Who we are and what we do
1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing evidence-based guidance on health and social care in England. NICE guidance, standards and other resources help health and public health professionals, and social care practitioners, to deliver the best possible care within the resources available.
2. NICE works closely with local and national organisations including NHS England and NHS Improvement, the Care Quality Commission, Public Health England and Health Education England. Together we encourage and support a quality- and safety-focused approach, in which commissioners and providers use NICE guidance and other NICE-accredited sources to improve outcomes.
3. NICE guidelines make evidence-based recommendations on a wide range of topics in health, public health and social care. They recommend the most effective ways to prevent and manage specific conditions and to improve health and manage medicines in different settings. Our guidelines make recommendations on effective social care interventions and services for adults and children, and outline ways to improve the health of communities. In addition, our guidelines recommend the most effective ways to provide integrated health and social care services that meet the needs of patients and people who use services. Alongside other initiatives in the health and care services, we are seeking ways to incorporate environmental sustainability into our guidance.
4. Our recommendations about the use of new medicines, medical technologies and diagnostics identify the most clinically- and cost-effective treatments available. We work collaboratively with the life sciences industry to evaluate their products, facilitating access to the NHS market for those products which are found to offer the best value for patients, and making a clear case for their adoption in the NHS. We also prepare advice on new health technologies in Medtech Innovation Briefings.
5. NICE quality standards are a key component of the drive to promote an outcomes-based approach to improving quality and consistency of care. They identify priority areas for quality improvement and contain a set of statements and measures to enable organisations to assess the quality of care they are providing or commissioning.
6. Our quality standards, along with other NICE products, underpin the menu of indicators that NICE produces each year. NICE Indicators are used nationally and locally to help the NHS to measure the delivery of safe, effective, and cost-effective care and services. NICE indicators measure the quality of care a person receives and the impact it has on their health and they focus on where improvements can be made. The NICE indicator menu comprises both indicators for Clinical Commissioning Groups and indicators for general practice.
7. Our support for organisations committed to improving the quality of care is accompanied by a responsibility to ensure careful and targeted use of finite resources. NICE enables the NHS, local government and social care providers to make the best use of resources by setting out the case for investment and disinvestment through our guidance programmes and other advice. Our position is to work with system partners to realise the benefits of appropriate care and spending on the right things. This includes identifying specific recommendations that can save money, to enable conversations at a patient and population level on appropriate treatments and interventions.
8. Our guidance, advice and quality standards are made available in a variety of formats to ensure they are easily accessible to users through the NICE website.
9. Our online NICE Evidence service provides a portal for easy access to evidence, accredited guidance and other products in health and social care. We commission evidence-based resources such as the British National Formulary and the Clinical Knowledge Summaries, on behalf of the health service These resources can be accessed from NICE Evidence via the NICE website.
10. Our guidance and other products are for the NHS, local authorities, social care organisations, charities and anyone with a responsibility for commissioning or providing healthcare, public health or social care services. Following our recommendations can help these organisations to reduce variations in practice across the country.
The principles that guide NICE's work
11. NICE guidance and quality standards are developed to a high standard and in accordance with a set of core principles that underpin all of our work and how it is produced. We are internationally recognised for the rigorous processes we use to produce our recommendations, and for the quality and accuracy of our products.
Principle 1. We prepare guidance and standards on topics that reflect national priorities for health and care.
Principle 2. We describe our approach in process and methods manuals and review them regularly.
Principle 3. We use independent advisory committees to develop recommendations.
Principle 4. We take into account the advice and experience of people using services and their carers or advocates, health and social care professionals, commissioners, providers and the public.
Principle 5. We offer people interested in the topic the opportunity to comment on and influence our recommendations.
Principle 6. We use evidence that is relevant, reliable and robust.
Principle 7. We base our recommendations on an assessment of population benefits and value for money.
Principle 8. We support innovation in the provision and organisation of health and social care services.
Principle 9. We aim to reduce health inequalities.
Principle 10. We consider whether it is appropriate to make different recommendations for different groups of people.
Principle 11. We propose new research questions and data collection to resolve uncertainties in the evidence.
Principle 12. We publish and disseminate our recommendations and provide support to encourage their adoption.
Principle 13. We assess the need to update our recommendations in line with new evidence.
A methodological approach
12. All our independent advisory committees take a rigorous and structured approach to guidance development, based on set processes and methods that are published on our website. We keep our methods and processes up to date by regularly reviewing them and consulting on changes with our stakeholders.
13. Our independent advisory committees typically assess value for money by calculating the additional ‘Quality Adjusted Life Years’ (QALYs) that new treatments and other health technologies offer compared to standard practice. QALYs show the benefits that a treatment provides in terms of length of life, and quality of life, over the life of the patient. They are calculated by estimating the number of years a new treatment will provide benefit and, using fractions of a scale of 0-1, what change in quality of life it will provide.
14. The number of extra QALYs a new treatment brings is then set against the cost of the new treatment to get a ‘cost per QALY.’ We usually recommend new treatments up to £20,000 per QALY but in special cases we can recommend up to £30,000 per QALY. For treatments that extend life at the end of life, we can go as high as £50,000 per QALY. For treatments for very rare conditions NICE uses a different threshold range of between £100,000 and £300,000 per QALY.
How we involve people
15. We take into account the opinions and views of the people who will be affected by our work, including patients, carers and members of the public, as well as healthcare professionals, social care practitioners, NHS organisations, industry, social care businesses and local government.
16. Our consultation process enables individuals and organisations to comment on our recommendations throughout the development of our guidance and quality standards. Our guidance is created by independent and unbiased advisory committees that include experts such as surgeons and midwives, health economists and social workers, as well as patients or carers or other members of the public.
