News blog

Women inspiring inclusion in NICE guidance

Thu, 07 Mar 2024 11:12:49 GMT

At NICE, we’re celebrating the theme #InspireInclusion as we mark International Women’s Day 2024.

From our reception staff to our technical analysts, chair and CEO, we’re an organisation driven by women from all backgrounds to create useful and useable evidence-based healthcare guidance, reflecting our commitment to inclusivity and collaboration.

As of March 2024, women constitute 68.4% of our workforce, and at executive team level this stands at 58.3%, showcasing diversity and equity at all levels of our organisation.

With women’s health occupying a prominent place on the national agenda, especially amid England's 10-year women's health strategy, we recently consolidated our guidance on women's and reproductive health, streamlining access to essential information in one place.

Meet two of the women involved in NICE's committees

I'm Chim, I’ve been a consultant in the NHS since 2014 and am currently leading an Early Pregnancy Unit, as well as serving as the divisional research lead for the women’s and children unit.

As vice chair of the Women’s and Reproductive Health Suite, I facilitate committees providing advisory insights to NICE’s board, guiding the development and updating of guidelines in the Women’s and Reproductive Health Suite.

My passion lies in global women’s health. Given alarming maternal health disparities worldwide, my involvement in NICE committees offers an opportunity to address such inequalities, especially for women from marginalised backgrounds, who we know are statistically more likely to have worse outcomes, and even die during pregnancy. Coming from a black ethnic background sitting on the NICE committee gives me the opportunity to contribute towards improving care and pregnancy outcomes in these women.

I’ve been privileged to contribute towards the review and update of the following guidelines, fetal monitoring in labour, intrapartum care for healthy women and babies and ectopic pregnancy and miscarriage: diagnosis and initial management just to mention a few. I know that through this work, I’ve helped ensure that the guideline review process considers the disparities in maternal health outcomes.

Developing and producing a clinical guideline is one thing, ensuring that the guideline is implementable is another. This is where, as clinicians on the ground our knowledge and experience provide insight to the committee on some of the challenges in the implementation pathway.

Inclusiveness to me means tackling persistent disparities underlying maternal mortality within the health systems from a strategic and policy making level, to the clinician on the ground. Every pregnant woman deserves a positive experience and outcome, and no woman should die from avoidable and preventable causes.

I’m Munira, and I’m the Director of The Ectopic Pregnancy Trust (EPT). I have personally experienced both ectopic pregnancy and miscarriage and my role with EPT involves supporting women, people, and families who are affected by pregnancy loss and complications.

The committee provides input on NICE’s guidelines across a range of women and reproductive health topics, spanning conditions that start in puberty through to menopause. This includes fertility and pregnancy and the topic group for which I am member, early pregnancy. Most recently I’ve been involved with updating NICE’s guidance on ectopic pregnancy and miscarriage. This involved reviewing new recommendations on practical aspects - such as what doctors should look out for on scans and miscarriage treatment. As well as overall consideration of recommendations, I have assisted with specific points from the patient’s view, for example what to look out for following discharge and when and how to seek further medical assistance.

At the start of this role, I had a touch of imposter syndrome, with so many clinical experts around the table! However, committee colleagues have been very welcoming and keen to hear the patient’s perspective. Often, the committee chair or other participants expressly refer a particular point for my input and the views I reflect feel very valued. Any nervousness I had at the outset quickly vanished.

To me “Inspire inclusion” means learning and working together to tackle discrimination and biases head-on. This includes asking and actively listening to affected groups. NICE’s public involvement programme aims to put that into practice.

Vanessa on inspiring inclusion

As we continue to update and prioritise guidance at NICE, it remains paramount we ensure women are central to our work. Their perspectives, experiences and needs must continually inform and shape our efforts to promote inclusivity and equity in healthcare.

Together, let's inspire inclusion and forge a future where every woman receives the care and support they deserve.

Listening to patients and organisations to update NICE’s quality standard on transition from children’s to adults’ services

Thu, 14 Dec 2023 12:11:32 GMT

NICE quality standards set out priority areas for quality improvement in health, public health and social care. They include a small number of concise statements describing the priorities, together with information on how to measure progress. Our previous quality standard on the transition from children’s to adults’ services was first published in 2016, based on the NICE guideline published in the same year, and has now been updated to ensure it remains current.

What has changed in the quality standard?

The key changes made are:

There is a new statement (statement 2) on having a co-ordinated transition plan in place to ensure there is a consistent response, particularly when several different services are supporting a young person with complex needs.
The statement on missed appointments after transfer to adults’ services (statement 6) now focusses on initial appointments (for example, those in the first year following transfer) rather than just the first appointment. This is to ensure young people are not discharged from adult services for not attending appointments.
The wording of the statement on meeting a practitioner in adults’ services (statement 5) has been amended to clarify who is included.

How will this improve transitions from children’s to adults’ services for young people, their families, and carers?

We know that improving transition from children’s to adults’ services is challenging and requires more resources but is important that young people can access the support they need to help them avoid crisis and the need for acute intervention.

The updated quality standard provides a focus for integrated care systems and paediatric and adult health and social care services to work together to make improvements to how the transition works. They can use it in many ways including identifying gaps, developing action plans, collecting data to benchmark and monitor their progress and building a business case to support investment.

How did NICE go about updating the quality standard?

The transition to adult services can be a challenge for many young people and families, particularly those living with rare diseases. In response to the England Rare Diseases Action Plan report, published by the Department of Health and Social Care earlier this year, NICE hosted a workshop with representatives of the rare diseases community in June 2023 to find out how best to ensure the updated quality standard met their needs. We heard that the areas included in the quality standard are important for young people with rare diseases but could be improved by emphasising the importance of having a transition plan and meeting the needs of different groups of young people.

What did NICE do?

We used the detailed feedback from the workshop to help update the quality standard. This included adding information from the NICE guideline on disabled children and young people up to 25 with severe complex needs (2022).

We held a public consultation on the partially updated quality standard in October this year. There was a good response to the consultation from 63 organisations, highlighting the importance of this area of care across health and social care services.

We finalised the quality standard based on the consultation feedback and have published responses to all the comments made by stakeholders.

What has the response been from partner organisations?

Dr Kath Bainbridge, Head of Rare Diseases and Emerging Therapies at the Department of Health and Social Care, said: “I am delighted that following feedback from the workshop and an extensive public consultation, changes have been made to the quality standard to better support young people with rare diseases. We know that moving from children’s to adults’ services can be difficult for all young people so it is really pleasing that NICE has worked closely with the public and partner organisations to produce this useful and useable update.”

You can read the full update to NICE’s quality standard on the transition from children’s to adults’ services on the NICE website.

Listening to the system - implementing virtual wards

Fri, 03 Nov 2023 09:53:26 GMT

Virtual wards (also known as hospital at home) provide hospital level care and monitoring outside of a hospital setting. They are a great way for patients to get the care they need at home, in a safe and familiar environment. 

Although we are seeing many areas embrace virtual wards, we know that there is still some scepticism among clinicians – and in some places they are not being utilised as much as they could.

I was interested to discover more about the reasons behind this. So, I spoke to people from across the system, including people working in clinical settings, to learn more about the benefits and challenges they had identified.

We’ve used this intelligence to plan a robust programme of work to provide useful and useable virtual wards guidance using the available evidence. You can find out more about our virtual wards programme by visiting our new webpage. 

Naming this service

One thing everyone I spoke to agrees on is that the term ‘virtual ward’ is quite confusing. Not just to patients, but to practitioners too. It doesn’t really explain the complexity behind the treatment given to patients, and the technology needed to deliver this. That’s why there has been a recent shift to using hospital at home or step up/step down support.  

