Quality Standards Advisory Committee 4

Transcription

1 Quality Standards Advisory Committee 4 Homes: preventing accident and unintentional injury prioritisation meeting Smoking: harm reduction post-consultation meeting Attendees Minutes of the meeting held on Thursday 26 th March 2015 at the NICE offices in Manchester Standing Quality Standards Advisory Committee (QSAC) members Damien Longson (DL) [Chair], Julie Rigby (JR), Zoe Goodacre (ZG) [agenda items 1-7], Tim Fielding (TF), Allison Duggal (AD), Alaster Rutherford (AR), Alison Allam (AA), John Jolly (JJ) [agenda items 1-7], Harry Allen (HA), Michael Varrow (MV), Jane Bradshaw (JB), Nicola Hobbs (NH) [agenda items 1-7], Moyra Amess (MA), David Weaver (DW), Rubin Minhas (RM), Roger Hughes (RH) Specialist committee members Homes: preventing accident and unintentional injury Rob Taylor (RT), Carolyn Cripps (CC), Catherine Churchill (CCh), Davina Hartley (DH), Mike Hayes (MH) Smoking: harm reduction Barrie Dwyer (BD), Ian Gray (IG), Linda Bauld (LB), Jan Sinclair (JS) NICE staff Melanie Carr (MC) [agenda items 1-7], Tony Smith (TS) [agenda items 1-7], Sabina Keane (SK) [agenda items 8-14], Thomas Walker (TW) [agenda items 7-14], Lisa Nicholls (LN), Rachel Neary Jones (RNJ) Topic expert advisers Denise Kendrick (DK) Apologies NICE Observers Roshni Joshi Standing Quality Standards Advisory Committee (QSAC) members Frances Garraghan, John Walker Specialist committee members Homes: preventing accident and unintentional injury Julie Mytton Smoking: harm reduction John Britton, Deborah Arnott Quality Standards Advisory Committee 4 meeting 26 th March of 11

2 Agenda item Discussions and decisions Actions 1. Welcome, introductions and plan for the day (private session) DL welcomed the attendees and the Quality Standards Advisory Committee (QSAC) members introduced themselves. DL welcomed AK as a new standing member to the Committee and introduced DK as the topic expert who would be doing a presentation. 2. Welcome and code of conduct for members of the public attending the meeting (public session) 3. Committee business (public session) DL informed the committee of the apologies and reviewed the agenda for the day. No public observers were present for the topic on homes: preventing accident and unintentional injury. Declarations of interest DL asked standing QSAC members to declare any interests that were either in addition to their previously submitted declaration or specific to the topic(s) under consideration at the meeting today. DL asked the specialist committee members to declare all interests. The following interests were declared: Standing committee members AR no DOI associated with anything in the current QSAC work programme Specialist committee members CC delivers training courses in accident injury prevention for Fit for Safety working with CAPT as well as independently. Also delivers home safety assessments for families under Fit for Safety and develops tools funded by the Child Accident Prevention Trust. MH freelance work and work funded by Child Accident Prevention Trust DH works in local government that implement the programmes being discussed. 4. Topic expert adviser presentation Minutes from the last meeting The committee reviewed the minutes of the last meeting held on 27 th February and confirmed them as an accurate record. DK gave a short presentation on Preventing children s injuries at home: issues to consider in developing quality standards. Quality Standards Advisory Committee 4 meeting 26 th March of 11

3 5. Topic session Homes: preventing accident and unintentional injury (public session) 5.1 and 5.2 Topic overview and summary of engagement responses 5.3 Prioritisation of quality improvement areas The committee then moved on to discuss homes: preventing accident and unintentional injury. MC and TS presented the topic overview and a summary of responses received during engagement on the topic. It was noted that NICE public health guidance PH29 and PH30 would provide the source recommendations for the quality standard, but recommendations relating to national initiatives would not be used. The committee asked that it be made clearer in the QS template what is excluded, e.g. national policy, strategy, workforce training. MC and DL led a discussion in which areas for quality improvement were prioritised. The QSAC considered the draft areas as outlined in the briefing paper prepared by the NICE team. NICE to review QS template to make exclusions more explicit Households at risk Home safety assessments Home safety equipment Injury prevention co-ordinator The QSAC agreed that the following areas for quality improvement should be progressed for further consideration by the NICE team for potential inclusion in the draft quality standard: Households at risk The committee identified the importance of workforce training but noted a core principle of quality standards development that it is assumed that people are appropriately trained and competent, therefore specific quality statements about training and competency are generally not appropriate. The committee had a broad discussion about potential local data sources to inform approaches to identifying at-risk households and agreed that this was an area for quality improvement. A distinction was drawn between using the data for primary and secondary prevention of unintentional injury the latter could be a response to A&E attendances, for example. The committee felt a focus on primary prevention NICE to draft quality statements about: The use of local data to identify and prioritise atrisk households The coordination of workforces across local services relevant to injury prevention Quality Standards Advisory Committee 4 meeting 26 th March of 11