17. In the case of our technology appraisals and highly specialised technologies guidance, in which we make recommendations about the use of new drugs and technologies within the NHS, we work with companies to ensure that evidence they submit on the effectiveness of their products is the most appropriate to enable an evaluation to be undertaken.
18. We value the input of patients, carers and the general public in our work. By involving them, we put the needs and preferences of patients and the public at the heart of our work. Our Public Involvement Programme supports individual patients, carers and members of the public, as well as voluntary, charitable and community organisations involved with NICE's work.
Working with the life sciences industry
19. Much of what NICE does has an impact on the healthcare industries that supply the NHS. We are very conscious of the responsibility we carry when we advise the NHS on the use of health technologies and we know that what we say about new technologies is often taken into account in health systems elsewhere in the world. For these reasons we regard the relationship we have with industry and individual companies as having equal importance with our other stakeholders and we will continue to work with the industry associations and companies in this country and abroad to build mutual respect and trust.
20. NICE digital services hosts UK PharmaScan, a horizon scanning database for information on new medicines in development which can be accessed by national horizon scanning organisations to support NHS budget and service planning to enable the faster uptake of new medicines across the NHS.
21. HealthTech Connect is also hosted by NICE and provides a service to companies, NHS England and the Academic Health Science Networks by allowing emerging medical device, diagnostic and digital products to be identified for NICE guidance.
22. The NICE Office for Market Access (OMA) works with drugs, devices and diagnostics companies on a fee-for-service basis. OMA gives any commercial stakeholders access to a dedicated team at NICE, offering tailored support to help them optimise their products’ journey through NICE and the rest of their pathway to market.
23. Our fee-for-service Scientific Advice programme engages life sciences companies to help them understand the evidence requirements of NICE’s advisory committees. Our Commercial Liaison Team (CLT) supports the development of commercial agreements, entered into by NHS England.
24. We work in partnership with NHS England to operate the Cancer Drugs Fund. The Fund provides a fast-track route for access to cancer treatments that require a further period of evidence-collection, before a final decision can be made about their routine use. It also allows speedier access to clinically- and cost-effective treatments that have been recommended by NICE, with treatments becoming available within the NHS before final NICE guidance is published.
How our guidance is used
25. Different types of NICE guidance have a different status within the NHS, public health and social care. Our technology appraisals and highly specialised technologies guidance are unique because clinical commissioning groups, NHS England and local authorities are required to fund and resource medicines and treatments recommended through these programmes. The legal status of this mandatory funding is reinforced in the NHS Constitution and the Health and Social Care Act 2012. The NHS Constitution states that patients have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if the doctor responsible for the patient’s care says they are clinically appropriate. The Health and Social Care Act 2012 also states that the Secretary of State and the NHS Commissioning Board (now NHS England and NHS Improvement) should have regard to the quality standards prepared by NICE as part of their duty to secure continuous improvement in the quality of services.
26. Nevertheless, health and social care professionals are actively encouraged to follow the recommendations in other guidance to help them deliver the highest quality care. Of course, our recommendations are not intended to replace the professional expertise and clinical judgement of health professionals, as they discuss treatment options with their patients.
27. We are aware that NICE guidance sometimes recommends changes in practice which the NHS, local government and social care providers may find difficult to implement, especially when faced with limited resources and differing local budget priorities. We work with partners at a national level to help local organisations by providing a programme of implementation support to put our guidance into practice locally.
28. Our guidance is relevant to charities, voluntary and community organisations, residential care homes, private sector employers, patients, carers, service users and the public as well as the NHS and local government. We do our best to provide support for all these groups to put our recommendations into practice locally.
29. We measure the use of NICE guidance and publish impact reports showing how our recommendations have been used in practice to improve outcomes in priority areas. Our impact reports are based on publicly available data and other sources which contain information about the uptake of our work.
Communicating about our guidance, standards and other resources
30. Our guidance, quality standards and other advice products are disseminated and communicated clearly to those responsible for putting them into practice. We also raise awareness about our broader role among those who use the NHS and social care and to members of the public whose health is influenced by our public health guidance.
31. Through our audience insights work, we ensure that the views and expectations of NICE’s audiences are systematically gathered and interpreted. We deliver a full suite of multi-channel communications activities, telling the story of NICE’s work through our website, social and traditional media, speaking engagements, exhibitions and conferences, internal platforms, public affairs and stakeholder engagement. We provide a timely, responsive service to direct enquiries from health and care professionals, patient groups, charities, parliamentarians and members of the public.
Access to our guidance
32. We use a number of innovative ways to help all users access all of our products including NICE Pathways and NICE Evidence. Website improvements and new digital developments are user-led and strive to maintain high standards of accessibility.
33. Patients, people using services, carers and the public can also use NICE guidance and other products as a guide to the high-quality care they should expect to receive.
Putting our guidance and standards into practice
34. NICE guidance and advice can both drive and enable the design and delivery of services provided by the health and care system. When used effectively, NICE resources can support local improvement initiatives, improve outcomes and reduce variation.
35. We deliver a substantial programme of support to encourage improvement and change in practice. For example: we work with third party organisations to motivate individuals to adopt NICE guidance and standards; we facilitate the availability of support tools which make following our guidance more straightforward at a local level and we also have a team of regional implementation consultants and prescribing advisors who provide practical support and advice to our audiences on a local level.
36. NICE is committed to supporting commissioners and providers, local authorities and organisations in the wider public and voluntary sector to make the best use of their money, setting out the case for investment and disinvestment through our guidance programmes and our other advice.