NICE National Institute for Health and Clinical Excellence. History 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 NHS. 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 considered. 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 factors. 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.