Using NICE guidance to improve and evidence quality in adult social care

1. Using NICE guidance to improve and evidence quality in adult social care 1- 2 pm, Monday 24 June

2. Welcome and Introduction Deanna Westwood, Interim Head of Inspection, Adult Social Care North East and Coast, Care Quality Commission Pauline Shaw Director of Care, The Royal Star & Garter Home Melanie Weatherley CEO Walnut Care at Home, Chair Lincolnshire Care Association, Co-Chair Care Association Alliance, NICE Fellow 2019-2022

3. Aims of the webinar We will be covering…….. • Overview of the NICE products available and what they cover • More detailed look at guidance on dementia and oral health and the opportunities and challenges that they present • Using NICE guidance to address areas of concern • Links between NICE guidance and CQC Key Lines of Enquiry – see the NICE Quality improvement resource for adult social care (QIR)

4. NICE • NICE aims to improve quality in health & social care through development of guidance based on the best available evidence Comprehensive set of recommendations for particular areas Prioritised set of measurable statements designed to support quality improvement

5. Relevant guidance and standards

6. Relevant guidance and standards

7. Social care resources – Quality improvement resource • NICE quality improvement resource: adult social care Relevant NICE quality statements mapped against CQC key lines of enquiry Can be adapted for local use (contracts, quality dashboards) Use to evidence quality in CQC inspections

8. Social care resources – quick guides

9. Other social care resources • Social care trainers resource • Webinars • Podcasts • NICE in Social Care ebulletin

10. Benefits for registered managers of using NICE guidance on dementia (NG97) Evidence base to reinforce practice Person-centred care Shared decision making Benchmarking current practice Workforce Advance care planning Advocacy Refer to guidance in discussions with other professionals (eg 6 weekly review of anti-psychotics)

11. Benefits cont’d System wide working Health and care professionals Carers Shared learning Local success stories

12. Guideline

13. Quality standard

14. Pathway

15. Tools

16. Benefits for registered managers of using NICE guidance on Oral Health (NG48) • Benchmarking • Support with dental hygiene • Assessment • Links to local dental services • Discussions with commissioners • Availability of oral health support • Cost of compliance • Advocacy • Availability of oral health support • Partnership working

17. Guideline

18. Quality standard

19. Pathway

20. Improve your CQC rating with NICE guidance 19% of ‘Outstanding’ CQC reports for ‘care homes’ and ‘services in your home’ since April 2018 have cited NICE guidance.

21. CQC Examples - putting guidance into practice An Inadequate Service Effective – “Best practice was not always embedded due to a failure to oversee staff were trained appropriately and applied their training in their roles. Staff did not have the required knowledge to provide people with appropriate catheter care.” An Outstanding service: Effective – “Assessments of people's needs were holistic and comprehensive. We saw that full information had been sought and recorded to identify outcomes. The internal multi-disciplinary team often discussed current guidance from The National Institute for Health and Care Excellence (NICE). NICE provides national guidance and advice to improve health and social care. This ensured the service was using evidence-based techniques to support the delivery of high-quality care and support.”

22. Oral Health Inadequate services Safe – “Another person's oral health assessment carried in December 2016 identified their dentures were over 5 years old and the home needed to consider referring the person to the dentist for replacement dentures. The persons oral health assessment was reviewed again in July 2017, Oct 2018 and Nov 2018. None of the outstanding actions identified from the December 2016 initial assessment had been followed up.” Effective - “The providers oral health pre-assessment form consisted of two tick box questions - one asked about whether the person had dentures and the other asked if they have any sores or pains. No information was taken relating to oral health daily routines, products used or the persons preferences. Only two out of the four people’s care records we looked at in relation to dental care did include completed oral health assessments. The lack of proper oral health assessments put people's oral health care needs at risk.”

23. Oral Health – NICE Guidance (extracts) Guidance states: Ensure care staff provide residents with daily support to meet their mouth care A needs and preferences, as set out in their personal care plan after their assessment. Ensure care staff know how to recognise and respond to changes in a resident's mouth care needs. Ensure care staff know how to respond if a resident does not want daily mouth care or to have their dentures removed (see NICE's website page on your care). Outstanding service Whilst staff were very much aware of people's anxieties, they worked in a collaborative way to ensure people received support from medical professionals that they required. One person had considerable anxiety regarding dental care… an appointment was arranged and a discussion had taken place between staff and the dentist prior to the visit. Staff had requested that minimal dental equipment was brought to the service as this would increase the persons anxiety, and that the dentist would need to sit and chat with the person to build trust before any examination could take place. The person accepted the examination and appropriate oral care was provided.

24. Dementia Inadequate Services Effective - The provider supported older people many of whom were living with some form of dementia. Research continues to be undertaken to develop best practice and to share the impact different environments can have on people living with dementia. During this inspection we did not find any best practice guidance had been followed either in the development of the extension or within the main body of the home. One person's authorisation stated that staff should consult with the GP and mental health team regarding the risks and benefits of the use of anti- psychotic medicines. The condition stated that this consultation should be included in the person's care plan. The registered manager showed us that some consultation had occurred with the GP but was unable to show us any evidence that this had been discussed with mental health team, as per the condition.

25. Dementia – NICE Guidance (extracts) Practitioners should support people to participate fully in tasks and activities by ensuring that: The environment is conducive to their needs They have access to the equipment they need (for example, hoists or recliner chairs). Commissioners and service providers should consider using a range of approaches to gather views and experiences (for example, focus groups, interviews or observation in addition to surveys), and use evidence from a range of sources. Outstanding service: In refurbishing the home, particular attention had been paid to the needs of people living with dementia. Toilet doors had been painted in 'dementia friendly' colours and each corridor had been decorated in a distinct theme, to make it easier for people to orientate themselves within the home and to stimulate memory. ..The people who lived in the home had been involved in every aspect of the refurbishment.

26. NICE guidance mapped to CQC’s KLOEs

27. NICE support for you NICE and SCIE quick guides based on NICE guidelines and quality standards concise practice-focused content for specific audiences free and available online or downloadable in a PDF format useful for staff training available on the quick guides page of the NICE website. NICE Field team offers organisations free support for putting NICE guidance into practice. visit the field team page on the NICE website for contact details.

28. Links NICE guidance on dementia NICE guidance on oral health Social care trainers resource Quality improvement resource for adult social care