Sex and drugs and rock ‘n roll . . . . (almost) everything you wanted to know about NICE Stephen Judge, Implementation Consultant SW

NICE Field Team Eight consultants based in the field - the ‘local face’ of NICE Providing people implementing NICE guidance with updates, advice and support for your local strategies for implementation fieldteam@nice.org.uk Implementation Facilitator role: To engage organisations and networks to inform, encourage and facilitate Share examples of good practice Promote use of implementation support tools to help put guidance into practice 2-way feedback

What is NICE? World leader in setting standards for high quality care and for promoting healthy living 2013 new remit for social care – renamed National Institute for Health and Care Excellence Evidence-based guidance and other products from NICE help resolve uncertainty about best quality care and what represents value for money www.nice.org.uk Remit is providing national guidance, advice and standards on the promotion of good health and the prevention and treatment of ill health that is both clinical and cost-effective.

Health and Social Care Act NICE may be directed to prepare statements of standards in relation to the provision of: NHS service Public health services or Social care in England. In discharging its duty, the NHS Commissioning Board/Secretary of State must have regard to the quality standards prepared by NICE. Organisations improving the quality of health services must have regard to the quality standards prepared by NICE. The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality.  Commissioners and providers will cross refer across the NICE quality standards library when designing high quality services The Act refers to the requirement for NICE to prepare statements of standards in relation to the provision of NHS service, PH services and Social Care in England. NICE is required to regularly review the QS, making revisions as appropriate. NHS England and SoS, in carrying out their duties must have regard to the standards prepared by NICE, as should organisations improving the quality of services.

NICE (Constitution and Functions) Regulations 2013 (s.i 2013 no 259) Regulation 7 makes provision for NICE to make a technology appraisal recommendation, in relation to a health technology identified in a direction of the Secretary of State, that recommends that the Board, a clinical commissioning group or a local authority arranging for the provision of services for the purposes of the health service, provide funding to ensure that the health technology can be made available for the purposes of treatment of patients. The NICE technology appraisal recommendation must be complied with normally within 3 months of publication of the recommendation (regulation 7(3)).

What makes NICE so controversial? Healthcare professionals capacity and ambition Patient expectations Health system objectives and resources NICE Guidance Growth in health technology NICE has a lot of people to please… Top – people working in the NHS want to use new drugs, develop new techniques and offer best available treatment and care. Left - strong patient views – patients want any treatment that will benefit them irrespective of cost Right – financial pressures of what the NHS can afford. NICE has to consider the bigger picture and the opportunity cost Bottom – Pressure from pharma (and medical technology) industry who as a massive global industry exert enormous pressure eg herceptin NICE has to produce its guidance and work in the middle of this and try to balance all these differing stakeholder views and desires. It is a bit like working in a pressure cooker!

Dilemma of a clinician Responsibility to individual Responsibility to society Individual patient’s best interest No considerations of opportunity costs Patient centred care Public health interest Accountability to tax payers Opportunity cost considerations Value for money As a practising clinician you will have to balance this also E.g. use of a medicine in hospital that patients may want but are expensive, have marginal benefits on patient outcomes and come at the expense of providing other kinds of treatment

The importance of using NICE - for health professionals Guides practice “Brings together what the research tells us in the context of what is already known” “Pragmatic approach to clinical problems seen every day” “Helps me to keep my practice up to date” Health professionals should take NICE guidance into account when deciding what treatments to give people However, NICE guidance does not replace their knowledge and skills; it is still up to health professionals to make decisions about a particular patient in consultation with the patient and/or their guardian or carer when appropriate “The important thing to remember is that NICE guidelines are guidelines – They don’t tell you what to do all of the time but they certainly help you to do things right the majority of the time and make you aware where you are leading off the evidence when you think things need to be done differently”

EFFECTIVE - (how well they work) COST-EFFECTIVE - (value for money) Types of guidance Technology appraisals - on the use of new and existing medicines and treatments Clinical guidelines - on the appropriate treatment and care of people with specific diseases and conditions within the NHS Interventional procedures guidance - on safety and efficacy (can it work) of processes or treatments Public health guidance - on the promotion of good health and the prevention of ill health Diagnostic guidance - on measurements and tests used to evaluate or monitor a patient’s condition Medical technologies guidance - on new or novel medical technologies (value proposition) Highly specialised technologies guidance (new!) Social care guidance (new!) Safe staffing guidance (new!) EFFECTIVE - (how well they work) COST-EFFECTIVE - (value for money)

