NICE…. ….past, present & future. Internationally …. Aging populations Increasing public...
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Transcript of NICE…. ….past, present & future. Internationally …. Aging populations Increasing public...
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)
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
Technology Appraisals
• 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
•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
NICE website & stakeholders
• Express an Interest
• See the scope of guideline
• Expected date of publication
• Lead developers
• Contact details
• Consultation documents.
Guidelines Process(2)
Initiate project(up to 2 weeks)
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)
Initiate project(up to 2 weeks)
Scoping and commissioning
(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.
Guidelines Process(4)
Initiate project(up to 2 weeks)
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
Scoping and commissioning
(up to 18 weeks)
Guideline Development(12-18 months)
Validation(up to 12 weeks)
Guidelines Process(5)
Initiate project(up to 2 weeks)
Publication:
•NICE & NCC publish & disseminate
NICE guideline (short form)
Patient version
Full guideline
•Guideline reviewed at agreed date
Scoping and commissioning
(up to 8 weeks)
Guideline Development(8-18 months)
Validation(up to 12 weeks)
Publication
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)
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