4 would be preferred for a quality standard statement and that local authorities were well placed to influence this. This could be based on local joint strategic needs assessments, use of health intelligence and data sharing agreements between partners in contact with at risk households which could be led by the local public health team, including Health and Wellbeing Boards. Injury prevention co-ordinator Additionally, the committee felt it was important to ensure that action around prevention of unintentional injury to children is coordinated, avoiding a duplication of effort. They agreed that the data shows that the majority of local authorities don t have an injury prevention coordinator but that these make a big difference to quality. The committee therefore asked the NICE team to draft a second quality statement about the role of a local injury prevention coordinator, noting that this is seen as a role, and not a job title. They agreed that the underpinning guideline is very specific about what this coordinator should do. Home safety assessments/ Home safety equipment Undertaking formal home safety assessments with families that have been identified as having the potential to benefit Following through the actions identified in formal home safety assessments Ensuring that there is coordination of action in respect of informal home safety assessments The QSAC discussed home safety assessments and home safety equipment together, noting that the provision of equipment was not always the most effective response to a risk of injury identified by an assessment advice (such as about the safe storage of medicines) could also be an effective approach. The committee noted that some parts of the relevant workforce (such as health visitors) were more likely to identify issues relating to children aged under 5, and the committee felt that this was the age group in which most accidents occurred and should therefore be the priority for assessments. The committee noted the distinction between informal assessments (for example, health visitors being watchful for potential risks when home safety is not the primary purpose of the home visit) and making referrals if required and formal assessments carried out by trained assessors on a room-by-room basis (the nature of such assessments and key risks were described to the committee). Following this discussion the committee asked the NICE team to draft three statements around home safety assessments and home safety equipment. One statement on formal assessment for families identified at need; another on following through the actions identified in formal home assessment to ensure actions are undertaken or equipment is provided if relevant; and a third on ensuring coordinated action in respect of informal home safety assessments i.e. making sure that all agencies visiting people s homes are aware of and considering safety issues. Additional areas Quality Standards Advisory Committee 4 meeting 26 th March of 11

5 A number of additional areas were discussed by the committee, but not progressed as potential quality statements, as they are out of scope of this quality standard: 6. QSAC specialist committee members and stakeholder list (part 1 open session) Local strategies and partnerships was not progressed because of lack of action-focus, but will be covered in detail underpinning the agreed statements. Workforce capacity and training was not progressed because training is not usually included within quality standards. Road safety speed restrictions was not progressed as it will be covered by another QS. E-cigarettes was not progressed as it is a very specific issue that may be covered by aspects of home safety assessments. RNJ asked the QSAC to consider the constituency of specialist committee members on the group and whether any additional specialist members were required. Specialist members: It was agreed that no additional Specialist Committee Members are required. Stakeholder list: The QSAC reviewed the stakeholder list and agreed that that they would send any suggestions for additional stakeholders to RNJ. 7. Next steps and timescales (part 1 open session) 8. Welcome and code of conduct for members of the public attending the meeting (public session) 9. Committee business (public session) LN outlined what will happen following the meeting and any key dates for the homes: preventing accident and unintentional injury quality standard. DL welcomed the public observers and reminded them of the code of conduct that they were required to follow. It was stressed that they were not able to contribute to the meeting but were there to observe only. They were also reminded that the Committee is independent and advisory therefore the discussions and decisions made today may change following final validation by NICE s guidance executive. Declarations of interest DL asked standing QSAC members to declare any interests that were either in addition to their previously submitted declaration or specific to the topic(s) under consideration at the meeting today. DL asked the specialist committee members to declare all interests. The following interests were declared: Standing committee members None Quality Standards Advisory Committee 4 meeting 26 th March of 11

