NICE …. ….past, present & future

1. NICE….….past, present & future

2. Internationally …. • Aging populations • Increasing public demands & expectations (consumerisation) • Rising costs • Limited budgets • Changes to the patterns of disease • Burgeoning knowledge base • Transparency decision making

3. 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.

4. NICE National Service Frameworks Professional Self-regulation Clinical governance Lifelong learning Commission for Health Improvement National Performance Framework National Patient & User Survey National Patient Safety Agency Setting, Delivering & Monitoring Standards Patient and public involvement Clear standards of service Patient and public involvement Dependable local delivery Patient and public involvement Monitored standards

5. Work programmes April 2003 • Technology Appraisals • Clinical Guidelines • Cancer Service Guidance • Interventional Procedures • Screening • Borderline substances • Confidential Enquiries • MeReC Series 1999 • Technology Appraisals • Clinical Guidelines • Audit • Confidential Enquiries • Prodigy • Effectiveness publications

6. 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.

7. 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 NICE Guidance…..

8. The 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)

9. NICE Style • inclusive • transparent • consultative • accessible • developmental

10. 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

11. Developing NICE guidance • Independent advisory committees • Expert contributions • Inclusive evidence base • Multiple perspectives • Genuine and public consultation • Regular review

12. Technology Appraisals

13. Technology Appraisals A review of clinical & economic evidence leading to recommendations on the appropriate use of new & existing medicines & treatments

14. 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)

15. Statutory Appraisal Committee Members appointed for 3 yrs • Primary Care (GP & Research) • Patients • Health Economists • NHS Management • Nursing • Biosatisticians • Professions Allied to Medicine • Midwifery • Secondary Care • Public Health • Healthcare Industries Professional & patient/carers (nominated by own groups) attend & inform as Experts.

16. 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

17. Independent Review Group Commissioned* Draft, Consult on & finalise scope of Appraisal* Identify & consult on Stakeholders * Topic referred to NICE* Appraisal Committee consideration (minutes*) Patients & experts attend Appraisal Committee Submissions received to inform the process from all stakeholders Consult on independent literature review * Appraisal Committee reconsideration (minutes*) Draft guidance (FAD) circulated for appeal* Consultation on provisional views (ACD)* Appraisal Process Guidance Issued direct to NHS, patients & public* *Published on NICE web site

18. Clinical Guidelines

19. 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.

20. 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.

21. 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.

22. Clinical Guidelines • Developed with national professional bodies- ‘collaborating centres’ • Recommend best sequence of treatment • … or service delivery arrangements • Contain full audit methodology

23. 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.

24. Collaborating Centres (1) Acute Care Surgeons*, Anaesthetists, Dental Surgery, Ophthalmologists Nursing & Supportive Care RCN*, 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

25. Collaborating Centres (2) Mental Health British Psychological Society*, Psychiatrists* RCN, College of Occupational Therapy, General Practitioners, Institute of Psychiatry, Royal Pharmaceutical Society, MIND, National Schizophrenia Fellowship, Manic Depression Fellowship Chronic Disease Physicians*, Physiotherapy Surgeons, General Practitioners, Royal Pharmaceutical Society, College of Health, Primary Care General Practitioners*, Royal Pharmaceutical Society, Community Practitioners & Health Visitors Association School of Health & Related Research- Sheffield, Department of General Practice & Primary Health Care- Leicester

26. 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 Guidelines Process(1) Initiate project (up to 2 weeks)

27. Patients Professions Industry NHS Stakeholders

28. NICE website & stakeholders • Express an Interest • See the scope of guideline • Expected date of publication • Lead developers • Contact details • Consultation documents.

29. 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 Guidelines Process(2) Initiate project (up to 2 weeks) Scoping and commissioning (up to 8 weeks)

30. Scope of the guideline Includes:- • Remit from the DoH / WAG • Population to be covered • Interventions • (lifestyle, complimentary therapies, carers) • Setting

31. 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 Guidelines Process(3) Initiate project (up to 2 weeks) Scoping and commissioning (up to 8 weeks) Guideline Development (12-18 months) GAC= Guidelines Advisory Committee

32. Guidelines Advisory Committee: Roles • Validating guidelines • Scope • Draft guidelines • Endorsing methodology • Workplans • Regular reports • Do not write guidelines

33. Guidelines Advisory Committee Chair: Professor Martin Eccles • Allied health professionals • Secondary care • Public health • Expertise clinical guideline development & effectiveness • Healthcare industries. • Patients • Health economists • Primary care (GP & Research) • NHS management • Nursing • Midwifery

34. 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 Guidelines Process(4) Initiate project (up to 2 weeks) Scoping and commissioning (up to 18 weeks) Guideline Development (12-18 months) Validation (up to 12 weeks)

35. Publication: • NICE & NCC publish & disseminate • NICE guideline (short form) • Patient version • Full guideline • Guideline reviewed at agreed date Guidelines Process(5) Initiate project (up to 2 weeks) Scoping and commissioning (up to 8 weeks) Guideline Development (8-18 months) Validation (up to 12 weeks) Publication

36. Confidential Enquiries

37. 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.

38. 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)

39. Citizens Council

40. Citizens Council The Citizens Council brings the views of the public to NICE decision making about guidance for treatments and care in the NHS

41. 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

42. Citizens Council Independent Groups & Advisory Committees CC Steering Committee How the Council fits in… NICE Guidance

43. Who are members of the Council? 30 members of the public who reflect………… • Age profile of England & Wales • Gender • Social demography • Ethnicity • Different abilities

44. 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

45. www.nice.org.uk