Breakfast seminar

The formality of NICE’s role in social care had been set out in the 2012 Health and Social Care Act, Gillian Leng told delegates, with a new responsibility to develop quality standards and guidance. “We’re probably best known for providing evidence-based guidance,” she said. “What we do is look at the best available evidence, followed by a wider consultation with stakeholders.”

Guidance is used to identify quality standands, essentially contained sentinel markers, she explained – prioritised sets of concise, measurable statements designed to drive quality improvements across a pathway of care – and NICE had so far produced two quality standards on social care, with ten new topics referred by the Department of Health and consultation on further areas. “Originally we’d get referrals from the Department of Health but no detail about what we should be considering, which is where the discussions with stakeholders came in.”

One of the new topics was home care, she said, with issues like the role of new technology and how to get people to best manage their personal budgets already highlighted as crucial areas by stakeholders. Guidelines Quality standards also included ‘quality statements’, she said, which needed to be closely defined in order to be measurable.  These statements are used to define , as well as ‘quality measures’ for providers to demonstrate they were achieving standards, such as evidence of local arrangements.

NICE worked closely with NHS England to encourage quality standards to be picked up and used, she said, looking at issues like financial levers, tariffs and other elements. “The primary audience for quality standards is health and social care professionals, but – particularly in the field of social care – getting the information out to individuals is crucial,” she stressed. “There are personal budgets, and a lot of social care is funded from people’s own pockets, so it’s vital that service users, families, carers and the public are able to find out about the quality of care they can expect.”

Relevant social care frameworks included the DfE’s national minimum standards, CQC’s essential standards and OFSTED’s inspection framework, she said. “The [Robert] Francis report also described ‘enhanced’ quality standards, which largely map out against what we already do, as well as ‘developmental’ standards. These are at the cutting edge – still evidence based, but not widely used.”

Quality standards would soon contain a developmental element, however, she pointed out. “There may be technological solutions that would fit the developmental bill in social care, for example. In the future, the CQC will give formal ratings based on four standardslevels of care, and these descriptors of ‘Good’ and ‘Outstanding’ will match map against our quality standards. One of the things that will help you be outstanding is if you are achieving developmental standards.”

The dementia quality standards would also be used as a basis for a new care audit tool for people living with dementia in social care homes, she said. “Overall, what we’re trying to do is provide clarity about what works and about value for money,” and NICE had also signed up to a DH-led document on integrated care and support.

“There’s regulation across health and social care, and the fact that we’ve got guidance that looks to that framework will help with supporting integration.” Staffing levels were another challenge that NICE was looking at, she said, initially in the acute sector but to be extended to the community sector. “We’ll very much look at cost-effectiveness when we do social care, the same as when we look at clinical topics, but and we’ll need to be selective to identify areas most in need of an economic assessment.”

The question of communicating NICE’s standards to providers, however, was perhaps the biggest issue, she stated. Working through partner organisations was vital here, she said, and DH was also aware of the challenge. “In social care you’re communicating with a very diverse workforce and set of providers. It’s vast compared with health, and we don’t have theose same sorts of professional networks in place.”