Services for people with chronic heart failure

This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg39

7 Further information

Table 10 summarises national drivers that are relevant to commissioning chronic heart failure services. Local service redesign may address only one or two of them.

Table 10 National policy relevant to chronic heart failure

Document	Author	Year	Significance
Coronary heart disease: national service framework for coronary heart disease - modern standards and service models	Department of Health	2000	Chapter 6 on heart failure sets out how the NHS and others can help people with heart failure to live longer, achieve a better quality of life and receive appropriate palliative care support when appropriate.
End of Life Care Strategy - promoting high quality care for all adults at the end of life	Department of Health	2008	Recommends a whole systems approach both for commissioning services and for the delivery of integrated care for individuals.
NHS Outcomes Framework 2011/12	Department of Health	2011	Commissioning services for chronic heart failure can help to achieve outcomes under domains 1, 2, 3, and 4.
Quality, innovation prevention and productivity (QIPP)	Department of Health	2011	The workstream on long term conditions includes a generic model of care developed around the person with long-term conditions through the proactive use of risk profiling data, integrated care teams and supported self-management (see also the LTC commissioning pathway). The workstream on end of life care focuses on improving systems and practice for identifying people as they approach the end of life and planning their care.
Liberating the NHS: legislative framework and next steps	Department of Health	2011	Describes in detail how reforms of the NHS will be put into practice, including the development of NICE quality standards.
NHS operating framework for 2011/12	Department of Health	2011	Sets out the role of PCT clusters in oversee management and implementation of medium term QIPP plans. Sets out some of the mechanisms to support reform of the NHS including the NHS Outcomes Framework and extension of quality accounts to cover community services for 2010/11. Describes priorities for end-of-life care.
Using the Commissioning for Quality and Innovation (CQUIN) payment framework – a summary guide	Department of Health	2010	Makes a proportion of providers' income conditional on quality and innovation.
End of Life Care Strategy - promoting high quality care for all adults at the end of life	Department of Health	2008	Describes a comprehensive framework aimed at promoting high quality care across the country for all adults approaching the end of life.

Additional resources

Commissioners may also find the resources in table 11 useful when commissioning services for people with chronic heart failure.

Table 11 Additional resources

Document	Author	Year	Significance
NICE pathway: Chronic heart failure	NICE	2011	Provides quick and easy access to the range of guidance on chronic heart failure from NICE, including quality standards, technology appraisals, clinical and public health guidance and NICE implementation tools
Commissioning framework for health and well-being	Department of Health	2007	Annex A outlines the process and data needed to undertake a joint strategic needs assessment.
Commissioning of cardiac services – a resource pack from the British Cardiovascular Society	British Cardiovascular Society	2011	Provides a summary of existing standards and guidelines that can be used as a basis for commissioning decisions
Commissioning framework for health and well-being	Department of Health	2007	Annex A outlines the process and data needed to undertake a joint strategic needs assessment.
NHS comparators	NHS Information Centre	2011	Analytical service for commissioners and providers. It helps improve the quality of care delivered by benchmarking and comparing activity and costs on a local, regional and national level.
Predicting and reducing readmission to hospital	The Kings Fund	2009	The tool is a risk prediction system to identify individuals at high risk of hospital readmission.
PRIMIS+	NHS Information Centre	2011	Provides support to general practices on information management (recording and analysis) of data quality, plus a comparative analysis service focused on key clinical topics.
Health Inequalities Intervention Toolkit	Association of Public Health Observatories and Department of Health		Designed to assist evidence-based local service planning and commissioning, including Joint Strategic Needs Assessments.
Indicators for Quality Improvement	NHS Information Centre	2011	A resource of robust indicators to help local clinical teams select indicators for local quality improvement. Assured by clinicians for use by clinicians. Published with full metadata for transparency.

End of Life Care	National Audit Office	2008	Report of National Audit Office identifies that there is room for improved coordination between health and social care services in planning and delivering end-of-life care. Include case examples of service development work, including the Care Plus Project in Tower Hamlets to support carers of people with severe heart failure.
End of life care in heart failure: a framework for implementation	National End of Life Care Programme and NHS Improvement	2010	Highlights how an end-of-life care service can best accommodate the specific needs of people with heart failure.
National End of Life Care Programme	National End of Life Care Programme	Various	A wide range of publications and resources to support health and social care staff working with people nearing the end of life.
Common core competences and principles for health and social care workers working with adults at the end of life	National End of Life Care Programme	2009	Supports workforce development, training and education and the development of new and enhanced roles.
A framework of national occupational standards to support common core competencies and principles for health and social care workers working with adults at the end of life	National End of Life Care Programme	2010	Provides the underpinning framework of core National Occupational Standards (NOS) for the end-of-life care workforce.

General information on quality and corporate assurance can be obtained from the following sources:

Indicators for Quality Improvement Programme from the NHS Information Centre. A resource of robust indicators to help local clinical teams select indicators for local quality improvement and a source of indicators for benchmarking
NHS Alliance online resources. NHS Alliance is the representational organisation of primary care and primary care trusts, and provides them with an opportunity to network and exchange best practice. The alliance supports its members with an open-access helpline, in-house and joint publications and briefings, internal newsletters and a website.
NHS Institute for Innovation and Improvement support for commissioners, includes The Productive Leader programme to enable leadership teams to reduce waste and variation in personal work processes, and Better care, better value indicators to help inform planning, to inform views on the scale of potential efficiency savings in different aspects of care, and to generate ideas on how to achieve these savings
The Qualities and Outcomes Framework is a voluntary quality incentive scheme that rewards general practices for implementing systematic improvements in the quality of patient care.
Skills for health works with employers and other stakeholders to ensure that those working in the sector are equipped with the right skills to support the development and delivery of healthcare services.

Sources of further information to help you in assessing local health needs and reducing health inequalities include:

NHS Evidence provides free access to clinical and non-clinical information - local, regional, national and international. Information includes evidence, guidance and Government policy
The National Cardiovascular Disease (CVD) profiles provide a snapshot of key issues relating to heart disease and stroke - these profiles have been designed to help local health services to assess the impact of these elements of cardiovascular disease on their local populations and the services provided to meet those needs
Department of Health Delivering quality and value – focus on benchmarking.
NICE Health equity audit – learning from practice briefing.
NHS Comparators provides comparator data for NHS commissioning and provider organisations to enable users to investigate aspects of local activity, costs and outcomes.
The Disease management information toolkit (DMIT) is a good-practice tool for decision-makers, commissioners and deliverers of care for people with long-term conditions, which presents data on conditions that contribute to high numbers of emergency bed days. It models the effects of possible interventions that may be commissioned at a local level and helps users to consider the likely impact of commissioning options.
Disease prevalence models produced by the Association of Public Health Observatories provides primary care trust-level prevalence estimates for coronary heart disease.
PARR (Patients at risk of rehospitalisation) is a risk-prediction system for use by primary care trusts to identify patients at high risk of hospital re-admission.
PRIMIS+ provides support to general practices on information management, recording for, and analysis of, data quality, plus a comparative analysis service focused on key clinical topics.
SHAPE (Strategic health asset planning and evaluation) application provides support to strategic health authorities and primary care trusts on strategic planning across a whole health economy.