6 Specialist committee members LB Organisation has received funding from NICE to perform evidence reviews. 10. Topic session smoking: harm reduction (private session) The committee then moved on to discuss smoking: harm reduction. The Committee moved to a closed session to discuss matters relating to a potential conflict of interest Recap of prioritisation exercise TW and SK presented a recap of the areas for quality improvement discussed at the first QSAC meeting for smoking: harm reduction At the first QSAC meeting on Monday 24 th November 2014 the QSAC agreed that the following areas for quality improvement should be progressed for further consideration by the NICE team for potential inclusion in the draft quality standard: Providing smoking harm reduction services offering harm reduction approaches Providing smoking harm reduction services commissioning harm reduction services Raising awareness raising awareness of nicotine-containing products Education and training for practitioners 10.2 and 10.3 Presentation and discussion of stakeholder feedback and key themes/issues raised However, the NICE team explained that a statement on education and training for practitioners could not be drafted as it was not possible to specify a level of training for harm reduction approaches to smoking that should be attained to make this statement clear and measurable. The full rationale for these decisions is available in the prioritisation meeting minutes which can be found here: TW and SK presented the committee with a report summarising consultation comments received on smoking: harm reduction. The committee was reminded that this document provided a high level summary of the consultation comments, prepared by the NICE quality standards team, and was intended to provide an initial basis for discussion. The committee was therefore reminded to also refer to the full list of consultation comments provided throughout the meeting. The committee was informed that comments which may result in changes to the quality standard had been highlighted in the summary report. Those comments which suggested changes which were outside of the Quality Standards Advisory Committee 4 meeting 26 th March of 11

7 process, were not included in the summary but had been included within the full list of comments, which was within the appendix. These included the following types of comment: Relating to source guidance recommendations Suggestions for non-accredited source guidance Request to broaden statements out of scope Inclusion of overarching thresholds or targets Requests to include large volumes of supporting information, provision of detailed implementation advice General comments on role and purpose of quality standards Requests to change NICE templates 10.4 Discussion and agreement of final statements A committee member questioned why pregnant women were excluded from the scope of the quality standard. Specialist Committee Members explained that the underlying source guidance excludes this group due to a lack of evidence concerning the effectiveness of nicotine containing products for smoking cessation in pregnancy and the benefits or appropriateness of particular harm reduction approaches (such as cutting down to quit) in pregnancy. The committee discussed each statement in turn and agreed upon a revised set. These statements are not final and may change as a result of the editorial and validation processes. Draft Quality Statement 1: People who decline a referral to a stop smoking service are offered a harm reduction approach to smoking. NICE team provided an overview of stakeholder comments. Stakeholders felt the setting in which harm reduction is offered should be considered and the statement shouldn t be limited to people who decline a referral to stop smoking but that discussions about harm reduction approaches should occur with all people if they are not ready or willing to stop smokign in one step. Stakeholders suggested that harm reduction could be appropriate for people who have stopped smoking but are concerned about relapse and those who have attempted unsuccessfully to quit. It was felt the statement didn t consider people who declined referral to a stop smoking service but may change their smoking behaviour or make a quit attempt through alternative means and that information on harm reduction should be available from sources other than one to one discussions. The subject of the statement as the person who declined referral was supported by one stakeholder. It was also suggested that electronic cigarettes or other unlicensed nicotine-containing products should be specifically mentioned within the definitions section of this statement. Quality Standards Advisory Committee 4 meeting 26 th March of 11

8 A question at consultation asked who should carry out the action in this statement to deliver the most impact. A variety of suggestions were received, including: all healthcare practitioners, pharmacists; GP s and nurses in primary and community care settings, clinicians and several other professionals including employed by local authorities and third sector organisations. The committee went on to discuss this statement in detail and considered the stakeholder comments. It was noted that this quality standard should be linked to the already published smoking cessation quality standard (QS43). The committee discussed when this should be offered and who should offer it. NICE team emphasised that it is important to ensure that this statement is measureable therefore who would carry out the statement must be considered. Specialist Committee Members noted that harm reduction approaches need to be broadly raised in awareness in order to have the most impact and to reach people who smoke and who would not necessarily access healthcare services. It was noted that the current wording could exclude a large proportion of people who could benefit. A Committee member noted that including an additional reference to people who refuse a referral to a stop smoking service (and who are not able or ready to stop smoking), could be useful to include within this quality statement. NICE team to re-draft this statement and process measures based on QSAC suggestions with the wording focussed on people who are unwilling or not ready to stop smoking rather than those who declined a referral The committee therefore agreed that the wording of the statement should focus on people who are unwilling or not ready to stop smoking rather than those who declined a referral. The NICE team will redraft this statement based on these suggestions, building on rewording put forward at the start of the meeting by the specialist committee members. It was also suggested by the committee to add another process measure to this statement and that the QOF could be used as a potential data source. NICE team to develop this further. Draft Quality Statement 2: People who decline a referral to a stop smoking service are advised that most health problems associated with smoking are caused by components in tobacco smoke other than nicotine, and about using nicotine-containing products The group discussed the feedback from stakeholders on this statement in relation to health problems associated with tobacco smoke and nicotine-containing products. NICE team provided an overview of stakeholder comments. Stakeholders felt discussions should be with all people who smoke and that supporting access to nicotine-containing products should be included. A stakeholder suggested amending the statement to refer only to licenced nicotine-containing products but Quality Standards Advisory Committee 4 meeting 26 th March of 11

