nice: what it is and how it works professor david haslam, chair, nice 10 th june 2015
TRANSCRIPT
NICE: what it is and how it works
Professor David Haslam, Chair, NICE10th 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 History1999: 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
NICE Guidance by YearN
umbe
r of
pub
licat
ions
Year
NICE: Improving outcomes for people
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
Clinical effectiveness
Cost effectivenessClinical
effectiveness
Committee decision making
RecommendationsRecommendations
Equality
legislation
Equality
legislation
InnovationInnovation
Social Value JudgementsSocial Value Judgements
Extent of uncertainty
Extent of uncertainty
Other health benefits
Other health benefits
Cost-effectiveness
Cost-effectiveness
Clinical effectivenessClinical effectiveness
Patients’ and service users’ views matter
Patient preferences
Example: kidney dialysisCommittee 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 self-harm
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
‘Yes’ recommended for routine use or under specific circumstances
‘no’ or ‘only in research’
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:
Service user and carer experience
Care and support of older people with learning disabilities
Regaining independence in older people who experience a fall
Challenging behaviour and learning disabilities
Transition from children’s to adults’ services
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