NICE needs to move faster to keep up with NHS changes

BMJ 2012; 344 doi: (Published 31 January 2012) Cite this as: BMJ 2012;344:e753
  1. Matthew Limb
  1. 1London

Health and social care experts are asking the UK National Institute for Health and Clinical Excellence (NICE) to produce guidance more quickly as it expands its role. They also want more to be done to measure the effect of new quality standards on the care of patients.

At a London seminar hosted by the Westminster Health Forum on 26 January, expert panellists and an audience from a range of sectors debated issues raised by NICE’s proposed new role, including how to ensure implementation of standards.

NICE is due to become a non-departmental public body in April 2013, and its role in social care is to be expanded. It will also increase its work in the area of setting quality standards, while still providing clinical guidance and carrying out technology appraisals.

NICE will also provide guidance on commissioning and develop indicators to help clinical commissioning groups improve the quality of care.

Leslie Turnberg, chairman of the all party parliamentary group on medical research, who co-chaired the seminar, said that a “brave new world” was opening up and that NICE would have a big influence on quality.

But it would not be easy for the NHS to put NICE’s recommendations into practice amid organisational upheaval and funding constraints, he said.

NICE’s proposed work in relation to public health as this discipline moves to a local authority setting under the government’s proposals was highlighted at the conference. John Middleton, vice president of the Faculty of Public Health, said that he believed local authorities would welcome a stronger emphasis on evidence based policy.

“In times of austerity there is something of an evidence premium,” he said. But he added that councils could struggle to implement monitoring regimes because of a lack of resources.

Rachel Flowers, joint director of public health for the borough of Newham in east London, said that councils were politically driven organisations that needed to take rapid decisions. “NICE is brilliant, but it is very slow,” she said. “How can we get the evidence base a little bit quicker?”

Amanda Edwards, deputy chief executive of the Social Care Institute for Excellence, said that attempts to raise standards in social care might usefully focus on “pinch points,” such as where patients moved out of hospital into the community, “which really tests the quality of joint working.”

Derek Bell, who leads an alliance of academic and health organisations working to get cost effective research initiatives adopted in the NHS, raised the need for formally assessing the use of evidence.

Professor Bell, who is director of the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care in northwest London, said, “Guidelines are the starting point. They need to be linked to an evidence based implementation appraisal and not left to chance.”

Anita Charlesworth, chief economist of the health policy think tank the Nuffield Trust, said that rooting out ineffective practices in health and social care should be a priority. Gillian Leng, NICE’s deputy chief executive, accepted that NICE needed to be clearer in its guidance to commissioners about what activities should be decommissioned.


Cite this as: BMJ 2012;344:e753

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