Interoperability challenges

Lots of areas said that interoperability between clinical systems was their biggest challenge. This includes the fact that GP teams often use different clinical systems which can make it difficult for virtual wards teams to share information with GPs. Also, the roll out of electronic prescriptions is challenging where not already in place.

Staffing the system

I wasn’t surprised to hear that developing a workforce has been a challenge in some places. Recruitment has been taking much longer than expected. However, one team I spoke to had great success by holding a recruitment day, with applicants interviewed there and then for roles. Some teams are worried that by recruiting virtual ward teams, they are just creating pressures in other parts of the system.  

Evidence generation

As we know, it is early days for virtual wards. And although they proved successful for covid-19 patients there is still a lot to understand about how well they support other conditions. Some say they haven’t seen enough evidence on the benefits of virtual wards, and there are some concerns that people could be put on virtual wards that don’t need to be there. This is not unusual when we are implementing new and promising technology. This is why the work NICE is doing is so important.

However, from my conversations it is already noticeable that virtual wards can be particularly suitable for some conditions. For example, some of the people I spoke to said virtual wards worked well for respiratory patients – particularly those with COPD.  

Monitoring effectiveness

Although, it may take a while to see long term cost effectiveness some areas are already reporting benefits such as a reduction in hospital admissions. There have also been reports of reduced readmissions, conveyance to hospital and length of stays. This can only be a benefit as we approach the winter months. 

Keeping it simple

In most cases, simple is best. Many sites talked about the benefits of having a single point of access for the virtual ward, with a multidisciplinary team sitting behind it.  

The hours are also important. Being available during evenings and weekends has helped reduce hospital admissions. 

Not surprisingly, people felt it was all about having the right workforce in place. A good mix of staff that are appropriately qualified to support patients.  

When asked what people would do differently

I asked the people I spoke to what they would have found helpful to know if they were just starting out. Engagement with others came out loud and clear. This includes making early contact with care homes and domiciliary care providers, as well as early engagement with pharmacy. Additionally, consideration of carers is essential. One area had done lots of work with their local carers centre. They had worked with the centre to co-produce patient information, to make sure patients and their carers were fully informed. Carers UK has provided a useful checklist to help answer any questions, worries or concerns carers might have about virtual wards.  

Not surprisingly, the set-up of virtual wards has worked much better where there has been strong clinical leadership from the outset – not to mention project management capacity to support the set up. 

To summarise... 

Based on these conversations, we know that the health and care system needs answers to the following questions: 

Are virtual wards effective in providing safe care? 
Are virtual wards cost effective? 
What does the evidence say?

To answer these questions, NICE is carrying out a robust programme of work to provide useful guidance using the available evidence.  

You can find out more about our virtual wards programme by visiting our new webpage.  

Patient safety and surgical innovation – why new isn’t always better

Tue, 19 Sep 2023 15:56:04 GMT

We often assume that “new is better”, but when things don’t work out as hoped it’s a different story. This is the culture of surgical innovation. Robots, gadgets and other novel ways of operating are exciting: they generate attention. Surgeon enthusiasm for improving outcomes sweeps patients along. They agree to undergo new procedures and information about uncertainties and “unknown unknowns” is downplayed. Informed consent is jeopardised by surgeon optimism bias. If a patient is harmed they may feel hoodwinked, data might not be shared and lessons might not be learnt.

When this happens, public enquiries have been initiated and, on some occasions, followed by legal proceedings. An independent inquiry in 2020 led by Baroness Cumberledge investigated the introduction of new medical devices, concluding that improvements must be made. This is why it is important to re-consider the way in which surgical innovation occurs. We need to look at patient information, regulatory oversight and reporting of innovative surgical procedures.

What is being done about this?

Over the past five years members of the surgical and orthopaedic innovation theme of the National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC) have explored this. The INTRODUCE study (Cousins et al. 2019 BMJ Open and BJS 2022) retrieved NHS hospital policies from England and Wales and scrutinised them in-depth to understand how local governance is provided for innovative surgical procedures.

The LOTUS study (Elliot et al BMJ Open 2020 and Annals of Surgery 2023) interviewed surgeons and patients and recorded their consultations in which surgical innovation was discussed. The LOTUS team unearthed that in consultations when patients are asked for informed consent for a new procedure, key information was often lacking. For example, a minority of surgeons communicated the uncertainty about safety or told the patient that they had limited experience with the new procedure. This meant that patients may not realise how new the procedure is and be aware of potential risks. This happens despite surgeons intending to be open and transparent about the novelty of procedure and unknown risks. It was found that surgeon innovators uniformly shared the theoretical benefits of the innovation (optimism bias).

The future

Although the way that surgical innovation occurs in the NHS is currently very different to the rigorous approach taken for new drugs it is hoped that this will soon change. Members of the Bristol BRC are collaborating with NHS trusts, national bodies and patients and the public to improve things.

This will strengthen and tighten the current system and close existing loopholes: it will increase patient safety.

How NICE manages the potential conflicts of interests of patient experts

Tue, 08 Aug 2023 08:22:11 GMT

NICE’s independent technology appraisal and highly specialised technologies committees produce guidance on the use of new medicines in the NHS. Their work is greatly enhanced by the voices of people who use services, carers, and the public and help to ensure our work is anchored in real life.

These independent committees make recommendations based on careful analysis of all the evidence in support of the medicine’s clinical and cost effectiveness, to determine whether the medicine provides value for money to the NHS.

The nature of NICE’s role in the health system means that we frequently experience pressure from across the health ecosystem and from a multitude of stakeholders. As a result, over more than two decades NICE has developed robust processes to ensure we can provide rigorous and independent assessments of complex evidence for new health technologies. This includes our policy for declaring and managing the interests of all those who participate in NICE’s advisory committees. The policy requires all relevant financial and non-financial interests that a person - and the organisation nominating them – has, to be declared such that these can be reviewed by NICE. A direct interest is any where there is, or could be perceived to be, an opportunity for a person involved with NICE’s work to benefit.

Patient groups will need to declare payments they have received from manufacturers. We recognise that these payments are made, and our committees are aware that both patient groups and their representative charities give their insights from their own perspective and interests. Having a declared interest does not necessarily mean the person or organisation are conflicted.

Our focus is on understanding the interests these patient experts may have, which is important context to the statements they might make in committee meetings.

Although patient experts play a key role in the appraisals process, they are not decision makers. Ultimately, our appraisal committee members will decide whether a medicine provides value for money to the NHS and should be recommended by NICE, informed by the evidence available to them. Our policy therefore outlines the robust risk-based approach for managing committee members’ potential conflicts of interests and will usually exclude them from the meeting if they have a direct financial interest.

NICE also allows the manufacturer of the medicine to participate in the committee meeting, to correct factual inaccuracies and to answer questions that committee members might have about the evidence supporting the medicine.

Implementing stricter requirements for patient experts than pharmaceutical companies – who are assumed to have a direct financial interest - for participating in committee meetings would be disproportionate to the role patient experts have in committee meetings.

NICE regularly reviews its policy on managing and declaring interests. For example, it was amended in response to a study on patient group funding from industry, and now requires experts who are nominated by an organisation to declare funding received by that organisation from the manufacturer of the medicine under review.

We have also considered whether we should extend the timeframe for declaring interests that are no longer relevant beyond the current 12-month requirement. However, if a financial interest has ceased to be relevant to the appraisal and ceased to be a relevant interest more than 12 months ago, it is unlikely that, if declared, it would result in a decision to exclude the person from participating in the meeting. On balance, it would increase the administrative burden for experts without making a meaningful change to the assessment of whether the interests prevent partaking in the committee meeting or not.

