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NICE in a changing world
North East Leading Improvement for Health and Well-being programme
Professor Mike Kelly
Director, Centre for Public Health Excellence
Gillian Mathews
Implementation consultant
Welcome!
• Purpose of session– to improve understanding of how
NICE and our guidance– to explore what is meant by
‘evidence’– to look at how evidence based
decision making can contribute to improved efficiency and effectiveness
– to look at how NICE’s role is developing for the future
How NICE are you?
1. The National Institute for Health and Clinical Excellence (but that will change...)
2. A source of evidence and evidence-based guidance for health and social care professionals
3. “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.”
4. All of these
5. They are not considered cost effective
6. All of these – but the main enforcement role is the Care Quality Commission
7. Independent committees of experts (although they are supported by NICE staff)
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.
Will have a role in social care from 2012
Core principles of all NICE guidance
• Comprehensive evidence base
• Expert input
• Patient and carer involvement
• Independent advisory committees
• Genuine consultation
• Regular review
• Open and transparent process.
A short history of NICE products
Primary care
indicators
Public health
Interventional Procedures
Clinical guidelines
Quality standards
What do we mean by ‘evidence?’
• There is a lot of data about this?
• Other people are doing this?
• There is a research study which shows this is effective?
• There is a significant body of research which shows that this is effective?
Breadth of the evidence base
• Descriptive studies the only source of evidence sometimes.
• Theory and models are an intrinsic part of the available evidence.
• Trials• Qualitative data.• Case studies.• Expert testimony.
What’s often missing
• How an intervention was done and what problems arose in doing it
• What was done – the content of the intervention so that it might be replicated
• How it might be implemented in non experimental settings
• Local infrastructures/context data• UK data
The limits of the evidence
• Evidence does not speak for itself – it always requires interpretation.
• Our committees do the interpretation
Example - Promoting physical activity for children
Consultation Documents• Review 1 - Epidemiology • Review 2 - Quantitative
correlates • Review 3 - Qualitative
correlates • Review 4 - Interventions for
under eights • Review 5 - Active travel
interventions • Review 6 - Interventions for
adolescent girls
• Review 7 - Family and community interventions
• Review 8 - Active play • Review 9 - Economic evidence • Cost effectiveness analysis
A word about ‘guidance’
• NICE’s expert committees use the best available evidence to look at what really works
• The committees make recommendations, which NICE publishes, to guide practitioners and managers to help distinguish between what works and what doesn’t work
• Our guidance is really very high quality advice – which you should, as a professional, be consulting to help you to make better decisions
• It is NOT – another layer of policy, or ‘must do’s’
Some NICE guidance you might find useful...
• PH30 Preventing unintentional injuries among under-15s in the home
• PH31 Preventing unintentional injuries - road design
• PH29 Strategies to prevent unintentional injuries
• PH24 Alcohol use disorders – preventing harmful drinking
• PH25 Prevention off cardiovascular disease
• PH23 School-based interventions to prevent smoking
• PH17 Promoting physical activity for children and young people
• PH14 Preventing the uptake of smoking by children and young people
• PH13 Promoting physical activity in the workplace
• PH9 Community engagement• PH8 Physical activity and the
environment• PH6 Behaviour change
Why use the best available evidence?
• To reduce variation• To reduce inequalities• To improve quality of
service provision• To reduce waste• To ensure the best
use of resources
Group discussion task
• How would you recognise evidence based practice where you work?
• What behaviours would people use – in the way they go about taking decisions?
• What systems and processes would be in place to ensure that decisions were supported by relevant and appropriate evidence?
10 mins to discuss in groups
Please nominate someone to feed back your conclusions
Group exercise and discussion
• What actions can you take on your return to work to start to introduce these behaviours and processes where you work?
Quality Standards topicsPublished to date• Stroke
• Dementia
• Prevention of venous thromboembolism
• Specialist neonatal care
• Diabetes in adults
• Depression
• Chronic kidney disease
• Glaucoma
Currently in development• COPD
• Breast cancer
• Chronic heart failure
• End of life care
• Alcohol dependency
31 new topics now announced for development in 2011-12
Social Care Standards
Social care – formally added to NICE’s remit in April 2012Pilot of 2-3 social care topics for standard development in 2011:– Workshop with key group in
June 2011 to inform the model– Evidence base and
underpinning ‘guidance’ is crucial
– Topics likely to bridge the health and social care interface
NICE pathways
• NICE pathways will bring together all related NICE guidance, including Quality Standards and implementation support tools
• This will greatly facilitate access for commissioners, who need to commission across a whole pathway
Summary
• We set out to:– improve understanding of how
NICE and our guidance– to explore what is meant by
‘evidence’– look at how evidence based
decision making can contribute to improved efficiency and effectiveness
– look at how NICE’s role is developing for the future
Contact usMike Kelly – Director, Centre for Public Health Excellence
Gillian Mathews - Implementation Consultant: North
Visit the NICE website
www.nice.org.uk
NHS Evidence
www.evidence.nhs.uk