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National Institute for Health and Clinical
   National Institute for Clinical Excellence was formed in 1999.
   The Institute absorbed the role of the Health Development
    Agency (a public health body) in April 2005 to create a single
    excellence-in-practice organisation responsible for providing
    national guidance on the promotion of good health and the
    prevention and treatment of ill health.
   Still called NICE, but is now the National Institute for Health and
    Clinical Excellence.
   93 clinical guidelines published so far.
What are NICE clinical guidelines?

   Clinical guidelines are recommendations by NICE on the
    appropriate treatment and care of people with specific diseases
    and conditions within the NHS. They are based on the best
    available evidence. Guidelines help health professionals in their
    work, but they do not replace their knowledge and skills.
The aim of clinical guidelines.

   To improve the quality of healthcare
   Provide recommendations for the treatment and care of people
    by health professionals
   To develop standards to assess the clinical practice of individual
    health professionals
   To be used in the education and training of health professionals
   To help patients to make informed decisions, and improve
    communication with patients.
How are NICE Guidelines developed?

   Topic chosen by the Secretary of State.
   ‘Stakeholder’ organisations register an interest.
   National Collaborating Centre (NCC) determines the boundaries of the
    guideline (what it will and will not cover).
   NCC establishes a Guideline Development Group (health professionals,
    representatives of patient and carer groups and technical experts).
   There are two consultation periods during which registered
    stakeholders can comment on the draft guideline (The draft guideline is
    posted on the NICE website).
   An Independent Review Panel reviews the guidelines and checks the
    stakeholders comments have been taken into account.
   NICE formally approves the guideline and issues its guideline to the
Developing clinical guidelines: a challenge to current methods. Raine R,
Sanderson C, Black N. BMJ 2005; 331:631-3.

   Lack of transparency as to why judgements are made.
   The translation of research evidence into guidelines has barely been
   Specialists tend to overstate the appropriateness of the interventions
    they perform compared to generalists.
   Whether a literature review was used and the procedure for
    aggregating judgements.
   International variation in guidelines suggests that the level of healthcare
    resources has an influence, along with cultural and organisational
   Are the guideline groups large enough to be reliable?
   Is the cost involved sustainable? NICE takes at least 18 months and
    may convene 15 meetings of the guideline development groups….This
    means only a small proportion of healthcare will ever be covered and it
    may not be feasible to update guidelines frequently enough.
Hot news ! (Sept 23   rd   2005)

   NICE in discussions with DOH to streamline
    development of guidelines (press release)
   5-Live report NICE to provide guidance within
    6 months and to prioritise drugs that enhance
    life expectancy.

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