Decisions on managing interests must balance the need for advisory committees to have access to the appropriate expertise on the areas under consideration, while minimising the risks to their perceived ability to objectively consider the evidence.

The reality is that many patient organisations have financial ties to the life sciences industry, and initiatives such as Disclosure UKhave increased the transparency of financial payments made to patient organisations in recent years, which is a welcome development that supports the ability of our committee members to be aware of the conflicts experts might have and enables a robust, risk based approach for managing potential conflicts of all those who participate in committee meetings.

NICE values the contribution patient groups make to its work and will continue to ensure their voices are heard.

NICE to stop supplying print copies of BNF and BNFC to support use of up-to-date content, and drive sustainability and digital transformation

Wed, 26 Jul 2023 10:21:23 GMT

Following extensive user research showing an increasing preference for the online and mobile app versions, and in line with the NHS’s plans to digitise, connect and transform, NICE has made the decision that the upcoming print edition of BNF86 and BNFC 2023-24 will be the last to be supplied by NICE to the NHS in England. These final print editions supplied by NICE are scheduled to be distributed in October and November 2023.

Benefits of the digital content

The benefits of moving to digital BNF and BNFC content are clear. They include:

Clinical safety – The digital offerings are updated monthly providing important clinical and safety information in a timely way. Print versions of the BNF and BNFC are provided once a year and are out of date by the time they are received by healthcare providers.
Environmental impact – Switching to a digital format of the BNF and BNFC supports the national priority to deliver a Net Zero National Health Service by 2040. Printing and distribution of the BNF and BNFC has a significant carbon footprint.
Digital transformation – Switching to digital BNF and BNFC content supports the NHS Long Term Plan objectives of digital transformation.

NICE funds and manages the provision of the British National Formulary (BNF) and British National Formulary for Children (BNFC) to the NHS and other eligible groups in England on behalf of the Department of Health and Social Care.

This includes providing access to the BNF and BNFC online, which is updated monthly and hosted on the NICE website and on MedicinesComplete, the BNF + BNFC mobile app, and the print editions of the BNF and BNFC.

NICE is a world-leading organisation, committed to getting the best care to people, fast, whilst ensuring value for the taxpayer. Moving to digital BNF and BNFC content helps us fulfil these objectives.

Accessing the digital content

Digital versions of the BNF and BNFC can be accessed in the following ways:

NICE Website available via https://bnf.nice.org.uk/ and https://bnfc.nice.org.uk/.
The NICE website is free to use for the NHS and eligible users and does not require a login or registration.
BNF App available via App Store and Google Play.
The BNF App can be used offline, is free to use and requires a login.
MedicinesComplete website available via https://www.medicinescomplete.com.
MedicinesComplete is free to use for the NHS and requires a login.

Prioritising the use of digital versions of the BNF and BNFC over the print version represents the most efficient and safe way of accessing this trusted source of medicines information.

Frequently asked questions

Can I still access new copies of the printed BNF and BNFC?
- Yes, while NICE will no longer be funding and supplying free copies to eligible groups, you can purchase directly from Pharmaceutical Press by visiting www.bnf.org.
How can I access the digital versions of the BNF and BNFC if I have limited internet access?
- Once downloaded, the digital BNF and BNFC app does not require internet access. The app content is updated every month and you will need internet access to update the app.
How can I access technical support for the digital versions of the BNF and BNFC?
- Please contact the BNF directly at pharmpress-support@rpharms.com regarding any technical issues with the app or the BNF on MedicinesComplete. If you have any technical issues with the digital BNF and BNFC hosted on NICE’s website, please email us at nice@nice.org.uk.
Which users can access the digital BNF and BNFC content?
- NHS users are able to access BNF content via the App, MedicinesComplete and NICE website free of charge.
How can users who are not NHS users access BNF and BNFC content?
- For non-NHS users, please contact the Pharmaceutical Press for access to BNF and BNFC content. Contact details are available on www.bnf.org.

NHS at 75

Tue, 04 Jul 2023 15:33:11 GMT

The NHS touches all our lives.

It treats over a million people a day in England, and was the first universal health system, available to all, free at the point of delivery.

As we mark its 75th anniversary, I’m sure many of us will be taking some time to celebrate this remarkable institution.

Over the years, one of the NHS’ key strengths has been its ability to adapt, and evolve, to meet the needs of successive generations. From providing Europe’s first liver transplant in 1968, to pioneering newer treatments such as whole genome sequencing service for seriously ill babies or children.

Throughout NICE’s existence, we’ve supported the NHS with getting such innovative treatments to patients fast.

And as the NHS has evolved, we are adapting to ensure we continue to meet these needs.

So, on this landmark day, I wanted to reflect on a few of the NHS’s key recent achievements, and the role NICE has played in supporting them.

Adopting innovative technologies at speed

The NHS leads the way in adopting innovative medicines.

Industry data shows there are five treatments available in England for every four in Europe, as well as almost a third more cancer drugs. In addition, the UK is 3rd globally in the number of medicines commercialised within one year of regulatory approval.

We know our stakeholders value the rigour and independence we apply to making the right decisions on treatments. But we also know that they would like us to make these decisions faster.

This year, we’ve taken important steps to achieve this ambition.

In 2022-23 we appraised 70% more medicines than 2019-20, and we evaluated medicines 17% faster on average, meaning thousands of patients gained access to new treatments sooner.

We also recommended 20 digital technologies and adopted a streamlined approach to our appraisals, allowing us to recommend treatments up to 20 weeks faster than our standard processes.

We could only achieve this through working closely with our partners and stakeholders to offer flexible solutions to issues of data and value.

Supporting integrated care systems

In 2022, the NHS set up integrated care systems (ICS) across England. The systems address issues such as health inequalities and plan services to better meet the needs of patients.

Over the past year, we’ve supported ICSs in three major ways.

We know our colleagues in the system are very time-pressured, inundated with information, and need easy access to summaries of our guidance. So, we put together three resources to help practitioners and commissioners:

We created a new resource that, for the first time, brings together all NICE guidance and advice on health inequalities in one place.
We launched a new tool that supports practitioners and commissioners with productivity and planning priorities.
We worked with NHS England to develop a quick guide on secondary prevention. The resource sets out advice on the most impactful interventions relating to the management and prevention of cardiovascular disease, diabetes, and respiratory disease.

Rapid guidance on COVID-19

We’re proud to have supported the NHS as it dealt with COVID-19

During the pandemic, we collaborated with researchers to identify potential new drugs for COVID-19. We produced rapid guidelines on COVID-19 for clinicians on topics, which were viewed over 4.2 million times in the first year alone.

We collaborated with partners to publish guidelines that, for the first time, recommended standards in information provision to people with the long-term effects of COVID-19.

More recently, we developed a new rapid review process to update recommendations on the cost-effectiveness of COVID-19 treatments. This is so that they can be made available more quickly to patients if they show promise against new variants and are found to be cost-effective.

We also issued guidance on treatments for COVID-19 that for the first time, considered evidence from in vitro studies. These lab-based studies can be used to quickly assess how well treatments work against new variants, and therefore predict whether they will work in the real world to protect people.

NICE transformation: keeping up with innovation

I’m proud of the ways that NICE has supported the NHS in the 24 years since our inception.

But the world is changing, and like the NHS, it’s important that we evolve to meet changing needs.

So, we’re taking measures to adapt.

We’re creating new processes, involving novel approaches to data collection and evaluation. This will ensure our guidance is relevant, timely useable and has impact.

You can hear more about this important work at an event we’re hosting next week. The event is free to attend and will explain how NICE is transforming over the next few years. I would welcome you to sign up to what will be an informative and engaging session.

