NICE …. ….past, present & future

NICE….….past,

present & future

Internationally ….• Aging populations

• Increasing public demands & expectations (consumerisation)

• Rising costs

• Limited budgets

• Changes to the patterns of disease

• Burgeoning knowledge base

• Transparency decision making

NICE was established to …

• encourage faster uptake of clinically & cost effective new treatments,

• promote more equitable access to treatments (new or existing) of proven clinical and cost effectiveness

• promote the better use of resources in the NHS, by focussing resources on treatments which achieve most health gain in relation to the NHS/PSS resources expended

• promote the longer-term interest of the NHS in the development of innovative treatments for the future.

Setting, Delivering & Monitoring StandardsSetting, Delivering & Monitoring Standards

NICENational Service Frameworks

NICENational Service Frameworks

Commission for Health Improvement National Performance Framework

National Patient & User Survey

National Patient Safety Agency

Commission for Health Improvement National Performance Framework

National Patient & User Survey

National Patient Safety Agency

Clear standards of service

Clear standards of service

Monitored standardsMonitored standards

ProfessionalSelf-regulationProfessional

Self-regulationClinical

governanceClinical

governanceLifelong learningLifelong learning

Patient and public

involvement

Patient and public

involvement

Patient and public

involvement

Patient and public

involvement

Patient and public

involvement

Patient and public

involvement

Dependable local

delivery

Dependable local

delivery

Work programmes

1999

• Technology Appraisals

• Clinical Guidelines

• Audit

• Confidential Enquiries

• Prodigy

• Effectiveness publications

April 2003

• Technology Appraisals

• Clinical Guidelines

• Cancer Service Guidance

• Interventional Procedures

• Screening

• Borderline substances

• Confidential Enquiries

• MeReC Series

Guidance represents the view of the Institute, which was arrived at after a careful

consideration of the available evidence. Health professionals are expected to take it

fully into account when exercising their clinical judgement, it does not however

override their individual responsibility to make appropriate decisions in the

circumstances of the individual patient, in consultation with the patient and/or guardian

or carer.

NICE Guidance…..

•Behavioural

•Cancer

•Cardiovascular

•Central Nervous System

•Dental, oral & facial

•Endocrine & metabolic

•ENT

•Eye

•Gastrointestinal

•Gynaecology, pregnancy & childbirth

• Infections & infectious diseases

• Injuries & accidents

• Mental health

• Miscellaneous

• Musculo-skeletal

• Nutritional disorders & weight control

• Renal & urinary

• Respiratory

• Skin disorders & wounds

The InstituteThe Institute

Special Health Authority

A network

Creates,manages & quality controls

Between 50 and 60 people in 2002/3

£15 million budget (60% invested externally in professional organisations)

NICE Style• inclusive

• transparent

• consultative

• accessible

• developmental

Topic Selection

• Is the technology likely to result in a significant :

health benefit, across NHS as a whole?

impact on NHS service priorities?

impact on NHS resources?

• Will NICE guidance add value?

Dept. of Health

Welsh Assembly Government

Developing NICE guidance

• Independent advisory committees

• Expert contributions

• Inclusive evidence base

• Multiple perspectives

• Genuine and public consultation

• Regular review

Technology Appraisals


A review of clinical & economic evidence

leading to recommendations on the

appropriate use of new & existing medicines

& treatments


• Pharmaceuticals (eg medicines)

• Devices (eg Hip Joints)

• Diagnostics (eg tests for illness)

• Procedures (eg key hole surgery)

• Health promotion (eg role of diet in managing

type 2 diabetes)

Statutory Appraisal Committee Members appointed for 3 yrs

Professional & patient/carers(nominated by own groups)attend & inform as Experts.

• Primary Care (GP & Research)

• Patients

• Health Economists

• NHS Management

• Nursing

• Biosatisticians

• Professions Allied to Medicine

• Midwifery

• Secondary Care

• Public Health

• Healthcare Industries

Frame of Reference• broad clinical priorities for the NHS

• degree of clinical need of patients with the condition

• broad balance of benefits and costs

• guidance on resources likely to be available

• effective use of available resources

• & encouraging innovation

Guidance Issued direct to NHS, patients &

public*

Guidance Issued direct to NHS, patients &

public*

Draft guidance (FAD)

circulated for appeal*

Appraisal Committee

reconsideration (minutes*)

Consultation on provisional views (ACD)*

Appraisal Committee

consideration (minutes*)

Patients & experts attend

Appraisal Committee

Consult on independent

literature review *

Submissions received to inform the process from all stakeholders

Draft, Consult on & finalise

scope of Appraisal*

Identify & consult on

Stakeholders *

Appraisal Process

Independent Review Group

Commissioned*

Topic referred to NICE*

* Published on NICE web site

Clinical Guidelines

Clinical Guidelines

•Recommendations on the appropriate NHS

treatment and care of patients with specific

diseases and conditions

• cover any aspect of management from

prevention & self-care through primary &

secondary care to more specialised services.

NICE guidelines

• Based on the best available evidence. Guidelines assist the practice of healthcare professionals, but do not replace their knowledge and skills.

• Guidelines are advisory

• Cover management of diseases/conditions in response to a request from the Dept of Health and Welsh Assembly Government.

Key principles of NICE guidelines...

• Improve the quality of clinical care

• Address clinical and cost-effectiveness

• Are developed through an inclusive and transparent stakeholder process

• Should command respect of patients and professionals

• Set out clinical care that can reasonably be expected in the NHS.

