Transcript Introduction to NICE – David Haslam

NICE: what it is and how it works
Professor David Haslam, Chair, NICE
10th June 2015
Contents
• An overview of NICE’s work
• How we make recommendations
• What’s new and in the pipeline?
The background: why NICE was
set up
• Established in 1999
• Aim: to reduce variation in the
availability and quality of
treatments and care (the so
called ‘postcode lottery’)
• To resolve uncertainty about
which medicines and
treatments work best and
which represent best value for
money for the NHS
“Probably not, but it’s
worth a bloody good try.”
Frank Dobson, Health Secretary, who established NICE in
1999, when asked whether he thought it would work.
A Brief History
1999: Technology appraisals
Clinical guidelines
2002: Interventional procedures
Implementation
2005: Public health guidelines
2008 : NICE International
2009: Cost saving MedTech programme (new technologies)
Diagnostics
NICE Evidence
2011: National Prescribing Centre (now Medicines Prescribing
Centre)
2013: Social care guidelines
Highly specialised technologies
2014: Safe staffing guidelines
Number of publications
NICE Guidance by Year
Year
NICE: Improving outcomes for people
Evidence-based
guidance and advice for
health, public health and
social care
Information services
for commissioners,
practitioners and
managers
Quality standards
and performance
metrics for those
providing and
commissioning
health, public health
and social care
Core principles of NICE’s work
• Based on the best available evidence of what
works and what it costs
• Independent and unbiased advisory committees
• Patient, service user and carer involvement
• Genuine consultation
• Regular review
• Open and transparent process
• Social values and equity considerations
NHS constitution 2012
“You have the right to
drugs and treatments
that have been
recommended by
NICE for use in the
NHS, if your doctor
says they are clinically
appropriate for you.”
How does NICE develop
recommendations?
Cost effectiveness
Cost
effectiveness
Clinical
effectiveness
Clinical
effectiveness
Committee decision making
Clinical effectiveness
Other health
benefits
Costeffectiveness
Recommendations
Extent of
uncertainty
Social Value Judgements
Innovation
Equality
legislation
Patients’ and service users’
views matter
Patient preferences
Example: kidney dialysis
Committee assumed
patients would prefer
dialysis at home.
Some patients told us they
disliked home machines as
it meant their illness
dominated their lives.
Patients’ experience of care
Example: people who selfharm
People in mental distress who
self-harm told us that they were
not routinely offered anaesthesia
or pain relief for sewing up
wounds in the hospital emergency
department.
Nothing in the published research to indicate this was an
issue.
NICE made recommendations to address this.
Economic evaluation of new
drugs/treatments
• How well does the drug/treatment work in relation
to how much it costs compared to standard
practice in the NHS ?
• Recognises the reality of fixed NHS resources
• Exposes the opportunity cost of new interventions,
that is if you spend money on a new healthcare
intervention, you have to take away the health
care from someone else
• Enables consistency and fairness across all
decisions
Cost per QALY (£’000)
Breakdown of recommendations
338 drug appraisals published from 1 Mar 2000 – 31 March 2015
Containing 578 individual recommendations
‘no’ or
‘only in research’
20%
80%
‘Yes’ recommended for routine use
or under specific circumstances
What’s new and in the
pipeline?
NICE and social care
• A new remit to produce
guidance and standards for
social care from April 2013
• A more integrated approach to
supporting people, crossing
health, public health and
adults and children’s services
• Developed in partnership with
service users, carers and
social care professionals
Social care topics in the
pipeline include:
Care and support of
older people with
learning disabilities
Regaining independence
in older people who
experience a fall
Challenging
behaviour and
learning disabilities
Service user and
carer experience
Transition from
children’s to adults’
services
Keeping up to date with
the latest from NICE
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Thank you.
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