The principles that guide the development of NICE guidance and standards

The principles that guide the development of NICE guidance and standards
NICE February 2020

• Replaces and updates the 2008 edition of "Social value judgements: principles for the development of NICE guidance".

NICE Connect

 NICE Connect

• NICE Connect is a multi-year project to transform the way guidance is produced and presented, making it easier to use and ensuring people receive evidence-based high quality care in the right place at the right time.  NICE are recruiting people with experience in health and social care to give feedback at different stages of NICE Connect.

NICE Resources for local partnerships

 Resources for local partnerships

• NICE has produced a set of resources for local partnerships designed to help systems work together to provide consistent, high-quality care, based on the best evidence. Each topic includes resources from PHE, NICE, Right Care, NHS England and others.
• Current resources are: CVD prevention (kidney management, risk assessment, NHS Health checks, hypertension, atrial fibrillation, diabetes); Frailty, Transfer of care, Making Every Contact Count, Medicines Optimisation and Urgent & emergency care.
• The Urgent and emergency care care resource includes detailed tables linking to appropriate guidelines, NICE Pathways, quality standards and quick guides relevant to each strand of work.

NICE Resources for STPs and ICSs

Resources for STPs and ICSs
NICE

• A collection of NICE resources (based on guidance, quality standards, advice and practical tools) which will help systems work in partnership to provide consistent, high-quality care, based on the best evidence to support STPs and ICSs. Topics include 
• Prioritisation, 
• CVD prevention: detecting atrial fibrillation and anticoagulation
• CVD prevention: preventing, detecting and managing diabetes
• Improving care and support for people with frailty
• Improving transfer of care
• Making Every Contact Count
• Medicines optimisation 
• Transforming urgent and emergency care
• Putting our guidance into practice

National variation between CCGs in referral criteria for primary total hip replacement surgery

National variation between clinical commissioning groups in referral criteria for primary total hip replacement surgery
Annals of the Royal College of Surgeons v100 (6), p443-445, 6 July 2018

• "The referral criteria used by the UK CCGs for primary total hip replacement surgery appear inconsistent; the criteria rarely follow NICE criteria. With established guidelines available, it is unclear why the CCGs have referral criteria with less evidence base, without obviously addressing particular issues in their locality."

Emergency and acute medical care in over 16s: service delivery and organisation. [NG94]

Emergency and acute medical care in over 16s: service delivery and organisation. [Guideline NG94]
NICE March 2018

• This guideline makes recommendations around organisation and delivery of emergency and acute medical care for people aged over 16 in the community and in hospital. It aims to reduce the need for hospital admissions by giving advanced training to paramedics and providing community alternatives to hospital care. 
• The Guideline makes a series of recommendations and is accompanied by a number of reviews of the evidence including 
• 02. Non-emergency telephone access and call handlers 
• 05. GP extended hours / 06. GP-led home visits / 07. GP access to laboratory investigations / 08. GP access to radiology 
• 10. Community-based pharmacists 
• 12. Alternatives to hospital care 
• 13. Community rehabilitation / 14. Community palliative care 
• 15. Advance care planning 
• 17. GPs within or on the same site as emergency departments 
• 18. Minor injury unit, urgent care centre or walk-in centre 
• 20. Physician extenders ( Advanced Nurse Practitioners, Physician Associates and Advanced Clinical Practitioners) 
• 23. Liaison psychiatry 
• 25. Admission through elderly care assessment units 
• 35. Discharge planning / 36. Standardised discharge criteria / 37. Post-discharge early follow-up clinics 
• 38. Integrated care 
• 39. Bed occupancy

NICE Safe staffing evidence reviews

Safe staffing evidence reviews

HSJ 18 January 2016 (Subscription required)

• NICE has published, through HSJ, four evidence reviews into staffing levels around nursing in A&E, community nursing, inpatient mental health services and management approaches to safe staffing. 
• The move comes after two NICE non-executive directors reversed a previous FOI request decision and concluded that it was in the public interest for the evidence reviews to be made public.

