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Standards Debate at the Centre for Better Managed Health Care, Cass Business School, City University London, 26th October 2011. Professor Mike Kelly Director of the Centre for Public Health Excellence The National Institute for Health and Clinical Excellence (NICE) Archie Cochrane’s Principles • The best care available to all. • The need for a means to determine what was best treatment. • The importance of rooting out harmful or useless practice. • The necessity of ascertaining costs and benefits. The legacy • The Cochrane and Campbell Collaborations. • Health economics and the Quality Adjusted Life Year (QALY) • The NHS Centre for Reviews and Dissemination (University of York). • The Cochrane controlled trials register. • Fast electronic search engines accessing large data bases. • Systematic Review and metaanalysis • NICE NICE The National Institute for Health and Clinical Excellence (NICE) is the independent organisation in the UK responsible for providing national guidance to the NHS and the wider public health community on the promotion of good health and the prevention and treatment of ill health. Has had a public health role since 2005. The pillars of NICE’s work • Comprehensive evidence base • Expert input • Patient and carer involvement • Independent advisory committees • Genuine consultation • Regular review • Open and transparent process. Methodological principles governing all NICE’s work • • • • • Base recommendations on the best available evidence. To determine cost effectiveness using the QALY. To be clear about scientific and other values To allow contestability. To be seen to be and to be independent of government, the pharmaceutical industry and other vested interests. The hierarchy of evidence Assessing Cost Effectiveness 1 Probability of rejection x XX XX 0 10 20 30 40 Cost per QALY (£K) 50 NICE Quality Standards • NICE quality standards are a set of specific, concise statements and associated measures. They set out aspirational, but achievable, markers of high-quality, cost-effective patient care, covering the treatment and prevention of different diseases and conditions. • Derived from the best available evidence such as NICE guidance and other evidence sources accredited by NHS Evidence, they are developed independently by NICE, in collaboration with NHS and social care professionals, their partners and service users, and address three dimensions of quality: clinical effectiveness, patient safety and patient experience. • NICE quality standards are central to supporting the Government's vision for an NHS focussed on delivering the best possible outcomes for patients, as detailed in the 2010 NHS White Paper Equity and Excellence Liberating the NHS. • Quality standards will be reflected in the new Commissioning Outcomes Framework and will inform payment mechanisms and incentive schemes such as the Quality and Outcomes Framework (QOF) and Commissioning for Quality and Innovation (CQUIN) Payment Framework. NICE quality standards enable: • Health and social care professionals to make decisions about care based on the latest evidence and best practice. • Patients and carers to understand what service they should expect from their health and social care provider. • Service providers to quickly and easily examine the clinical performance of their organisation and assess the standards of care they provide • Commissioners to be confident about purchasing. E X A G B F I C H K D J Y L The health gradient Hi Health state Lo Lo Hi Social status The health gradient Hi Health state Lo Lo Hi Social status The health gradient Hi Health state Lo Lo Hi Social status Shifting the health gradient Hi Health state Lo Lo Hi Social status