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NEWS: Susan Mayor Can NICE guidance be given more clout? BMJ 2006; 333: 170 [Full text]

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Implementing NICE guidelines: is it all about the money or do we need an interpreter?

Dennis Ougrin, Ricky Banarsee, Paul Ferguson   (21 July 2006)

Clarification of Healthcare Commission position

Nicholas L Bishop   (27 July 2006)

What is the value of guidelines which cannot be monitored?

Chris Jones, Derick T Wade, Consultant and Professor in Neurological Rehabilitation, Oxford Centre for Enablement   (28 July 2006)

Implementing NICE guidelines: is it all about the money or do we need an interpreter? 21 July 2006
Dennis Ougrin, Research and Audit Consultant West London Research Network, Applied Research Unit, Wembley Centre for Health and Care, Brent PCT,, Ricky Banarsee, Paul Ferguson Send response to journal: Re: Implementing NICE guidelines: is it all about the money or do we need an interpreter?	Mayor (1) reported self assessment health checks as a possible way of improving adherence to National Institute of Clinical Excellence (NICE) guidelines. She also reported the Audit Commission's view that cost was a principal hindrance to the guidelines implementation. We would like to draw attention to another obstacle that might impede NICE guidelines' implemetation. NICE produced guidelines on the management of depression (2) using severity of depression to guide the management options. Diagnostic terminology in the guidelines is loosely based on International Classification of Diseases, 10th Edition (ICD 10). NICE guidelines could only be usefully implemented if appropriate terminology is used and depression severity is rated. However, there appears to be significant differences in the way general practitioners and the NICE collaborators classify depression. We performed a survey of approximately 50,000 Electronic Patients' Records at a random sample of 6 GP services in North London. We identified 5,441 depression diagnoses. Of those 1,293 (24%) used NICE guidelines’ terminology and 384 (7%) contained depression severity rating. This might indicate that NICE guidelines on depression management need to be significantly revised to be useful in primary care. NICE collaborators and primary care professionals need to adopt a common diagnostic language in the future guidelines' revisions. References 1. Mayor S. Can NICE Guidelines be given more clout. BMJ 2006;333:170. 2. National Institute for Clinical Excellence. Depression: management of depression in primary and secondary care. Clinical Guideline 23. London: NICE, 2004 Competing interests: None declared
Clarification of Healthcare Commission position 27 July 2006
Nicholas L Bishop, Senior Medical Advisor Finsbury Tower, 103-105 Bunhill Row, London EC1Y 8TG Send response to journal: Re: Clarification of Healthcare Commission position	The Commission for Healthcare Audit and Inspection began in April 2004, not 2002 as stated. Soon after this it adopted the title 'Healthcare Commission' for ease of reference. The Commission for Health Inspection was primarily responsible for assessing clinical governance structures within NHS organisations, every four years. The Healthcare Commission has a wider remit that includes the inspection of independent sector providers. The Healthcare Commission assesses the quality of healthcare by measuring compliance with prescribed standards. This is done on an annual basis using the annual health check. This includes assessing the extent to which the organisation complies with guidance issued by NICE. The degree of compliance may affect the overall annual rating issued to organisations. More is available on www.healthcarecommission.org.uk Competing interests: Senior Medical Advisor, Healthcare Commission
What is the value of guidelines which cannot be monitored? 28 July 2006
Chris Jones, Chief Executive MS Trust, Letchworth Garden City, SG64ET, Derick T Wade, Consultant and Professor in Neurological Rehabilitation, Oxford Centre for Enablement Send response to journal: Re: What is the value of guidelines which cannot be monitored?	27th July 2006 Dear Editor Susan Mayor writes of the difficulties in knowing if Trusts are implementing National Institute for Health and Clinical Excellence (NICE) guidance (BMJ 2006;333:170). A joint research project undertaken by the Royal College of Physicians and the MS Trust to audit NHS services for MS demonstrates that it is possible to assess uptake of guidance, using an innovative 360 degree methodology and by questioning SHAs, PCTs, hospital trusts and people with MS. The results demonstrate that the NHS has barely begun to implement NICE Guidelines published over two years ago to improve care of people with multiple sclerosis. Most of the Guidelines’ seven recommendations are not complied with at present; there are few plans to change this, and the standard of data available within organisations would not allow them in any case to monitor compliance or undertake change. This calls into question the value of NICE Guidelines. What is the point of two years’ hard work on our part – and on the part of many other experts – to produce solid evidence-based guidance without the ability or resources to implement them, monitor any implementation or indeed to hold anyone to account for their delivery? We are mindful of God-like pronouncements from on high. “Let there be light”. But without power, indeed without a national grid, the people with MS will remain in darkness. Yours sincerely Professor Derick Wade Consultant and Professor in Neurological Rehabilitation Clinical Director, Enablement Directorate Oxford Centre for Enablement Christine Jones Chief Executive, MS Trust Competing interests: None declared