Celebrating 75 years of the NHS and looking to the future

On the NHS’s 75th anniversary, I’ll be reflecting on how proud I am of its achievements and of NICE’s role in supporting them. I’ll also look to the future with excitement for how we’ll meet the challenges and opportunities ahead.

Through NICE’s programme of transformation, I know we’ll continue to support the NHS, to ensure it remains sustainable, and that it remains the healthcare envy of the world.

Find out how NICE is transforming.

Tackling health inequalities in children and young people

Thu, 15 Jun 2023 11:17:08 GMT

Inequality in health and care is a significant issue that affects us all.

At NICE, we define health inequalities as unfair and avoidable differences in health across the population and between different groups of society. The impact of these differences is profound – not only affecting a person’s physical and mental health, but also limiting a person or group’s prospects in life.

There is an economic impact too, with estimates suggesting health inequalities cost the NHS an extra £4.8 billion a year, and society around £31 billion in lost productivity.

Before joining NICE, I was directory of strategy at Liverpool University Hospitals NHS Foundation Trust. It was a role I was privileged to hold; helping to join up and translate health and care transformation at an NHS provider, place and system level.

Working in Liverpool, I got to see first-hand the profound and lasting impact of health inequalities, which were exacerbated by the COVID-19 pandemic.

The health of people across the region is considerably below the rest of England on average. It’s reflected in lower life expectancy, higher obesity rates in children, and higher than average mortality rates in people under 75.

The scale and complexity of poor population health has a profound impact upon the system; impacting access to health and care services for people and demand management for health and care providers.

My observations in Liverpool are sadly all too common across the country and the impact of health inequalities is significant.

Addressing health inequalities: part of NICE’s core principles

I joined NICE last year as director of implementation and partnerships, aware that reducing health inequalities is part of NICE’s core principles.

NICE guidance underpins national and regional strategies that improve overall population health, considering where there is particular benefit to the most disadvantaged.

We have also delivered a focussed programme of work on health inequalities, which is now entering its third year. This programme makes sure health inequalities are considered and embedded in our work and guidance. Maintaining this focus, ensures NICE is enabling the health and care system to reduce health inequalities, where it will have the greatest impact.

First practical web resource on health inequalities

Through this work, NICE recently developed a practical web resource that - for the first time - maps all its guidance and advice to existing health inequalities frameworks.

This interactive resource lets you see all our relevant guidance and advice aligned to initiatives such as the NHS’s Core20PLUS5 and the adapted Labonte model. Aimed at practitioners and commissioners, the resource is a one-stop-shop of evidence-based recommendations aligned to established health inequalities frameworks.

New update - Core20PLUS5 for children and young people

The resource was really well received on its launch in October 2022. Many users commented on the depth and breadth of information offered. However, some also commented that the resource needed more guidance specifically relevant to children and young people.

We had planned to address children and young people in a second phase of work. However, based on this user feedback, we brought forward this update, by mapping our guidance with the six policy objectives set in the Marmot Review. This review, originally published in 2010 and recently revisited, was an independently produced report proposing effective evidence-based strategies for reducing health inequalities from birth onwards.

So, this week, I’m pleased to announce that we have launched a further significant update, which maps our guidance to the new Core20PLUS5 model for children and young people.

Core20PLUS5 is a national NHS England approach to inform action to reduce healthcare inequalities at both national and system level. The approach defines a target population – the ‘Core20PLUS’ – and identifies ‘5’ clinical areas of focus requiring accelerated improvement.

Our updated web resource maps NICE guidance to the NHS’ five areas of clinical focus, where care can be improved for children and young people:

Asthma
Diabetes
Epilepsy
Oral health
Mental health

We’ve also included case studies of where other organisations have put our guidance into practice under each of these areas.

Help us continually improve our web resource

We know colleagues working in health and care are looking for help and resources to tackle the enormous challenge of health inequalities. The fact that nearly 10,000 visitors engaged with our resource within the first month highlights this. But we also know that the health and care landscape is evolving at an unprecedented rate, meaning that the resources and support we can provide may need to change.

So, we would appreciate any feedback you might have on this updated resource. This will help us make improvements, to make sure we’re delivering tools which are useful and usable. Ultimately, NICE is part of the jigsaw of people and partners working together to drive equity in health and care.

Find out more

Visit our health inequalities web resource.

For, feedback, comments or further information on our guidance and health inequalities please email healthinequalities@nice.org.uk

Supporting the NHS's ambition for virtual wards

Tue, 30 May 2023 10:28:19 GMT

Why do we need virtual wards?

The ambition for virtual wards is to expand the capacity of the acute care sector by managing patients, who would otherwise be in hospital, remotely in their homes, creating potential staffing efficiencies and providing safe and more convenient care for patients.

The NHS has an ambition for systems to deliver 40-50 virtual ward beds safely and sustainably per 100,000 population. Already, more than 100,000 patients have been treated in NHS virtual wards in the last year. At a minimum, NHS England state that they expect each integrated care system (ICS) to implement virtual ward models for 2 pathways: acute respiratory infection and frailty.

Successful implementation will require systems to:

maximise their overall bed capacity to include virtual wards
only use virtual wards for patients who would otherwise be admitted to an NHS acute hospital bed or facilitate early discharge
maintain the most efficient safe staffing and caseload model
manage length of stay in virtual wards through establishing clear criteria to admit and reside
fully exploit remote monitoring technology and wider digital platforms to deliver effective and efficient care.

How NICE is contributing to this effort

NICE has 3 streams of work that are actively contributing to support these ambitions:

Development of a NICE clinical guideline on acute respiratory infection in over 16s: initial assessment and management. This guideline will aid healthcare professionals in deciding where to refer people aged 16 and over with suspected acute respiratory infections, including referrals to Virtual Wards and acute respiratory infection Hubs. Expected publication October 2023.

Development of technology assessment guidance on technologies that enable virtual wards for acute respiratory infections. The aim of this guidance is to outline key considerations and characteristics of the digital platforms that help to materialise the value and benefits of virtual wards for patients, healthcare professionals and the system. This will include guidance and advice on future priorities for data collection. Expected publication September 2023.

Development of economic evaluations and implementation support tools
- NICE plans to publish an update of the economic evidence that supports its clinical guideline (NG94) on emergency and acute medical care (for over 16s). This guideline aims to reduce hospital admissions through training and community alternatives. Expected publication late June 2023.
- NICE is accessing and reviewing real-world economic data from NHS sites that have implemented virtual wards to provide general advice to support economic business case development. NICE will develop case studies and implementation support tools highlighting benefits and barriers. Expected publication phased July – November 2023.

Use these links to our guidance development pages to register as a stakeholder and keep up to date with the progress of this work.

How ‘surrogate outcomes’ influence long-term health outcomes

Thu, 13 Apr 2023 11:09:16 GMT

As part of NICE’s assessment of the clinical and cost effectiveness of new medicines we look at the long-term effects on health that a drug might have. For example, when assessing a new drug that lowers blood pressure, NICE will not only consider whether the drug is effective, but also whether it prevents people who take it from having heart attacks or strokes in the future.

When new drugs are approved, they don’t always have all evidence for their longer-term effects available. However, when we know and understand the relationship between short-term effects, and long-term outcomes, we can use cost-effectiveness models to make predictions about the long-term health effects that new drugs are likely to have.

This is important because for many drugs, most of their value to patients and the National Health Service (NHS) is determined by these predicted long-term effects. We refer to short-term effects as ‘surrogate outcomes’ as it’s a replacement for the longer-term effect.

We are building our understanding of the relationship between surrogate outcomes and how they influence longer-term health outcomes. This has led to an increase in drugs that are approved based on improving a surrogate outcome in clinical trials. If we can assess new drugs based on their ability to improve the surrogate outcome, we can get new treatments to people who need them faster, as we don’t have to wait for the evidence that the drug also improves long-term outcomes before making a recommendation.