Quality Standards Evidence Guidance Quality Standards A set of systematically developed recommendations to guide decisions for a particular area of care or health issue Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements. Guidance – aim is to improve individual or population wellbeing and health – for social care aim is to improve independence and wellbeing Evidence - these are examples to show the breadth of evidence that will be considered depending on the question and the types of evidence available Also have the option of inviting expert witnesses to provide expert advice in the absence of published evidence, and the option to call for evidence (ie ask stakeholders if they are aware of anything) What’s new is social care guidance and related QS

How quality standards can be used? Health and social care professionals and public health professionals to make decisions about care based on the latest evidence and best practice Service providers to examine the performance of their organisation and assess improvement in standards of care they provide Commissioners to be confident that the services they are purchasing are evidenced-based and cost effective care which aims to drive up quality People receiving health and social care services, their families and carers and the public to find information about the quality of services and care they should expect from their health and social care provider

Accessing the guidance Improved search returning more relevant results Prominent ‘feature section promoting NICE’s latest developments

Health Protection Lifestyle Service Delivery Settings Communicable disease Drug misuse Health Protection Alcohol, smoking, drug misuse Diet and obesity, physical activity Sexual health, mental health, sunlight exposure Lifestyle Contraception Service Delivery Educational settings Workplace Transport Settings

Practical resources to help you use NICE guidance Podcast – medicines management options for local implementation in support of QIPP QS33 podcast with Professor Robert Moots and Dr Louise Warburton - relevant to GPs and rheumatology teams This podcast is 10 minutes in length. It covers: Timely GP referral to a rheumatology service The offer of combination medication to treat people with newly diagnosed rheumatoid arthritis From RCGP supporting information for revalidation Revalidation – keeping up to date “requires doctors to keep their knowledge and skills up to date, and encourages them to take part in educational activities that maintain and further develop their competence and professional performance.” = NICE News, Evidence summaries of medicines, education and learning tools such as BMJ Learning online and podcasts, Pathways Revalidation - reviewing practice “you will have to demonstrate that you regularly participate in activities that review and evaluate the quality of your work “. For example, clinical audit (participate in at least one complete audit cycle (audit, practice review and re-audit) in every 5 year revalidation cycle): case reviews, review of clinical outcomes, audits of significant events or SUIs = Audit, quality standards

NICE Pathways To bring together related guidance, between and within topics To link other products – Quality Standards, implementation support tools etc. To provide a useful format - network of recommendations To improve digital formatting for easier access Easier, quicker access to the evidence

NICE Evidence Services is a service that provides fast access to authoritative health and social care evidence and best practice through a web-based portal. In one place, you can simultaneously search over 250,000 resources from hundreds of trustworthy and accredited sources including The Cochrane Library, NICE and Royal Colleges. CKS Journals & databases Evidence Search Evidence Uncertainties A-Z of Topics Medicines Information Public Health Information QIPP Subscribe to Evidence Awareness Bulletins and access Evidence Updates Ability to add Evidence Search to Browser Personalised Site coming within 12 months

Clinical Knowledge Summaries New NICE CKS service launched April 2013 Aimed at Primary Care Practitioners Over 300 topics of the most common or significant primary care presentations The evidence behind each topic is regularly reviewed and prioritised for updating Up to 10 new topics to be added each year

Features Browse over 760 items (7000+ chapters) of NICE guidance. Guidance is arranged topically by conditions and diseases, and public health topics Rapidly search all NICE Guidance on your smartphone Select full guidance documents or selections of individual chapters from guidance documents, bookmark individual sections of guidance chapters for use as offline reference on your smartphone Adjust the font size; alter the colour presentation of the text; ‘swipe' from chapter to chapter when reading guidance. Automatically receive updates and new guidance as soon as it's published on the NICE website. Troubleshooting

Prescribing information at your fingertips

Education, learning and professional development

Keeping up to date with the latest from NICE... Sign up for NICE news www.nice.org.uk/newsletter Contains details of guidance, quality standards and tools published that month NICE Evidence Services www.evidence.nhs.uk NICE Pathways http://pathways.nice.org.uk 25,000+ people now follow us on Twitter for guidance updates @NICEcomms

Student Champions University-based, certificated, short courses on NICE Help others use NICE (facilitation) 650 people already (inc Plymouth, Bristol and Exeter) Email studentchampions@evidence.nhs.uk Travel costs and food met by NICE (but you need permission from your head of dept)

OK, so we don’t do rock ‘n roll . . .