Ko Awatea was recently fortunate enough to host Professor Sir David Haslam, Chair of the UK’s National Institute for Health and Care Excellence (NICE). Professor Haslam hosted a learning session on March 6th, where he spoke to Counties Manukau Health staff about the work of NICE.
NICE was formed in 1999 with two main aims: to reduce variation in the availability of treatments and quality and care across the UK – the so-called ‘postcode lottery’; and to resolve uncertainty about which medicines and treatments work the best, and which represent the best value for the NHS.
NICE began by producing health technology appraisals and clinical guidelines, but its role quickly expanded. Today, NICE also produces interventional procedures, public health guidelines, NICE Evidence, the British National Formulary, medical technologies and diagnostics guidance, social care quality guidelines and advice on safe staffing levels in health services.
Its reach extends beyond the UK. In 2008, NICE International was launched to help low and middle income countries tackle the problem of demand for healthcare outstripping supply. New Zealand has also benefitted through a licence granted to Best Practice New Zealand to adapt NICE guidelines for use in this country.
NICE operates on core principles of being evidence-based, independent, unbiased, open and transparent. It seeks genuine consultation with stakeholders and actively involves patients, service users and carers in its work. These things are crucial for maintaining the level of trust and confidence NICE needs to make difficult decisions on behalf of citizens about how to prioritise the limited healthcare budget. Its decisions carry a lot of weight: under the NHS constitution, citizens have a right to the drugs and treatments recommended by NICE. Consequently, NICE recognises the right of citizens to have an active voice in the decisions it makes. Patients are represented on every NICE committee and on the NICE board. NICE also has a citizens’ council made up of 30 people chosen to be representative of the British public, which helps to ensure the organisation’s work reflects the social values of the people it affects.
The patient voice will become even more important to NICE’s work into the future, as healthcare faces the challenge of multimorbidity. As the population ages, more and more people live with multiple long-term conditions. Current hospital care is organised into departments that treat each condition separately, and are poorly designed to deliver optimum care to such people. Similarly, developing evidence to decide what ‘good care’ for multimorbidities looks like is difficult, because most healthcare research deals with single conditions and specifically excludes people with co-morbidities.
Dealing with multimorbidity means recognising that the only person who really knows what ‘good care’ looks like is the patient but, too often, patient-centred care is rhetoric rather than reality. Professor Haslam argued that medicine needs to move into a new area of combining the best of evidence-based practice with genuinely patient-centred care. To do this, it’s vital to really take people’s views on board. NICE is meeting the challenge by developing the concept of shared decision-making and investigating the differences between what matters to patients and what matters to doctors. The organisation plans to publish guidance on the issue of multimorbidity in 2016.
Visit https://www.nice.org.uk/ to learn more about NICE.