NICE: what it is and how it works Professor David Haslam, Chair, NICE 10 th June 2015

NICE: what it is and how it works

Professor David Haslam, Chair, NICE10th June 2015

Contents

• An overview of NICE’s work

• How we make recommendations

• What’s new and in the pipeline?

The background: why NICE was set up

• Established in 1999

• Aim: to reduce variation in the availability and quality of treatments and care (the so called ‘postcode lottery’)

• To resolve uncertainty about which medicines and treatments work best and which represent best value for money for the NHS

“Probably not, but it’s worth a bloody good try.”

Frank Dobson, Health Secretary, who established NICE in 1999, when asked whether he thought it would work.

A Brief History1999: Technology appraisals

Clinical guidelines

2002: Interventional procedures

Implementation

2005: Public health guidelines

2008 : NICE International

2009: Cost saving MedTech programme (new technologies)

Diagnostics

NICE Evidence

2011: National Prescribing Centre (now Medicines Prescribing

Centre)

2013: Social care guidelines

Highly specialised technologies

2014: Safe staffing guidelines

NICE Guidance by YearN

umbe

r of

pub

licat

ions

Year

NICE: Improving outcomes for people

Core principles of NICE’s work

• Based on the best available evidence of what works and what it costs

• Independent and unbiased advisory committees• Patient, service user and carer involvement• Genuine consultation• Regular review• Open and transparent process• Social values and equity considerations

NHS constitution 2012

“You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you.”

How does NICE develop recommendations?

Cost effectiveness

Clinical effectiveness

Cost effectivenessClinical

effectiveness

Committee decision making

RecommendationsRecommendations

Equality

legislation

Equality

legislation

InnovationInnovation

Social Value JudgementsSocial Value Judgements

Extent of uncertainty

Extent of uncertainty

Other health benefits

Other health benefits

Cost-effectiveness

Cost-effectiveness

Clinical effectivenessClinical effectiveness

Patients’ and service users’ views matter

Patient preferences

Example: kidney dialysisCommittee assumed patients would prefer dialysis at home.

Some patients told us they disliked home machines as it meant their illness dominated their lives.

Patients’ experience of care

Example: people who self-harm

People in mental distress who self-harm told us that they were not routinely offered anaesthesia or pain relief for sewing up wounds in the hospital emergency department.

Nothing in the published research to indicate this was an issue. NICE made recommendations to address this.

Economic evaluation of new drugs/treatments

• How well does the drug/treatment work in relation to how much it costs compared to standard practice in the NHS ?

• Recognises the reality of fixed NHS resources• Exposes the opportunity cost of new

interventions, that is if you spend money on a new healthcare intervention, you have to take away the health care from someone else

• Enables consistency and fairness across all decisions

Cost per QALY (£’000)

Breakdown of recommendations 338 drug appraisals published from 1 Mar 2000 – 31 March 2015

Containing 578 individual recommendations

‘Yes’ recommended for routine use or under specific circumstances

‘no’ or ‘only in research’

What’s new and in the pipeline?

NICE and social care• A new remit to produce guidance

and standards for social care from April 2013

• A more integrated approach to supporting people, crossing health, public health and adults and children’s services

• Developed in partnership with service users, carers and social care professionals

Social care topics in the pipeline include:

Service user and carer experience

Care and support of older people with learning disabilities

Regaining independence in older people who experience a fall

Challenging behaviour and learning disabilities

Transition from children’s to adults’ services

Keeping up to date with the latest from NICE

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Thank you.

David.haslam@nice.org.uk