NICE National Institute for Health and Clinical Excellence.

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NICE National Institute for Health and Clinical
Excellence.
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History

• National Institute for Clinical Excellence was
  formed in 1999.
• The Institute absorbed the role of the Health
  Development Agency (a public health body) in
  April 2005 to create a single excellence-in-practi
  ce organisation responsible for providing
  national guidance on the promotion of good health
  and the prevention and treatment of ill health.
• Still called NICE, but is now the National
  Institute for Health and Clinical Excellence.
• 93 clinical guidelines published so far.

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What are NICE clinical guidelines?

• Clinical guidelines are recommendations by NICE
  on the appropriate treatment and care of people
  with specific diseases and conditions within the
  NHS. They are based on the best available
  evidence. Guidelines help health professionals in
  their work, but they do not replace their
  knowledge and skills.

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The aim of clinical guidelines.

• To improve the quality of healthcare
• Provide recommendations for the treatment and
  care of people by health professionals
• To develop standards to assess the clinical
  practice of individual health professionals
• To be used in the education and training of
  health professionals
• To help patients to make informed decisions, and
  improve communication with patients.

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How are NICE Guidelines developed?

• Topic chosen by the Secretary of State.
• Stakeholder organisations register an interest.
• National Collaborating Centre (NCC) determines
  the boundaries of the guideline (what it will and
  will not cover).
• NCC establishes a Guideline Development Group
  (health professionals, representatives of patient
  and carer groups and technical experts).
• There are two consultation periods during which
  registered stakeholders can comment on the draft
  guideline (The draft guideline is posted on the
  NICE website).
• An Independent Review Panel reviews the
  guidelines and checks the stakeholders comments
  have been taken into account.
• NICE formally approves the guideline and issues
  its guideline to the NHS.

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Developing clinical guidelines a challenge to
current methods. Raine R, Sanderson C, Black N.
BMJ 2005 331631-3.

• Lack of transparency as to why judgements are
  made.
• The translation of research evidence into
  guidelines has barely been considered.
• Specialists tend to overstate the appropriateness
  of the interventions they perform compared to
  generalists.
• Whether a literature review was used and the
  procedure for aggregating judgements.
• International variation in guidelines suggests
  that the level of healthcare resources has an
  influence, along with cultural and organisational
  factors.
• Are the guideline groups large enough to be
  reliable?
• Is the cost involved sustainable? NICE takes at
  least 18 months and may convene 15 meetings of
  the guideline development groups.This means only
  a small proportion of healthcare will ever be
  covered and it may not be feasible to update
  guidelines frequently enough.

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Hot news ! (Sept 23rd 2005)

• NICE in discussions with DOH to streamline
  development of guidelines (press release)
• 5-Live report NICE to provide guidance within 6
  months and to prioritise drugs that enhance life
  expectancy.