However, NICE, and similar organisations abroad, do need to be certain that the drug’s effect on the surrogate outcome will result in longer-term benefits for patients. When such evidence is missing this can make it difficult for organisations like NICE to use cost-effectiveness models to predict what the long-term benefits of the drug are likely to be. This can make it challenging to recommend such drugs for use in the NHS.

NICE is working with a group of organisations who make recommendations for the use of new drugs in other countries to develop more guidance on the use of surrogate outcomes when analysing cost-effectiveness. The guidance will help pharmaceutical companies understand how surrogate outcomes should be used when analysing cost-effectiveness of the drugs they are developing.

The international organisations NICE is collaborating with are:

Scottish Medicines Consortium (SMC),
Canadian Agency for Drugs and Technologies in Health (CADTH),
Health Technology Assessment international (HTAi) Global Policy Forum,
Australian Department of Health and Aged Care,

the National Healthcare Institute (ZIN),
Colombian Institute for Technology Assessment in Health (IETS).

NICE is also working with several international organisations to explore developing a joint scientific advice procedure that offers advice on the proposed use of new surrogate outcomes in analysing cost-effectiveness.

The organisations are:

Institute for Clinical and Economic Review (ICER),

Canada’s Drugs and Health Technologies Agency (CADTH),
Health Technology Assessment international (HTAi) Global Policy Forum,
All Wales Theraputics and Toxicology Centre (AWTTC),
Australian Department of Health and Aged Care.

Work on these projects began in January and will continue over the next year. You can keep up to date on progress through the NICE website and social media channels.

How my experience as a patient helped shape NICE guidelines for colorectal cancer

Mon, 03 Apr 2023 09:36:14 GMT

My previous work experience in Careers had involved sitting on several university committees which I felt would be helpful preparation for NICE committee work. I was also interested in medical science, having done a degree in Physiology many years ago, though scientific knowledge is not required by public members.

A rewarding experience

I learnt a lot about research and the strict requirements needed to provide good evidence before a new treatment or guideline could be published. It was a very thorough and detailed process, but I felt fully supported by NICE staff and other members of the committee throughout. When the final report was published, I felt very satisfied that safe recommendations had been produced which would benefit patients in future.

Using my experience to help future patients

My input throughout was to put forward points which would be important to patients in making decisions about treatment.

Contributing my personal experience to the discussion, I shared my experience of developing chronic peripheral neuropathy, which came about as a side effect following chemotherapy. Unfortunately, it didn’t respond to a number of treatments, and resulted in my feet being extremely painful 24/7 and my ability to walk any distance was severely restricted.

My experiences were supported by the research results - which led to a reduction in dosage from 6 months to 3 in the NICE guideline. This was recommended to help reduce the number of people who go on to develop this, and the statement made in section 1.2.6 about managing and monitoring symptoms and reducing dosage of chemotherapy if necessary will also help. However, this depends on patients being very honest about their symptoms, and when people are concentrating on survival, they tend not to want to reduce the dosage of a drug which might save them vs a side effect. This was certainly true for me and for many others I suspect.

The decision to do this was finally based on very good evidence, but I think this was the guideline that gave me the most personal satisfaction.

Happily for me, I did find a solution to the problem – outlined in a NICE Technology Appraisal Guideline which suggested spinal cord stimulation for chronic neuropathic pain. Two years ago, I had a spinal stimulator implanted and it has changed my life. I can now walk for an hour quite happily with feet which are a bit uncomfortable but not painful.

Becoming a co-author

I was also a member of a subgroup which produced a NICE Patient Decision Aid for Aspirin in Lynch Syndrome, where the patient representative views were very important in making this very lay friendly for patients to read. A BMJ summary for the Colorectal Cancer Guideline was published in March 2020 and I was listed as a co-author – something I had never expected to see!

So, what’s next for me?

Currently, I am sitting as a Public Representative on the Trial Management Group for POLARiS, an NIHR Project assessing different treatments for patients who have LARS (Low Anterior Rection Syndrome) following cancer surgery. This condition affects bowel control which can severely affect people’s quality of life. Interestingly, this was an aspect we looked at on the NICE Committee, but there was insufficient evidence to make any recommendations for treatment, so NICE made a recommendation for further research in this area. My experience on the NICE Committee played a significant role in helping me to get a position on the research group for this condition.

Advice for others thinking of joining as a lay member

I would say ‘go for it’ of you feel you have some relevant experience of the condition under study but do be prepared to do quite a bit of reading of documents before meetings. Don’t be put off by the idea of sitting on a committee with some very highly qualified clinicians. They are very friendly and helpful, and they really need the patient view in their discussions.

Find out more about NICE’s current committee vacancies.

Working at the forefront of neurodegenerative disease research

Thu, 30 Mar 2023 08:48:34 GMT

In the UK, over 1 million people are living with a neurodegenerative disease. These include conditions such as Alzheimer's, Parkinson's and multiple sclerosis. It’s an area of unmet clinical need. Despite high levels of research expenditure, there is a lack of effective new treatments.

In response, the Innovative Medicines Initiative (IMI) committed over €380 million on a diverse portfolio of more than 20 different research projects. Their purpose was to better understand and develop treatments for neurodegenerative conditions. Key areas of focus included improved frameworks for risk factor screening and innovative trials for disease prevention.

The Neuronet project

NICE was a key partner in the 3-year Neuronet programme, which completed in August 2022.

Neuronet aimed to connect the IMI projects on a single platform to:

help scientists identify gaps in research
make findings more visible for society as a whole
create links between IMI projects and other international research initiatives.

Our role in the project was to analyse the IMI neurodegenerative disease research portfolio and investigate its impact. We also chaired a working group on the health technology assessment and regulatory challenges that are unique to medicines for neurodegenerative diseases.

Results

The Neuronet project has produced some useful tools to help developers of treatments for neurodegenerative conditions get their products to patients faster.

Knowledge base. Brings together key information about the various projects in the IMI neurodegeneration portfolio. We identified tangible actions to enhance collaboration between project partners. These recommendations could help increase the efficiency and impact of future public-private partnerships on neurodegeneration.
Asset map. Details all the resources resulting from the different IMI projects. These outputs, which include training materials, biological sample data and ethical frameworks, bring real value to the neurodegenerative disease research field.
Decision tool. The tool provides an interactive overview of how developers should engage with European regulatory and health technology assessment bodies. It includes helpful case studies and signposts to useful resources.

Find out more

If you’re keen to learn more, along with our partners, we’ve published 2 articles in the Frontiers in Neurology journal:

If you work in neurodegenerative disease research and you’d like to learn more about the project, please get in touch by emailing research@nice.org.uk.

Please note: The IMI helped to fund the Neuronet project. The IMI receives support from the European Union's Horizon 2020 research and innovation programme, the European Federation of Pharmaceutical Industries and Associations, and the UK Parkinson's Disease Society.

Time to talk: about NICE’s latest depression guidelines and quality standard work

Thu, 02 Feb 2023 09:02:06 GMT

To mark Time to Talk Day (February 2) we spoke with Catherine Ruane, who acted as a carer for her father and sister, who both lived with depression.

Catherine was part of NICE’s patient involvement group committee, as a lay member participant for our depression in adults: management and treatment guideline (NG222), published in June 2022, and more recently was involved in the independent advisory committee for a new draft quality standard (QS) for adults.

Q: How did you come to be part of NICE’s patient involvement group?

A: My family owe a huge debt of gratitude to the NHS for the treatment and care given to my sister and father during the many years that they lived with depression. Sadly, they have now both passed away from other illnesses.

