Transcript Nice - new background,

NICE….
….past,
present &
future
Internationally ….
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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 …
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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
Standards
Patient and
public
involvement
Patient and
public
involvement
Patient and
public
involvement
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
Clear
standards
of service
Dependable
local
delivery
Monitored
standards
Work programmes
1999
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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
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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
• Infections & infectious
diseases
•Cancer
• Injuries & accidents
•Cardiovascular
•Central Nervous System • Mental health
• Miscellaneous
•Dental, oral & facial
• Musculo-skeletal
•Endocrine & metabolic
• Nutritional disorders &
•ENT
weight control
•Eye
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Renal & urinary
•Gastrointestinal
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Respiratory
•Gynaecology, pregnancy & • Skin disorders & wounds
childbirth
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)
NICE Style
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inclusive
transparent
consultative
accessible
developmental
Topic Selection
• Is the technology likely to
result in a significant :
Dept. of Health
 health benefit, across NHS
as a whole?
Welsh Assembly
Government
 impact on NHS service
priorities?
 impact on NHS resources?
• Will NICE guidance add
value?
Developing NICE guidance
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Independent advisory committees
Expert contributions
Inclusive evidence base
Multiple perspectives
Genuine and public consultation
Regular review
Technology
Appraisals
Technology Appraisals
A review of clinical & economic evidence
leading to recommendations on the
appropriate use of new & existing medicines
& treatments
Technology Appraisals
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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
• 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.
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
Appraisal Process
Topic referred to
NICE*
Independent
Review Group
Commissioned*
Identify &
consult on
Stakeholders *
Draft, Consult
on & finalise
scope of
Appraisal*
Appraisal
Committee
consideration
(minutes*)
Patients &
experts attend
Appraisal
Committee
Consult on
independent
literature review *
Submissions
received to inform
the process from
all stakeholders
Consultation
on provisional
views (ACD)*
Appraisal
Committee
reconsideration
(minutes*)
Draft guidance
(FAD)
circulated for
appeal*
Guidance
Issued direct to
NHS, patients &
public*
* 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 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
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
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
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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)
Scoping and
commissioning
(up to 8 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
Scope of the guideline
Includes:-
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Remit from the DoH / WAG
Population to be covered
Interventions
• (lifestyle, complimentary
therapies, carers)
Setting
Guidelines Process(3) Collaborating Centre:
Development:
Initiate
project
(up to 2
weeks)
Scoping and
commissioning
(up to 8 weeks)
Guideline Development
(12-18 months)
GAC= Guidelines Advisory Committee
 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 Advisory
Committee: Roles
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Validating guidelines
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Endorsing methodology
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Do not write guidelines
• Scope
• Draft guidelines
• Workplans
• Regular reports
Guidelines Advisory
Committee
Chair: Professor Martin Eccles
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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
Scoping and
commissioning
(up to 2
weeks)
(up to 18 weeks)
Guideline Development
(12-18 months)
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
Validation
(up to 12
weeks)
• NICE and GAC
approve use of
guideline for NHS
Guidelines Process(5)
Initiate
project
Scoping and
commissioning
(up to 2
weeks)
(up to 8 weeks)
Guideline Development
(8-18 months)
Validation
(up to 12
weeks)
Publication
Publication:
•NICE & NCC
publish &
disseminate
NICE
guideline
(short form)
Patient
version
Full guideline
•Guideline
reviewed at
agreed date
Confidential
Enquiries
Confidential Enquiries
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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:
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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
Citizens Council
The Citizens Council brings the views of
the public to NICE decision making about
guidance for treatments and care in the
NHS
Why a Citizens Council?
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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…
Citizens
Council
Independent Groups &
Advisory Committees
CC
Steering
Committee
NICE Guidance
Who are members of the
Council?
30 members of the public who
reflect…………
• Age profile of England & Wales
• Gender
• Social demography
• Ethnicity
• Different abilities
Who are not on the council?
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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