healthy eating and physical activity.
• Pregnant women who smoke are referred to an evidence-based stop smoking service at the booking appointment.
• Pregnant women are offered testing for gestational diabetes if they are identified as at risk of gestational diabetes at the booking appointment.
• Pregnant women at high risk of pre-eclampsia at the booking appointment are offered a prescription of 75 mg of aspirin to take daily from 12 weeks until at least 36 weeks.
• Pregnant women at intermediate risk of venous thromboembolism at the booking appointment have specialist advice provided about their care.
• Pregnant women at high risk of venous thromboembolism at the booking appointment are referred to a specialist service.
• Pregnant women are offered foetal anomaly screening in accordance with current UK National Screening Committee programmes.
• Pregnant women with an uncomplicated singleton breech presentation at 36 weeks or later (until labour begins) are offered external cephalic version.
• Nulliparous pregnant women are offered a vaginal examination for membrane sweeping at their 40- and 41-week antenatal appointments, and parous pregnant women are offered this at their 41-week appointment.

Macmillan Cancer Support has attacked NICE for not including key cancer survival indicators in the first ‘menu’ of the NHS Commissioning Outcomes Framework (COF).

NICE published 44 indicators including ones for stroke patients, COPD, maternal care and access to mental health services.

However, Ciarán Devane, Chief Executive at the charity, said Macmillan is “shocked” at the omission of key cancer indicators.

He added that the absence of these indicators would result in commissioners lacking “strong incentives to improve cancer survival rates” and that NICE must include a revised list of indicators if the NHS is to hit survival targets.

From April next year, the COF will be used to hold CCGs to account for improvement in quality of local healthcare and patient outcomes through the services they commission.

The indicators have been developed using the Outcomes Framework, NICE Quality Standards and existing indicator collections, such as national audits.

A further menu of indicators will now be developed using NICE’s quality standards to ensure that all topics are covered.

NICE has defended its first ‘menu’ of indicators insisting the Framework will allow the NHS Commissioning Board to “identify the contribution” of CCGs in achieving national priorities.

More than 44 new indicators have been proposed in the first Commissioning Outcomes Framework (COF) by NICE.

The proposed indicators include care for stroke patients, plus ones for COPD, maternal care and access to mental health services.

The ‘menu’ of indicators covers the five domains outlined in the NHS Outcomes Framework.

Professor Danny Keenan, COF Advisory Committee Chair, said he hoped the “robust” set of indicators would “lead to improved health outcomes”.

From April next year, the COF will be used to hold CCGs to account for improvement in quality of local healthcare and patient outcomes through the services they commission.

The indicators have been developed using the Outcomes Framework, NICE Quality Standards and existing indicator collections, such as national audits.

A further menu of indicators will now be developed using NICE’s quality standards to ensure that all topics are covered.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the indicators will “support high quality commissioning”.

“Each indicator has been through public consultation and feasibility testing (conducted by the Health and Social Care Information Centre), so commissioners can be reassured that they will work in practice,” she said.

The final selection of indicators that will be included within the 2013/14 COF will be decided by the NHS Commissioning Board later this year.

The NHS operating framework provides the blueprint for the NHS in England. Pf examines its objectives around quality and reform.

The Operating Framework for the NHS in England 2012/13 is an important document for UK medical sales professionals. It outlines the national priorities, system levers and mechanisms that the NHS in England must focus on to improve patient care. The strategic framework details expectations for the NHS’ ongoing efficiency challenge and the transition to the new commissioning and management system. It sets out the planning, performance and financial requirements for NHS organisations and the basis on which they will be held to account. With QIPP imperatives at the heart of the strategy, proactive pharmaceutical companies that can demonstrate an ability to help NHS customers deliver efficiencies and improve qualities in areas of national priority will be best placed to succeed.

The Framework identifies four key themes for NHS organisations in 2012/13:

1. Putting patients at the centre of decision making in preparing for an outcomes approach to service delivery
2. Completing the final year of transition to the new system
3. Accelerating the delivery of the QIPP challenge
4. Maintaining a strong grip on services and financial performance.

Quality - a focus on outcomes

The Operating Framework says that the NHS’ model of delivery must be overhauled in 2012/13 to become a system driven by quality and outcomes. It identifies the Outcomes Framework as the catalyst for this – with its focus on clinical outcomes and the reduction of health inequalities driving changes in culture, behaviour and service delivery. The Outcomes Framework sets out the improvements against which the NHS
Commissioning Board will be held to account from 2013/14.

These measurements are set out within five domains:

Domain 1: preventing people from dying prematurely.

Domain 2: enhancing quality of life for people with long-term conditions.

Domain 3: helping people recover from episodes of ill health or following injury.

Domain 4: ensuring people have a positive experience of care.

Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm.

The Operating Framework details a range of indicators for each domain, all of which are explored in the NHS Outcomes Framework. These will be supported by NICE quality standards, which provide definitions of what high-quality care should look like for a particular pathway of care. The document also advises NHS organisations to meet the service specific outcomes strategies that have already been published in areas such as mental health, cancer, COPD, asthma and long-term conditions.

Each domain in the NHS Outcomes Framework has a strong relevance to pharma, whether through the development of medicines to treat disease in priority areas, or via collaborative service design to move care closer to patients’ homes and reduce hospital admissions. Organisations that are able to show how their innovations can improve a care pathway or be used as part of a redesigned service will enjoy
more positive NHS engagement.

The Operating Framework identifies dementia and care of older people as a key priority, and sets clear goals to integrate health and social care. It also highlights examples of initiatives where NHS organisations have successfully improved services in line with each of the four key elements of QIPP; quality, innovation, productivity and prevention.

Reform - the transition blueprint

The Operating Framework outlines the key milestones for the reorganisation of the NHS. Whilst the headlines are widely known, it is interesting to track current progress against a timetable that was set out many months before the Health & Social Care Act was passed. The Framework notes that by
the end of 2012/13:

“The NHS will have transformed the commissioning landscape into one focused on local clinical decision
making, with the development and authorisation of CCGs, assisted by commissioning support vehicles and overseen by the NHS Commissioning Board. Local authorities will take the lead role in public health, alongside the new Public Health England. Central to the new system will be the establishment of Health & Wellbeing Boards (HWB), who will provide local systems leadership across health, social care and public health. Alongside this, developments will continue to the provider landscape, through the extension of Any Qualified Provider (AQP), progress with the NHS Foundation Trust (FT) pipeline and the establishment of the new NHS Trust Development Authority.”

Key 2012/13 objectives in the transition are as follows:

• PCTs and SHAs will remain statutory organisations until April 2013. They will be held to account on delivering performance and support the development of new organisations for clinical leadership. Clinical Senates and networks will be established
• PCTs will support CCG authorisation and the transition of power before March 2013
• HWBs will be established in shadow format, becoming statutorily operational from April 2013. They will act as the local system leader through JSNA and HWB Strategies
• CCGs must be coterminous with a single HWB ‘as far as possible’
• CCGs must: play an active role in planning and budgeting, develop relationships with local partners
  including social care, deliver their share of the QIPP agenda and identify how to secure commissioning support services in line with their running cost allowance
• Public Health England will become a statutory executive agency from April 2013
• NHS Trusts are expected to achieve FT status by April 2014
• PCT clusters should start to offer patients choice of AQP in at least three services that are local priorities. There should be a presumption of choice for most services from 2013/14.