Implementing National Institute for Health and Care (NICE) Guidelines in Long-term Care in England and Wales: “Is it worth it?”- A theory-informed economic evaluation

Background: Providing affordable, good-quality long-term care is a pertinent challenge. Little is known about how councils implement good practice guidelines, resources required and the benefits of implementation. Objective: To assess the processes, cost and consequences of implementing guidelines by the National Institute for Health and Care Excellence in three councils in England and Wales. Methods: Using a theory-informed approach to economic evaluation, data were gathered from managers in councils and providers using workshops, conversations and questionnaires. Implementation activities were gathered systematically and costed using a tailored framework. Consequences were established by asking providers to estimate service use impacts from guideline adherence and assigning costs. A participatory approach was used with participants. Results: Costs of implementation linked to staff time inputs were £96,400 (council 1), £113,300 (council 2), and £130,000 (council 3). Cost referred to setting up organisational structures, conducting a wide range of activities with providers (e.g., training, audits) and dissemination. Cost drivers were linked to processes such as gaining senior managers’ buy-in and involving front-line staff. Quantifiable gains related to guideline adherence reflected a shift to prevention-focused services, promoted in many of the NICE guidelines. Wider benefits included those of staff wellbeing. Although service providers were satisfied with the implementation activities, the contribution to guideline adherence was difficult to establish. Conclusion: Resource implications linked to adherence with recommended practice might need to be carefully considered when developing and disseminating guidelines. Theory-informed, participatory approaches to evaluation are supporting relevance and feasibility.