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

The role of NICE

A quick quiz...

What do you know – or think you know – about NICE?

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

This is what we do

NICE and NHS Evidence

Evidence – guidance – shared learning

This is how we add value

Independence, objectivity and transparency.

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

Who writes the guidance?

Understanding evidence

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

...and if you can’t find what you need...

Search 200 sites in one click...

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

Evidence based practice

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?

The future for NICE

We have become a unique platform

NICE and NHS Evidence

Evidence – guidance – shared learning

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

Example - Stroke Quality Standard

www.nice.org.uk/aboutnice/qualitystandards/stroke

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

mike.kelly@nice.org.uk

Gillian Mathews - Implementation Consultant: North

gillian.mathews@nice.org.uk

Visit the NICE website

www.nice.org.uk

NHS Evidence

www.evidence.nhs.uk