See also the leaked NICE guidance on staffing levels in A&E published by HSJ on 20 January 2016

Effectiveness and efficiency of committee work

Effectiveness and efficiency of committee work: a rapid systematic review
NICE Research Support Unit December 2015

• A rapid assessment of the evidence for the impact of the structure and management of committees on decision making and outputs.
• Findings
• Committee performance depends upon their members, whether they: are aware of their tasks, roles and responsibilities; understand the wider the context and culture; bring analytical and political competence, interest and willingness; offer time and commitment; actively participate; and behave appropriately over external relationships, confidentially and conflicts of interest.
• Particularly important are the different perspectives and sets of knowledge brought by individual members or presented to them in papers or meetings. Time is required for a committee to explore their collective knowledge to make choices or solve problems.
• Time and facilitation skills for sharing knowledge and developing mutual trust allows sharing of ideas and individual learning, better quality decisions, more commitment to decisions by group members and wider acceptability of decisions within the group’s wider networks.
• Implications for the organisation and management of committees.
• Committee composition and size: Having members representing the full range of stakeholders could bring the full range of relevant knowledge to discussions, although increasing the size of a committee above 12 members has diminishing returns.
• Competencies of effective chairs: Effective chairs are more likely to be generalists with good facilitation skills to help members share their knowledge; manage hierarchy and conflict constructively; and develop an atmosphere of inclusiveness, openness and trust.
• Timing of committee work: Time is required to allow knowledge brought to the meeting to be shared and evaluated before decisions are made.
• Effective processes and structures for supporting group decision making: Formal consensus methods are recommended, with guideline groups given the relevant technical literature to inform their decisions.
• Use of media for committee interaction and decision making: Distance working reduces the influence of individuals, but also opportunities for discussion. Computer-mediated communication (email and chat) may take longer and reduce member satisfaction.
• Equity issues: Demographic diversity is valued for bringing different perspectives and a wider variety of alternatives for consideration. Educational and functional diversity has given teams greater strategic clarity. More time and effort may be required to explore issues requiring judgements where committee members vary in status.

Innovation Scorecard - uptake of NICE TA recommendations

NICE Technology Appraisals in the NHS in England (Innovation Scorecard)
HSCIC, 1 October 2015

• The objective of the Innovation Scorecard is to support appropriate access to NICE approved products (medicines, devices and diagnostics), by highlighting information which can be used to identify and act on unwarranted variation in patient access to these treatments. 
• There is no central collection of data which can directly support the assessment of uptake of NICE recommendations, nor is data on the number of patients treated available. This experimental publication makes use of data currently available from a range of sources, both from the NHS and the commercial sector.
• Data is at AT, CCG, LA and trust level.
• The NHS is legally obliged to fund and resource medicines and treatments recommended by NICE's technology appraisals. See NICE technology appraisal guidance

Tackling the causes of early death

Tackling the causes of premature mortality (early death)
NICE Advice LGB26, February 2015

• NICE's recommendations for local authorities and partner organisations on tackling the more direct causes of premature mortality. 
• The briefing focuses on actions that local authorities can take on specific lifestyle issues, access to services and preventing unintentional injuries. It makes explicit the links between the wider determinants and a range of health outcomes linked to premature mortality.

Must commissioners implement NICE guidelines?

Must commissioners implement NICE guidelines? (blog)
Mills & Reeves August 2014

• Discussion of the Rose v NHS Thanet Clinical Commissioning Group (2014) judgement by the Administrative Court when considering whether the CCG had acted unlawfully in failing to implement a clinical guideline issued by the NICE, despite there being no statutory duty to do so.

Commissioning Outcomes Framework from NICE

Consultation on Commissioning Outcomes Framework (COF) indicators
NICE

• As part of the process to develop a COF, stakeholders are being invited to comment on potential new indicators which will become operational in April 2013.
• The consultation will close at 5pm on 29th February 2012.

Local Formularies

Recommendation around Local Formularies from NICE
NICE, 2 Feb 2012

• NICE is to produce a best practice guide to help trusts develop local formularies, as part of a move to ensure that all patients in England have access to clinically and cost-effective drugs and remove the postcode lottery where patients miss out on drugs approved by NICE.