Quality Standards Advisory Committee 4 Winter deaths: preventing excess winter deaths prioritisation meeting Attendees Minutes of the meeting held on Friday 29 th May 2015 at the NICE offices in Manchester Standing Quality Standards Advisory Committee (QSAC) members Damien Longson (DL) [Chair], Tim Fielding (TF), Alaster Rutherford (AR), Rubin Minhas (RM), Alison Allam, (AA), John Jolly (JJ), Harry Allen (HA), Frances Garraghan (FG), Jane Bradshaw (JB), Moyra Amess (MA) Specialist committee members Winter deaths Neil Walker (NW), John Kolm-Murray (JKM), Andrew Probert (AP), Simon Roberts (SR), Nada Lemic (NL) NICE staff Karyo Angeloudis (KA), Tony Smith (TS), Nick Baillie (NB), Lisa Nicholls (LN) Apologies Standing Quality Standards Advisory Committee (QSAC) members Zoe Goodacre, Allison Duggal, Roger Hughes, Michael Varrow, Nicola Hobbs-Brake, David Weaver, Asma Khalil 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 informed the committee of the apologies and reviewed the agenda for the day. 3. Committee business (public session) 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: Quality Standards Advisory Committee 4 meeting 29 th May 2015 1 of 5
Specialist committee members SR - Chief Executive of Centre for Sustainable Energy charity runs initiatives on tackling causes of cold homes and fuel poverty. JKM - Employed as Seasonal Health & Affordable Warmth Co-ordinator at London Borough of Islington, Director of National Right to Fuel Campaign, Trustee of British Gas Energy Trust, member of End Fuel Poverty Coalition Steering Group, Deputy Chair of Carbon Action Network and Vice Chair of London HECA Forum 4. Topic session winter deaths: preventing excess winter deaths (public session) 4.1 and 4.2 Topic overview and summary of engagement responses Minutes from the last meeting The committee reviewed the minutes of the last meeting held on 30 th April and confirmed them as an accurate record. The committee then moved on to discuss winter deaths: preventing excess winter deaths. KA presented the topic overview and a summary of responses received during engagement on the topic. There was some initial discussion between specialist committee members and standing members about the relationship between cold homes, ill-health and winter deaths. The committee suggested that the focus of the source guideline was on health consequences of cold homes and should be reflected in the title of the quality standard. NICE team to review the title of the quality standard to reflect the focus of the statements and the source guideline. 4.3 Prioritisation of quality improvement areas KA 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. Local service coordination Identification of at-risk people Referral Interventions The QSAC agreed that the following areas for quality improvement should be progressed for further NICE team to draft quality statements about: The use of local joint strategic needs assessment and data sharing to identify at-risk people. Quality Standards Advisory Committee 4 meeting 29 th May 2015 2 of 5
consideration by the NICE team for potential inclusion in the draft quality standard: Local service coordination Use and integration of data was discussed in relation to identifying at-risk populations. Potential data sources were discussed that could inform local joint strategic needs assessment. The range of potential services provided by different sectors was highlighted, and joint strategic needs assessment was discussed as a mechanism for coordinating local action. The committee agreed that a quality statement should be drafted using the guideline recommendations about local strategy and coordination through joint strategic needs assessment to identify at-risk people. The value of a single point of contact referral service was discussed as a focus for referrals from health and social care practitioners, and with effective links to all relevant agencies and services. It was emphasised that such a referral service should be able to provide effective tailored help to its service users, and should not simply be a signposting service. The committee agreed that a quality statement should be drafted using the guideline recommendations about the provision of an effective local single point of contact referral service to help vulnerable people who live in cold homes to receive tailored interventions and services. Identification of at-risk people It was noted that some aspects of identification of at-risk people would be covered by the suggested quality statement about the joint strategic needs assessment. The committee discussed other potential actions to identify people at risk of ill-health from cold homes, including the use of GP clinical information systems to records risk factors. It was agreed that national GP information system standards were not appropriate as a potential quality standard statement. The committee agreed that a quality statement should be drafted to cover assessment of the heating needs or risks associated with cold homes for vulnerable people as part of routine care and assessment by primary healthcare and home care practitioners. It was noted that such a statement would need to be underpinned by reference to the relevant guideline recommendations about training and awareness among practitioners. Referral The committee felt that care quality in terms of referrals could be addressed by the provision of an The provision of an effective local single point of contact referral service to help vulnerable people who live in cold homes to receive tailored interventions and services. Vulnerable people having their heating needs assessed regularly by primary healthcare and home care practitioners. Assessment of the risk of ill-health due to cold homes when vulnerable people are discharged from hospital or social care settings. NICE team to draft a statement referral, underpinned by the knowledge and awareness to do this. Quality Standards Advisory Committee 4 meeting 29 th May 2015 3 of 5
effective single point of contact referral service, which would be the focus of a statement as outlined above. Interventions Committee discussion focused on the suggestion for a quality statement about the discharge process from hospital or social care settings to home, and the potential benefits of ensuring that people are not discharged to cold homes (even if they are discharged in the summer when they may be vulnerable later in the year). An assessment of risks from cold homes at discharge could lead to referral to a single point to contact service. The committee agreed that a quality statement should be drafted to cover the assessment at discharge of the risk of cold homes. Additional areas The following additional areas were discussed by the committee, but not progressed as potential quality statements: Respiratory conditions not progressed because quality standards for COPD and asthma have been developed and a quality standard on pneumonia has been referred. Pneumococcal vaccinations not progressed because no source recommendations were identified to support this suggested improvement area. In addition, this area of quality improvement will in part be addressed by a specific quality standard on vaccinations (ages 0-18). Flu vaccinations not progressed because this will be addressed by a specific quality standard on influenza. Smoking cessation not progressed because a quality standard has been developed on smoking cessation. Falls not progressed because a future quality standard will be developed on falls. Social isolation not progressed because it will be addressed by a specific quality standard on older people: promoting mental wellbeing and independence through primary, secondary and tertiary prevention, for which the source guideline is due to publish in November 2015. Based on recommendation 5 (second bullet) underpinned by recommendation 8 & 9. NICE team to progress a statement on tailored interventions. What services do in the way of intervention and what makes a difference. Include some elements of what makes an effective point of contact in definitions. Quality Standards Advisory Committee 4 meeting 29 th May 2015 4 of 5
Age-friendly housing designs not progressed because it will be addressed by a specific quality standard on housing: planning to improve health and wellbeing. Prompt evidence based treatment (when older people develop illness associated with cold weather, in particular respiratory tract infections) not progressed because quality standards have been published for COPD and asthma and a quality standard on pneumonia has been referred. Training quality statements are not developed on training, but practitioner awareness will be referenced in the draft statement about assessment by primary healthcare and home care practitioners. It was noted that equality issues would be considered for each of the draft statements, and that committee members would be invited to highlight any relevant considerations during the drafting of the quality standard. 5. QSAC specialist committee members (part 1 open session) 6. Next steps and timescales (part 1 open session) 7. Any other business (part 1 open session) NB 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 suggested that an occupational therapist be recruited to help with the statement on assessment of risk from cold homes at discharge from hospital or social care settings. Such specialist input could contribute to ensuring that relevant issues are considered for people discharged from hospitals (including mental health settings) and social care settings. LN outlined what will happen following the meeting and any key dates for the winter deaths: preventing excess winter deaths quality standard. The following items of AOB were raised: None raised Date of next meeting for winter deaths: preventing excess winter deaths: Thursday 26 th November 2015 Date of next QSAC 4 meeting: Thursday 26 th June 2015 Quality Standards Advisory Committee 4 meeting 29 th May 2015 5 of 5