NICE: what it is and how it works Professor David Haslam, Chair, NICE 10 th June 2015

Contents An overview of NICE’s work How we make recommendations What’s new and in the pipeline?

The background: why NICE was set up Established in 1999 Aim: to reduce variation in the availability and quality of treatments and care (the so called ‘postcode lottery’) To resolve uncertainty about which medicines and treatments work best and which represent best value for money for the NHS

“Probably not, but it’s worth a bloody good try.” Frank Dobson, Health Secretary, who established NICE in 1999, when asked whether he thought it would work.

A Brief History 1999: Technology appraisals Clinical guidelines 2002: Interventional procedures Implementation 2005: Public health guidelines 2008 : NICE International 2009: Cost saving MedTech programme (new technologies) Diagnostics NICE Evidence 2011: National Prescribing Centre (now Medicines Prescribing Centre) 2013: Social care guidelines Highly specialised technologies 2014: Safe staffing guidelines

NICE Guidance by Year Number of publications Year

NICE: Improving outcomes for people Evidence-based guidance and advice for health, public health and social care Quality standards and performance metrics for those providing and commissioning health, public health and social care Information services for commissioners, practitioners and managers

Core principles of NICE’s work Based on the best available evidence of what works and what it costs Independent and unbiased advisory committees Patient, service user and carer involvement Genuine consultation Regular review Open and transparent process Social values and equity considerations

NHS constitution 2012 “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.”

How does NICE develop recommendations?

Cost effectiveness Clinical effectiveness Cost effectiveness Clinical effectiveness

Committee decision making Recommendations Equality legislation Equality legislation Innovation Social Value Judgements Extent of uncertainty Other health benefits Other health benefits Cost- effectiveness Clinical effectiveness

Patients’ and service users’ views matter

Patient preferences Example: kidney dialysis Committee assumed patients would prefer dialysis at home. Some patients told us they disliked home machines as it meant their illness dominated their lives.

Patients’ experience of care Example: people who self- harm People in mental distress who self-harm told us that they were not routinely offered anaesthesia or pain relief for sewing up wounds in the hospital emergency department. Nothing in the published research to indicate this was an issue. NICE made recommendations to address this.

Economic evaluation of new drugs/treatments How well does the drug/treatment work in relation to how much it costs compared to standard practice in the NHS ? Recognises the reality of fixed NHS resources Exposes the opportunity cost of new interventions, that is if you spend money on a new healthcare intervention, you have to take away the health care from someone else Enables consistency and fairness across all decisions

Cost per QALY (£’000)

Breakdown of recommendations 338 drug appraisals published from 1 Mar 2000 – 31 March 2015 Containing 578 individual recommendations ‘Yes’ recommended for routine use or under specific circumstances ‘no’ or ‘only in research’

What’s new and in the pipeline?

NICE and social care A new remit to produce guidance and standards for social care from April 2013 A more integrated approach to supporting people, crossing health, public health and adults and children’s services Developed in partnership with service users, carers and social care professionals

Social care topics in the pipeline include: Service user and carer experience Care and support of older people with learning disabilities Regaining independence in older people who experience a fall Challenging behaviour and learning disabilities Transition from children’s to adults’ services

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