NICE Guidance

How does NHS Oxfordshire take account of NICE guidance in its funding decisions?

The National Institute for Health and Clinical Excellence (NICE) is an independent organisation established in 1999. Its purpose is to provide guidance for NHS health care providers and commissioners in England on the promotion of good health and the prevention and treatment of ill health in line with the best available evidence of clinical effectiveness and cost effectiveness.

To achieve this aim, NICE produces four types of guidance:

  1. Technology Appraisals
  2. Clinical Guidelines
  3. Interventional Procedures Guidance
  4. Public health guidance

As a commissioner of healthcare, NHS Oxfordshire (the PCT) takes particular account of guidance from NICE and the NHS Constitution for England when making funding decisions.

How PCTs are expected to use the NICE guidance depends on the type.

1. Technology appraisals (TAG)

Technology appraisals (TAG) are recommendations on the use of new and existing medicines and treatments within the NHS, such as:

  • medicines
  • medical devices (for example, hearing aids or inhalers)
  • surgical procedures (such as repairing hernias)

The PCT is obliged to fund and resource medicines and treatments recommended by NICE's technology appraisals. Most must be implemented within 3 months of publication. This right is enshrined in the NHS Constitution. However, it should be noted that treatments and care recommended in NICE Technology Appraisals will not be suitable for every patient in every circumstance, and the PCT will provide funding only if the patient’s clinician requests it.

2. Clinical Guidelines and Cancer Service Guidance

Clinical Guidelines and Cancer Service Guidance are recommendations by NICE on the appropriate treatment and care of people with specific diseases and conditions within the NHS. Clinical guidelines take account of nationally agreed ‘best practice’, and discuss the treatments that might be provided at all stages of the disease.

Clinical guidelines can:

  • provide recommendations for the treatment and care of patients by health professionals
  • may be used to develop standards to assess the clinical practice of individual health professionals
  • may be used in the education and training of health professionals
  • help patients to make informed decisions about their care
  • improve communication between patient and their health professional

In general, doctors, nurses and other healthcare professionals in the NHS are expected to take account of NICE clinical guidelines when developing treatment plans for their patients. However, there is no statutory obligation for PCTs to fund the advice provided in NICE Clinical Guidelines and Cancer Service Guidance.

3. Interventional Procedures Guidance

Interventional Procedures Guidance aims to make sure that surgical procedures and innovations are introduced safely into the NHS. As the procedures evaluated are usually new, there may not be a lot of information available about how well an intervention works, how safe it is and which patients might benefit most from it. Even if a procedure is considered safe to use, not all hospitals will be able offer it as their doctors and nurses may not be trained in its use.

PCTs are not obliged to fund Interventional Procedures Guidance. NHS Oxfordshire does not routinely fund the use of surgical procedures where NICE has identified excessive risks or minimal health benefits to patients.

4. Public Health Guidance

Public Health Guidance provides advice on the promotion of good health and the prevention of ill health. Examples of this type of guidance include information to promote sensible drinking; maternal and child nutrition; and school based smoking cessation programmes.

NHS Oxfordshire is not obliged to fund public health guidance however it considers NICE’s advice when developing its public health programmes and strategies.

NHS Oxfordshire’s NICE Implementation Group advises the PCT on the local implementation of Clinical Guidelines, Cancer Service Guidance, Interventional Procedures Guidance and Public Health Guidance.