The development and delivery of standards and guidelines in the National Health Service were the subjects of a session at the British Pharmaceutical Conference on September 12. Jo Barnes reports
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The role of pharmacists in the early development of the National Institute
for Clinical Excellence (NICE) was acknowledged by Dr SHEILA ADAMS (health services
director, National Health Service [NHS] Executive). She was discussing the development
of national standards in health care.
National standards were set by the NICE and national service frameworks (NSFs),
Dr Adams explained. Each framework was developed by a team of health professionals,
service users, carers, managers and partner agencies, and in order to set standards,
an assessment of health and social care needs, organisation, key issues, resource
implications and the time scale for change, was undertaken. The delivery of
national standards was monitored by the Commission for Health Improvement (CHI),
the NHS performance assessment framework and the NHS patient survey.
Dr Adams pointed out that, in addition to specifying standards, NSFs also defined
service models for particular services or care groups. The latter was much more
difficult, since service models needed to be adapted to local circumstances.
NSFs made provision for national and local programmes and delivery strategies
to support implementation, and also established milestones and performance indicators
against which progress within agreed time scales could be measured. For example,
some of the performance indicators included in the NSFs for coronary heart disease
and mental health were measured early on in NSF delivery, so that the progress
of institutions and organisations could be monitored and difficulties identified
as soon as possible.
Outlining the NSF for mental health, Dr Adams said that it comprised seven evidence based national standards (see Panel) covering:
According to Dr Adams, additional investment in this area was aimed at “fast-forwarding”
the NSF. The areas targeted were: investment in services for women (especially
around the time of childbirth), initiatives aimed at improving care for those
individuals who no longer needed high security services, and “in-reach”
services into prisons. Dr Adams said that concordance was of particular importance
for people with mental health problems.
The NHS cancer plan and the NSF for older people were expected soon, and the
NSF for diabetes was expected next year. Other NSFs would then follow. With
regard to the NSF for older people, Dr Adams suggested that the work on medicines
management would be particularly relevant. Each NSF would have a range of underpinning
programmes, including research and development, clinical decision support systems,
information, and education and training (including continuing professional development).
Dr Adams then outlined what was needed to deliver NSFs. They were: ambitious
but realistic programmes which “pulled all levers simultaneously”,
a recognition that change required time if it was to be sustained, a determined
and effective approach to reshaping clinical and social work practice and a
commitment to improving partnerships and relationships in health care.
With regards to the NICE, Dr Adams identified its key activities as being the
appraisal of technologies (drugs, devices, etc) and the promulgation of clinical
guidelines. She acknowledged the role that several pharmacists had played in
the early development of the NICE, especially with the horizon-scanning project.
Clinical guidelines in preparation included the secondary prevention of myocardial
infarction, risk assessment and prevention of pressure ulcers, electronic foetal
monitoring and induction of labour.
Concluding, Dr Adams emphasised the importance of focusing on delivery as well
as development. There was a need to improve performance indicators and the performance
assessment framework. Dr Adams pointed out that there was a new role for the
CHI in working with the Social Services Inspectorate and the Audit Commission,
and an even newer role for the modernisation agency. Importantly, there were
new proposals for patient and citizen involvement. The importance of this was
that it built in a new feedback loop.
Pharmacists in scotland
Mr BILL SCOTT (Scottish chief pharmaceutical officer), said that pharmacy had
a crucial role to play in helping the Government deliver its health priorities
for the NHS in Scotland (NHSiS). These were coronary heart disease, smoking,
cancer, teenage pregnancy, drug and alcohol misuse and dental disease and diet.
Mr Scott referred to a survey which had shown that 60 per cent of the public
visited a pharmacy frequently and, in older people, the figure was 80 per cent.
The profession’s view was that it wished to be involved with domiciliary
visits, warfarin clinics, and managing and reviewing patients’ medicines.
There was a link between what patients wanted, what pharmacists wanted, and
what the Government wanted, said Mr Scott.
On the role that pharmacists had to play in the pharmaceutical health of the
nation, Mr Scott was concerned that the absence of patient scrutiny by the pharmacist
could result in undetected problems, since not all medication errors could be
identified from the prescription alone. Mr Scott outlined a process in which
risk groups from the total patient population could be identified and targeted,
screened for health problems, and reviewed. The pharmacist’s role in this
process would be to identify patients with pharmaceutical care problems and
needs, he said.