9 another comment felt the focus should be on all nicotine-containing products not just licensed ones, as this may result in people rejecting unlicensed products. Some stakeholders raised concerns in relation to the wording of nicotine-containing products as these stakeholders perceived that these are not without harmful effects and suggested that the statement should detail how to handle enquiries on e-cigarettes. The committee felt two issues were being discussed in the statement- discussion about the relative safety of nicotine and advice about nicotine-containing products. The Committee also emphasised the importance of supporting access to nicotine- containing products. The specialist committee members suggested two alternative statements for this statement. One statement focussed on advising about nicotine and another on advising on (and supporting access to) nicotine-containing products. The Committee agreed to progress these statements and the NICE team agreed to re-draft based on the proposed amended statements while ensuring that the statements intent remained based on underlying source guidance (NICE PH45) recommendations. The committee also noted the importance of talking about unlicensed nicotine products. They pointed out that unlicensed nicotine-containing products such as electronic cigarettes are increasingly popular and should be mentioned in this quality standard. The NICE team agreed to take this away and look at including direct reference to electronic cigarettes while ensuring that the quality standard did not exceed the scope of the underlying source guidance. NICE team to re-draft this statement into two statements. One statement focussed on advising about nicotine and another on advising on (and supporting access to) nicotinecontaining products The Committee also questioned whether the word most should be included in the phrasing: most health problems associated with smoking are caused by components in tobacco smoke other than nicotine. It was suggested to remove the word most from the statement as the specialist committee members felt that there was no evidence that nicotine caused health problems. NICE team however noted that the statement s phrasing needed to be in line with phrasing in the underlying source guidance recommendation which states most, so this must be retained. Draft Quality Statement 3: Stop smoking services provide harm reduction approaches alongside existing approaches to stopping smoking in 1 step The group discussed stakeholder feedback on this statement in relation to stop smoking services providing harm reduction alongside existing approaches. Quality Standards Advisory Committee 4 meeting 26 th March of 11

10 There were relatively few stakeholder comments on this statement. This statement was supported by one stakeholder as being important and straightforward. Concern was, however, raised by other stakeholders that this statement wording missed the opportunity to reach people who would not access stop smoking services. A stakeholder felt that although harm reduction services offer support, other healthcare professionals should also engage with people who smoke. Stakeholders highlighted that this statement appears to suggest that referral to a stop smoking service is needed for harm reduction and may be confusing in relation to statement 1. It was suggested that unlicensed nicotine containing products should be explicitly mentioned in the definitions section of harm reduction approaches in this statement. Specialist Committee Members suggested a re-wording of this statement to include other healthcare professionals (as well as stop smoking services) providing harm reduction services. NICE team agreed to make the minor amendments to this statement, provided that the additional professionals could be defined using the source guidance (PH45) recommendations. A question included at consultation asked stakeholders to comment on whether at publication this smoking: harm reduction quality standard should be incorporated within the published smoking cessation quality standard (QS45). Overall, there was a mixed response in combining the two published quality standards. Stakeholders agreed that if the quality standards were not combined, that they should be cross linked. A Specialist Committee Member highlighted that NICE pathways already combine quality statements taken from different quality standards in a single resource so this would address the cross linkage. The committee discussed these comments. It was agreed on balance to keep the two smoking quality standards as separate. Additional areas suggested by stakeholders NICE team to try and reword this statement to include other additional healthcare professionals (as well as stop smoking services) providing harm reduction services by using the source guidance (PH45) recommendations to define these NICE team to keep the two smoking quality standards as separate at publication Additional areas for statements suggested at consultation were presented by the NICE team. The suggestions were discussed and it was felt these had already been addressed by the amendments to statements already proposed. 11. Supporting the quality standard (part 1 open session) RNJ presented a summary of the organisations who have expressed an interest in supporting the quality standard and asked the QSAC to consider whether any key organisations were missing. The specialist committee members agreed to send any suggestions by to RNJ. Quality Standards Advisory Committee 4 meeting 26 th March of 11

11 12. Next steps and timescales (part 1 open session) 13. Any other business (part 2 Private session) LN outlined what will happen following the meeting and any key dates for the smoking: harm reduction quality standard. The following items of AOB were raised: Specialist Committee Members expressed continued concern over the issue of tobacco companies being included as stakeholders, with specific reference to the UK s obligations under Article 5.3 of the Framework Convention on Tobacco Control, a global public health treaty. Therefore the NICE team agreed to provide a formal response with regards to NICE s position in this matter after the meeting. The Specialist Committee Members also wished to state for the record that they had discounted comments from the tobacco industry when reviewing the quality standard. DL thanked the specialist committee members for their input into the development of this quality standard, Date of next QSAC 4 meeting: Thursday 30 th April 2015 Quality Standards Advisory Committee 4 meeting 26 th March of 11