Clinical Guidelines

•Developed with national professional bodies - ‘collaborating centres’

•Recommend best sequence of treatment

•… or service delivery arrangements

•Contain full audit methodology

National Collaborating Centres

• 6 National Collaborating Centres

•NCC Acute Care

•NCC Chronic Care

•NCC Mental Health

•NCC Nursing and Supportive Care

•NCC Primary Care

•NCC Women and Children’s Health

• 2 Support Units

•Patient Involvement

•Technical Support.

Collaborating Centres (1)

Acute CareSurgeons*, Anaesthetists, Dental Surgery, Ophthalmologists

Nursing & Supportive CareRCN*, College of Health, UK Cochrane Centre, Institute of Health Sciences Oxford, College of Occupational Therapists, Centre for Evidence Based Nursing

Women and Child Health

Obstetricians & Gynaecologists*, Faculty of Family Planning & Reproductive Health Care, Paediatrics & Child Health, Association of Genito-urinary Medicine, Midwives

Collaborating Centres (2)

Mental HealthBritish Psychological Society*, Psychiatrists*RCN, College of Occupational Therapy, General Practitioners, Institute of Psychiatry, Royal Pharmaceutical Society, MIND, National Schizophrenia Fellowship, Manic Depression Fellowship

Chronic DiseasePhysicians*, Physiotherapy Surgeons, General Practitioners, Royal Pharmaceutical Society, College of Health,

Primary CareGeneral Practitioners*, Royal Pharmaceutical Society, Community Practitioners & Health Visitors AssociationSchool of Health & Related Research- Sheffield, Department of General Practice & Primary Health Care- Leicester

Guidelines Process(1)

Initiate project(up to 2 weeks)

Initiate:• Topic received

from DH & NAW

• NICE identifies National Collaborating Centre

• Topic published on website and expressions of interest called for

• Identify stakeholders & interested parties

Stakeholders

Patients

Professions Industry

NHS

NICE website & stakeholders

• Express an Interest

• See the scope of guideline

• Expected date of publication

• Lead developers

• Contact details

• Consultation documents.



Commission:• NCC produces

scope

• Scope published on web

• Scope revised in line with stakeholder comments

• NICE commissions NCC to produce guideline

• NCC produces detailed work plan

Scoping and commissioning

(up to 8 weeks)

Scope of the guideline

Includes:-

• Remit from the DoH / WAG

• Population to be covered

• Interventions

• (lifestyle, complimentary therapies, carers)

• Setting

Guidelines Process(3) Development:Collaborating Centre:

develops models of care

formulates questions

access analysis & evidence

Develops audit criteria

prepare draft consults

NICE: Provides tech

input monitors reports progress

to GAC

Draft guideline submitted to NICE

Guideline Development(12-18 months)



(up to 8 weeks)

GAC= Guidelines Advisory Committee

Guidelines Advisory Committee: Roles

• Validating guidelines

• Scope

• Draft guidelines

• Endorsing methodology

• Workplans

• Regular reports

• Do not write guidelines

Chair: Professor Martin Eccles

Guidelines Advisory Committee

• Patients

• Health economists

• Primary care (GP & Research)

• NHS management

• Nursing

• Midwifery

• Allied health professionals

• Secondary care

• Public health

• Expertise clinical guideline development & effectiveness

• Healthcare industries.



Validation:• NCC submits

guideline to NICE• Draft documents

published on the web

• Consultation on draft guideline with stakeholders

• GAC review of guideline

• NICE & NCC review & agree further work

• Consultation on second draft

• NICE and GAC approve use of guideline for NHS


(up to 18 weeks)


Validation(up to 12 weeks)



Publication:

•NICE & NCC publish & disseminate

NICE guideline (short form)

Patient version

Full guideline

•Guideline reviewed at agreed date


(up to 8 weeks)


Validation(up to 12 weeks)

Publication

Confidential Enquiries

Confidential Enquiries

• Research into the way patients who die have been treated that identifies ways of improving the quality of care.

• Aim to identify changes in practice that might improve the quality of clinical practice and reduce the number of deaths.

Reviewed, reorganised & roles expanded into 3 new enquiries:

• Mental Health, building on the current work of Confidential Inquiry into Suicide and Homicide by People with Mental Illness (CISH).

• Medical and Surgical Care, extending the work of National Confidential Enquiry into Perioperative Deaths (NCEPOD)

• Maternal and Child Health, formed by the reorganisation and merger of Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) + Confidential Enquiry into Maternal Deaths (CEMD)

Citizens Council

The Citizens Council brings the views of

the public to NICE decision making about

guidance for treatments and care in the

NHS

Citizens Council

Why a Citizens Council?

• because NICE need to know that their values are consistent with those who use the NHS

• NICE and the NHS will benefit from the experience of ordinary people about dealing with uncertainty

• it's a meaningful way of involving the public in NHS decision-making

• NICE will take better decisions as a result

How the Council fits in…

Independent Groups & Advisory Committees

NICE GuidanceNICE Guidance

CC Steering

Committee

Citizens Council

Who are members of the Council?

•Age profile of England & Wales

•Gender

•Social demography

•Ethnicity

•Different abilities

30 members of the public who reflect…………

Who are not on the council?

• People connected with the NHS

• All health professionals

• People connected with or who work for pharmaceutical companies or device manufacturers

• People who already belong to a patient representation group, health lobby groups or pressure groups

www.nice.org.uk

Documents

NICE …. ….past, present & future