Process and methods
This guide should be read alongside Developing NICE guidelines: the manual.
The Centre for Clinical Practice at NICE is responsible for developing guidance that is solely or mostly focused on the organisation and delivery of healthcare services ('service guidance'). The guidelines manual provides limited information about methods for developing evidence-informed recommendations in this area, so specific methods for developing service guidance are needed.
NICE clinical guidelines deal mainly with aspects of the process of care, and in particular the interventions that should be delivered. Some clinical guidelines have also considered the questions of by whom, where and when interventions should be delivered. What service guidance attempts to do is link these issues with the broader health service – in particular, the interaction between structures and processes. For example, to deliver effective care it is necessary to ensure that there is enough appropriate equipment to deliver the required service.
Although the term 'service guidance' in the context of clinical guidelines has no clear or agreed definition, a working definition is that it comprises recommendations on what resources need to be available, how services should be organised and configured, and the processes that need to be followed to ensure the efficient provision of healthcare interventions of proven clinical and cost effectiveness.
NICE guidance on service configuration has been based on a set of core principles: multidisciplinary teams make better decisions than individuals; the configuration of services should optimise a clinician's ability to specialise by providing sufficient volume of procedures. These principles have guided the reorganisation of cancer and stroke care in England. Future service guidance will in part evaluate the transferability of these principles to other clinical areas. As with other NICE guidance, NICE service guidance will be developed with public involvement as an integral part of the process.
The purpose of this methods guide is to provide information additional to that in The guidelines manual to guide developers on how to approach developing service guidance, and also to inform stakeholders about the steps that NICE will take in developing this guidance.
To ensure consistency with the purpose of NICE and its other guidance programmes, the essential criteria for NICE service guidance are that it is:
designed to promote good health and prevent ill health
produced by the people affected by our work, including health and social care professionals, patients and the public
based on the best available evidence
transparent in its development, consistent, reliable and based on a rigorous development process
good value for money, weighing up the cost and benefits of the service.
It is likely that a variety of methods will need to be used to develop service guidance based on different types of questions, and this methods guide outlines possible approaches rather than being prescriptive. Developers should plan the development of service guidance in collaboration with NICE to ensure that there is sufficient time to identify and review the evidence base, and to develop and test the assumptions underpinning the conceptual model.