As a carer, I saw first-hand many of the challenges depression can bring and gained some knowledge about what worked well and what could work better from the point of view of a person with depression and a carer. I wanted to give something back to the NHS and to find a way to use my experience to make a positive difference for patients and carers. I also felt that applying to be a NICE committee lay member on the guidelines was a fitting tribute to my sister and my father.

Q: What have been the biggest takeaways from your involvement, with the committee so far?

A: There’s been significant progress in science and medicine in the past 12 years. This guideline emphasises a greater amount of patient choice, taking greater account of the things that really matter to the patients and their carers.  The QS also recommends that people who are considering taking, or stopping, antidepressants medication should talk with their healthcare professional about the benefits and risks. The healthcare professional should explain that withdrawal may take weeks or months to complete successfully, that it is usually necessary to reduce the dose in stages over time (called ‘tapering’) and that most people stop antidepressants successfully.

Q: How did you find being a lay committee member?

A: As a lay member on the depression guideline and quality standard, I have been heartened to see how hard everyone on the committee has worked to develop the guidelines for the benefit of people with depression and carers. Suggestions by lay members were taken seriously and are reflected in the new guidance. I have found it such a positive experience and I would encourage anyone with experience to apply for any relevant committee.

Q: What’s happening next in relation the draft quality standard?

A: A consultation on the draft quality standard is now open, and registered stakeholders can take part until Tuesday, 14 February on the NICE website.

International collaboration - advancing the use of real-world evidence in health technology assessment

Tue, 24 Jan 2023 11:15:25 GMT

Real-world evidence has the potential to transform current models of evidence generation. It allows us to better substantiate the benefit of a medical intervention outside clinical trials. Data is taken from sources such as electronic health records, medical claims data and disease registries.

Here at NICE, we want to use real-world data to resolve gaps in knowledge. By making better decisions sooner, we will be able to more quickly drive innovation into the hands of health and care professionals to enable best practice.

Over the last year, we’ve made great progress towards this goal. In June 2022, we published our real-world evidence framework. This identifies when such data can be used, and describes how best to plan, conduct and report real-world evidence studies.

The European Health Data and Evidence Network and the GetReal Institute

In October 2022, NICE hosted a half-day virtual workshop: ‘Regulators are formally adopting real-world evidence, when will health technology assessment?’ We hosted the event as part of our work within the Innovative Medicines Initiative (IMI) grant-funded project European Health Data and Evidence Network (EHDEN). We organised it in collaboration with the GetReal Institute of which NICE is a founding member.

IMI EHDEN is establishing a network of healthcare databases in Europe. Each database in the network conforms to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM). This model aims to standardise the format and content of data so that data resources can be queried to answer important questions quickly and efficiently.

The network also supports the aims of the GetReal Institute to facilitate the adoption and implementation of real-world evidence in healthcare decision-making in Europe. This important partnership places NICE at the forefront of global developments in this field.

The workshop

We developed the workshop for a broad audience including health technology assessment agencies, industry, academia and not-for-profit organisations. The workshop explored:

Developments in the use of real-world evidence at the European Medicines Agency (EMA).
Implications and opportunities for health technology assessment agencies and their stakeholders.

Developments at the EMA – DARWIN EU®

The EMA and the European Medicines Regulatory Network recently established the Data Analysis and Real World Interrogation Network (DARWIN EU®). Using the OMOP CDM, DARWIN EU® delivers real-world evidence from across Europe on diseases, populations and the use and performance of medicines. This enables EMA and other organisations in the European medicines regulatory network to use this data whenever needed throughout the lifecycle of a medicinal product.

Implications and opportunities

As part of the workshop, I presented 2 use cases that we are leading on within IMI EHDEN. One focusses on oncology and the other on COVID-19.

One of the difficulties health technology assessment agencies face when assessing treatments for cancer is the uncertainty surrounding long-term projections for overall survival. This is due to insufficient follow-up in clinical trials. During my presentation, I explained how we are exploring the use of data from EHDEN partners to examine real-world survival rates from common cancers (such as breast, lung and colorectal) and one rarer cancer (head and neck). We are using this data to create a dashboard that will help us examine long-term survival projections. This could be used to validate trial-based survival extrapolations, helping health technology agencies like NICE to make better decisions for the benefit of patients and society as a whole.

I also outlined a COVID-19 project we are leading in collaboration with the University of Oxford. We are analysing data from the EHDEN network to assess the effectiveness of baricitinib, tocilizumab and remdesivir in a hospital setting. This demonstrates the potential application of real-world evidence in health technology assessment. It will enable NICE and other health technology assessment organisations to make robust decisions more quickly.

Next steps

The workshop prompted discussion between panellists and speakers, who identified some key steps to support decision-making in health technology assessment:

Develop a training strategy to help upskill users and beneficiaries of real-world evidence within health technology assessment.
Identify projects that will help develop methodology and build trust in real-world evidence.
Use real-world data to define and characterise patient populations and natural history of disease.

Chief executive’s end of year message

Wed, 14 Dec 2022 14:25:25 GMT

As another busy year draws to a close, I’d like to take a moment to reflect on our key achievements of the past 12 months, and to look ahead to our priorities for 2023 and beyond.

I was immensely proud to join NICE as chief executive in February. It’s an organisation that I’ve admired and respected throughout my career. In my previous roles as a doctor and NHS manager, I found its expertise indispensable for decision making.

For over 20 years, NICE has got the best care to people fast, while ensuring value for the taxpayer. And it’s achieved this through independence, transparency and rigour - principles that are rightly respected across the globe, and that underpin everything NICE does, to this day.

As we enter 2023, NICE’s core purpose remains the same. But the world around us is changing: the rate and pace of innovation is increasing exponentially, and health and care practitioners are working under exceptional pressures.

So, this year, we’ve taken important strides to adapt. We’ve listened to our stakeholders, and they’ve told us we would make a greater contribution to the health and care system by:

focusing on what matters most
creating advice that’s useful and usable
continually learning from data and implementation.

Reflecting on our activity of the past 12 months, I can see that we’ve responded to these challenges at speed, and that we’re developing innovative approaches to meet them.

Focusing on what matters most: adolescent mental health, health inequalities, cancer

This year, we’ve focused on areas where NICE advice can make the biggest difference.

To speed up access to care that generates the most significant health gains we have evaluated COVID-19 therapeutics and apps for children and young people with anxiety and depression, both of which have the potential to benefit hundreds of thousands of people during the high-pressure winter period.

To address key areas of unmet need, we published landmark guidelines for people with type 1 diabetes that will enable over 250,000 people to benefit from real-time glucose monitoring, improving glycaemic control and long-term health outcomes. And since June, we’ve recommended 3 new treatments for triple-negative breast cancer, a type of cancer that has fewer treatment options and accounts for a disproportionately higher number of breast cancer deaths.

We’ve also begun work on virtual wards – a key project that will help the health and care system with current capacity and efficiency challenges.

Continuing our work on health inequalities, we launched a new practical online resource that provides NICE-recommended, evidence-based approaches aimed at integrated care systems. Nearly 10,000 people engaged with this resource in the first month, and I was incredibly pleased to see the warm reception it’s had by colleagues, practitioners and system partners.

Creating advice that’s useful and usable: ‘living’ guidelines and increasing capacity for technology appraisals

While preserving our independence, transparency, and rigour we are improving the speed and proportionality of our advice.

I’m delighted that NHS patients are now often the first in Europe, or the world, to access innovative new pharmaceuticals. Industry data shows that the UK is third globally in the number of medicines commercialised within one year of their first approval.

