NICE in a changing world North East Leading Improvement for Health and Well- being programme Professor Mike Kelly Director, Centre for Public Health Excellence Gillian Mathews Implementation consultant

Welcome! Purpose of session –to improve understanding of how NICE and our guidance –to explore what is meant by ‘evidence’ –to look at how evidence based decision making can contribute to improved efficiency and effectiveness –to look at how NICE’s role is developing for the future

The role of NICE

A quick quiz... What do you know – or think you know – about NICE?

How NICE are you? 1.The National Institute for Health and Clinical Excellence (but that will change...) 2.A source of evidence and evidence-based guidance for health and social care professionals 3.“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.” 4.All of these 5.They are not considered cost effective 6.All of these – but the main enforcement role is the Care Quality Commission 7.Independent committees of experts (although they are supported by NICE staff)

NICE The National Institute for Health and Clinical Excellence (NICE) is the independent organisation in the UK responsible for providing national guidance to the NHS and the wider public health community on the promotion of good health and the prevention and treatment of ill health. Has had a public health role since Will have a role in social care from 2012

This is what we do Evidence assessment and interpretation Economic evaluation and resource impact assessment Pathways, guidance and standards Web access for decision support and e-learning NICE and NHS Evidence Evidence – guidance – shared learning

This is how we add value Better outcomes for patients Knowledge for professionals and patients Effective use of NHS resources Access to the NHS market Our purpose is to improve the quality and productivity of clinical practice, public health and social care Independence, objectivity and transparency.

Core principles of all NICE guidance Comprehensive evidence base Expert input Patient and carer involvement Independent advisory committees Genuine consultation Regular review Open and transparent process.

A short history of NICE products Primary care indicators Public health Interventional Procedures Clinical guidelines Quality standards

Who writes the guidance?

Understanding evidence

What do we mean by ‘evidence?’ There is a lot of data about this? Other people are doing this? There is a research study which shows this is effective? There is a significant body of research which shows that this is effective?

Breadth of the evidence base Descriptive studies the only source of evidence sometimes. Theory and models are an intrinsic part of the available evidence. Trials Qualitative data. Case studies. Expert testimony.

What’s often missing How an intervention was done and what problems arose in doing it What was done – the content of the intervention so that it might be replicated How it might be implemented in non experimental settings Local infrastructures/context data UK data

The limits of the evidence Evidence does not speak for itself – it always requires interpretation. Our committees do the interpretation

Example - Promoting physical activity for children Consultation Documents Review 1 - Epidemiology Review 2 - Quantitative correlates Review 3 - Qualitative correlates Review 4 - Interventions for under eights Review 5 - Active travel interventions Review 6 - Interventions for adolescent girls Review 7 - Family and community interventions Review 8 - Active play Review 9 - Economic evidence Cost effectiveness analysis

A word about ‘guidance’ NICE’s expert committees use the best available evidence to look at what really works The committees make recommendations, which NICE publishes, to guide practitioners and managers to help distinguish between what works and what doesn’t work Our guidance is really very high quality advice – which you should, as a professional, be consulting to help you to make better decisions It is NOT – another layer of policy, or ‘must do’s’

Some NICE guidance you might find useful... PH30 Preventing unintentional injuries among under-15s in the home PH31 Preventing unintentional injuries - road design PH29 Strategies to prevent unintentional injuries PH24 Alcohol use disorders – preventing harmful drinking PH25 Prevention off cardiovascular disease PH23 School-based interventions to prevent smoking PH17 Promoting physical activity for children and young people PH14 Preventing the uptake of smoking by children and young people PH13 Promoting physical activity in the workplace PH9 Community engagement PH8 Physical activity and the environment PH6 Behaviour change

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Why use the best available evidence? To reduce variation To reduce inequalities To improve quality of service provision To reduce waste To ensure the best use of resources

Evidence based practice

Group discussion task How would you recognise evidence based practice where you work? What behaviours would people use – in the way they go about taking decisions? What systems and processes would be in place to ensure that decisions were supported by relevant and appropriate evidence? 10 mins to discuss in groups Please nominate someone to feed back your conclusions

Group exercise and discussion What actions can you take on your return to work to start to introduce these behaviours and processes where you work?

The future for NICE

We have become a unique platform Optimal use of new and existing treatments Clinical guidelines, QOF and quality standards Health promotion and disease prevention Comprehensiv e evidence service NICE and NHS Evidence Evidence – guidance – shared learning

Quality Standards topics Published to date Stroke Dementia Prevention of venous thromboembolism Specialist neonatal care Diabetes in adults Depression Chronic kidney disease Glaucoma Currently in development COPD Breast cancer Chronic heart failure End of life care Alcohol dependency 31 new topics now announced for development in

Social Care Standards Social care – formally added to NICE’s remit in April 2012 Pilot of 2-3 social care topics for standard development in 2011: –Workshop with key group in June 2011 to inform the model –Evidence base and underpinning ‘guidance’ is crucial –Topics likely to bridge the health and social care interface

Example - Stroke Quality Standard

NICE pathways NICE pathways will bring together all related NICE guidance, including Quality Standards and implementation support tools This will greatly facilitate access for commissioners, who need to commission across a whole pathway

Summary We set out to: –improve understanding of how NICE and our guidance –to explore what is meant by ‘evidence’ –look at how evidence based decision making can contribute to improved efficiency and effectiveness –look at how NICE’s role is developing for the future

Contact us Mike Kelly – Director, Centre for Public Health Excellence Gillian Mathews - Implementation Consultant: North Visit the NICE website NHS Evidence