Given the rate of innovation, to continue this we need to take a proportionate approach to our assessment of medicines. We will move towards applying light-touch, faster evaluations to simpler, low-risk treatments. This year, we've piloted our first new medicines through this streamlined approach, which is 25% faster than our full standard process, and which we expect to expand our capacity for new drug appraisals by 20%.

We launched our Early Value Assessment Programme, through which we’re identifying promising healthtech products, including apps and digital technologies, and enabling earlier access to them while further data is collected for a full evaluation.

We’ve also begun to change how we manage our portfolio of guidelines, so we can prioritise recommendations that matter most to the system for more frequent and quicker updates, as part of our ‘living guidelines’ programme. Our ultimate aim is to update recommendations on key topics within 3 to 6 months of new, practice-changing evidence emerging.

Continually learning from data and implementation: establishing partnerships and using real world evidence

In 2022, we established key partnerships that will enable us to shape and improve the health and care system.

Together with the Medicines and Healthcare products Regulatory Agency, NICE was awarded £1.8m funding by Wellcome to produce guidance on regulating digital mental health tools, a key area of need. We have also partnered with international health technology assessment agencies, including those in Canada, Australia, Scotland, and Wales to deliver key strategic work efficiently.

We’ve made great progress towards our goal to use real world data to improve our guidance. We published our real world evidence framework, which identifies when such data can be used, and describes best practice for planning, conducting and reporting real world evidence studies.

We’re continuing to support cancer patients to get access to promising new treatments more quickly via the Cancer Drugs Fund (CDF) when further data is needed before NICE can recommend them for routine use in the NHS. This summer, a new breast cancer treatment we recommended for the CDF became the 100th treatment to be funded through the CDF and nearly 18,000 patients have been registered to receive a CDF treatment this year alone. The launch of the Innovative Medicines Fund this year promises to help us ensure patients can benefit from early access to potentially life-saving new non-cancer medicines too – including cutting-edge gene therapies.

2023 and beyond…

As we move forward into 2023, we will build on the impact we’ve had this year. We’ll focus on horizon-scanning and deepening our relationships with key partners to ensure we’re concentrating in on the topics that matter most.

And, behind the scenes, we’ll continue to work at pace to align our methods and processes - so we’re operating efficiently to produce the streamlined products and services our users tell us they need.

Thank you and warm wishes for the festive season

I would like to thank our staff, chairman and board who have set these new processes in motion, while continuing with our core role of producing guidance. As ever, I would also like to thank all our dedicated independent committees and system partners, on whose vital support we depend.

Wishing you warm wishes for a very happy and healthy festive season.

Celebrating the people who support NICE: International Volunteer Day

Mon, 05 Dec 2022 09:51:52 GMT

International Volunteer Day is an opportunity for NICE to celebrate the people who help us to be part of a system that constantly learns. This year we would like to applaud the members of the Public Involvement Programme expert panel who support us to improve outcomes for people using the NHS and other public health and social care services.

What is the expert panel?

NICE is committed to building partnerships with members of the public who are interested in supporting and influencing NICE, and we do this via our expert panel. Our expert panel is designed to make public involvement simple and effective, and provide people interested in supporting NICE with an opportunity to do so. It is designed to provide flexibility to enable people to engage how they want to, and when they can. Essentially, it’s designed to meet the needs of each panel member.

Panel members get involved in a range of opportunities depending on their interest and availability. Whether this is joining a guidance committee, participating in a focus group, joining a project working group, completing a survey, or attending a panel members’ meet up.

Since 2020, panel members have supported NICE in over 200 projects, with 48 members joining a guidance committee as a lay member. We would like to thank every single panel member for their continued interest and enthusiasm. Their positive contribution has enabled public involvement to be further rooted in NICE, and the views of patients and the public incorporated in all that we do.

The success of the expert panel could not have been achieved without the 3 members who also sit on the expert panel steering group. They make key operational decisions and ensure panel members set the direction of the panel.

Meet the 3 Steering Group members

Carole Pitkeathley

“I wholeheartedly believe in the ability of the expert panel to bring a wide range of lived experience and expertise to help NICE ensure that its work is anchored in real life as it seeks to improve outcomes for people using the NHS and other public health and social care services. I joined the expert panel steering group to help deliver that vision and to ensure what matters to people is treated with the same importance as what is the matter with them.

"I am especially proud of the way we have helped NICE to develop the expert panel focusing on the skills and abilities of those already part of it and seeking to recruit new members to give the widest range of experience possible. I am also proud of the way the expert panel has developed beyond the usual guideline and technical committees to provide members with a wide range of opportunities to contribute to the work of NICE and other areas of the NHS and to develop their own skills while doing so.

"I would urge anyone with an interest in health and social care to find out more about the expert panel. There is space for all sorts of experience and expertise, there are opportunities to get involved in a range of areas which need different experiences and expertise. The team is great, very supportive and interested in hearing your story and helping you understand how you can contribute. Definitely worth a few minutes of your time to find out more.”

Diane Davies

“I joined the expert panel because I believe that NICE needs an enthusiastic and motivated group of people who have lived experience of health and social care issues to support the vital work that NICE does – and I wanted to be one of those people.

"Our perspectives are vital in steering the expert panel as it navigates its way through to being truly embedded in the work of NICE. I’ve been particularly pleased with the way we have developed the expert panel to be a fantastic resource that NICE teams see as a vital part of their work. We have worked hard to highlight the amazing range of skills and experiences that members possess, and to offer opportunities to members to make a real positive difference around innovations in health and social care.”

Matthew Moore

"I joined the expert panel steering group because I’m passionate about representing patient voices and being able to use my own lived experience to help inform changes, developments and improvements. I wanted the opportunity to work at a strategic level alongside a respected and incredibly important organisation that is ensuring patients are part of their decision-making process through their expert panel."

How do I join?

To join the panel or to find out more visit the Public Involvement Programme expert panel page on the NICE website and click on the ‘apply to join the expert panel’ button. If you have any queries, please write to us at pipexpertpanel@nice.org.uk.

Simplifying our offer for the life sciences industry

Thu, 01 Dec 2022 09:32:28 GMT

NICE has provided scientific advice to the life sciences industry for more than 13 years and has given advice on more than 550 different products along the way.

During that time, NICE’s portfolio of early support services has expanded to include variations of our traditional scientific advice service (such as a faster timelines or joint advice with partner organisations) as well as different services such as the Office for Market Access safe harbour meetings, the META Tool gap analysis or our PRIMA health economic model check.

We continually look for ways to improve our offer and stakeholders have told us the range of support services NICE provide can seem overly complex for new companies trying to understand the landscape and engage with us. We have decided to make various refinements over the next few years both to the services we provide and in how we communicate our offer to industry.

One area that we have been able to address straight away is to simplify our core scientific advice offer. From December 2022, we will discontinue our standard and express services and replace them with a single, ‘set’ scientific advice process. The new 15-week process is a hybrid of our express and standard services but with some improvements for both the internal team working on the projects and also for the company seeking advice.

The advice meeting and report will not change. The main improvement for companies using the service will be earlier access to the agenda and slide deck allowing more time ahead of the meeting to prepare.

For companies that have already booked projects with us on express or standard timelines, these will continue as expected. New projects will be scheduled using the new set timeline.

This new timeframe for seeking advice will also form the basis of our PRIMA and Medtech Advice services, which will also follow a single 15-week process going forward.

Pricing will remain unchanged for the remainder of 2022/23 and we will continue to review pricing on an annual basis in the lead up to each new financial year.

There are other tweaks and improvements that we intend to make in the short, medium and long term. These will be communicated through our channels and through the NICE newsletter for life sciences (which you can sign up for through the NICE website).

If you are interested in seeking advice or have any questions about our services or processes, feel free to get in touch through our online enquiry form.

NICE leads the way to develop a new approach to routinely value and pay for crucial antimicrobials

Fri, 18 Nov 2022 09:49:10 GMT

Paying the right amount for an antimicrobial is an important but challenging task. It should reward clinical value, encourage companies to develop new products and support appropriate use in the real world.

NICE, NHS England and the Department of Health and Social Care are developing a new approach to evaluating antimicrobials that balances these key objectives in a robust and efficient way.

What happened in the pilot antimicrobial evaluations?

In August 2022, we published ground-breaking guidance on two new antimicrobials, cefiderocol and ceftazidime–avibactam. NICE is the first health technology assessment organisation anywhere in the world to attempt to estimate the full value of an antimicrobial – capturing public health benefits that go beyond the direct benefits for the people who receive the drug – to inform payments delinked from sales volume.

This was the culmination of a 3-year project to assess antimicrobials targeting difficult-to-treat drug-resistant pathogens designated as a global priority by the World Health Organisation (WHO) and take account of unmet need in the UK.

The project aimed to address the urgent global need for a supply of new products able to treat types of infections that have become resistant to existing drugs.

By using subscription contracts instead of paying for each dose used, the new NHS payment model aims to incentivise antimicrobial companies to develop new products, while also upholding the important principles of antimicrobial stewardship - an approach that seeks to limit the growth of resistant infections caused by an overuse of antimicrobials.

The pilot evaluations used innovative methods to estimate the health benefits and costs of cefiderocol and ceftazidime–avibactam. In the absence of any relevant randomised or observational studies, they combined laboratory evidence showing how well an antimicrobial slows a pathogen’s growth, with expert opinion and other published evidence on how laboratory outcomes might predict clinical outcomes in order to estimate health benefits and resource-use savings. This allowed the NICE committee to assess the effectiveness of the products in terms of how much they contribute to length and quality of life relative to their cost, as is done for many NICE technology evaluations.

What is happening now?

During the summer, NICE and NHS England held stakeholder workshops to capture the lessons learnt from the antimicrobial pilot – the output from those workshops has been published today.

The next phase of the project is to use that experience to develop a routine framework for evaluating other new antimicrobials and paying for them using the same subscription contract approach. While the pilot evaluations were an important advance in the evaluation of antimicrobials, NICE and its stakeholders agreed that the methods for economic analysis need to be further developed. Combined with the need for improved surveillance data on antimicrobial usage and the resource-intensive nature of the pilot, it was neither practical nor feasible to replicate the approach used in the pilot evaluations on a routine basis.

In its place are plans to adopt a more pragmatic approach to determine the value of the contract payments for qualifying products. We see this as being a clinical points-based scoring system that will allow aspects of value that are unique to antimicrobials to be captured.

We are developing these plans as we continue to work with key stakeholders over the coming months, with an engagement exercise planned in early 2023.

Towards a new partnership – NICE and the voluntary and community sector

Thu, 03 Nov 2022 09:31:25 GMT

I am delighted to share news of NICE’s latest exciting initiative, our voluntary and community sector (VCS) forum.

The forum brings together a range of organisations who want to inform and shape our work. It is a way for health and care sector charities and not for profit groups to share their organisation's views, perspectives and priorities with NICE’s senior decision makers.

From its inception, NICE has liaised closely with the organisations who work on behalf of those people most directly affected by our guidance – patients, carers, the public, advocates and service users. Organisations from the voluntary and community sector are invaluable in ensuring that the breadth of perspectives from across society are reflected in the guidance we produce.

This expertise also has the potential to help us shape NICE’s strategic approaches, and in particular, our approach to how we work with, involve and engage different groups of people and communities.

Why should you join?

The VCS forum is an opportunity to collaborate with NICE in new and exciting ways - you will work in partnership with senior NICE staff and board members to shape and transform the way that NICE works. Working as part of the forum will have a direct benefit and impact on the lives of the people you work to support.

NICE's role is to improve people’s health and wellbeing by putting science and evidence at the heart of health and care decision making. We welcome constructive challenge and a broad range of views when we make difficult and complex decisions based on evidence, striking a balance between effectiveness and the best use of public funding – helping to protect the NHS and delivering maximum value to the taxpayer.

The forum means you will have opportunities to get involved in NICE projects such as shaping our updated public involvement policy, to ensure the views of the people you work with help shape our future work.

Changing the way we do things

We want the forum to help us transform how NICE works, which in turn will improve the lives of the people you work with, as well as the health and care services they receive. Working with other voluntary and community sector organisations who also collaborate with NICE will be the opportunity to build a support network, as well as share your own organisational priorities.

The first forum meeting

We held the first of the forum’s quarterly meetings in October, with over 70 organisations attending and offering their exceptional insights and enthusiasm. We heard from NICE’s chief executive, Sam Roberts, about NICE’s vision for the future and discussed how the voluntary and community sector can be an integral part of this vision. We also heard from a senior member of NICE’s ‘technologies’ team, Jenna Dilkes, about our plans to take a proportionate approach to our assessment of new technologies. It was a great start to this new way of working.

Who can join the forum?

The forum is open to all organisations who are eligible to be stakeholders in NICE’s work. We particularly welcome involvement from those working around public health and health promotion, as well as social care services, and those who work with historically underserved populations.

Even if you cannot attend the quarterly meetings, you can still have an influence and be part of a community. We will send links to recordings of each meeting so that you can catch up with what happened. We will also send regular email updates to the forum to let you know what’s happening as a result of your involvement and input and provide you with opportunities to influence in other ways.

How do I join?

To join the forum or to find out more visit the NICE voluntary and community sector forum page on the NICE website and click on the ‘apply to join the forum’ button. If you have any queries, please write to us at NICEvcsForum@nice.org.uk.

Please join us on this journey to help us ensure that people and communities remain at the heart of all that NICE does. We cannot wait to work with you.

How NICE is helping to build the role of the NHS on the global stage

Fri, 30 Sep 2022 13:23:52 GMT

The role of the NHS Consortium for Global Health (NHSC) is to foster health system-to-system dialogue by providing specialist advisory support to programme design and delivery. This includes monitoring, evaluation and cross-programme learning.

The NHSC was created in 2018 to support the government’s Global Better Health Programme, a prosperity fund operating in 8 partner countries in the Indo-Pacific, Latin America and Africa. Set up as a strategic partnership with the Foreign, Commonwealth and Development Office, it is co-hosted by Health Education England and the UK Health Security Agency and ensures a coordinated approach to sharing NHS and UK healthcare expertise on the international stage.

NICE International has been a member since its inception. NICE International has:

contributed over 400 hours of expertise
through 20 subject matter experts
delivered 36 knowledge exchanges
reviewed 30 products.

The NHS is facing unprecedented domestic challenges following the pandemic. But in the spirit of global collaboration and learning, the NHS must find the space to develop an ongoing programme of support for universal health coverage beyond our own borders.

A key highlight has been the relationship that NICE has built with the Philippines. Through workshops and virtual knowledge exchanges, NICE has shared its technical methods and governance processes for assessing health technologies and developing evidence-based guidance, quality standards and indicators. This included featuring on the hugely successful webinar Strengthening COVID-19 response in the Philippines through health technology assessment.

In its first 4 years of operating, the NHSC has evolved to provide a point of access to expertise from 11 of the UK’s national health organisations, including the major NHS executive agencies and public bodies. Each member contributes essential and complementary elements to foster government-to-government, peer-to-peer collaboration. Ultimately, the NHSC seeks to shape long-term NHS engagement that will contribute to the UK’s international development strategy. Through its active offer of support and collaboration, it will strengthen health systems and advance health protection, health equity and health diplomacy across the globe.