Last September NICE took over the topic suggestion and selection process from the Department of Health. Six months on it is clear that the new processes are working: topics are being collected, sifted, and prioritised speedily.
The National Institute for Health and Clinical Excellence.regularly gives birth (sometimes after a rather difficult gestation) to a range of new guidance documents. However, although healthcare professionals, the media and the public are becoming familiar with NICE products, there is much less understanding about their conception.
Every NICE clinical guideline, technology appraisal or item of public health guidance starts life as a topic suggestion. The term 'topic' is very broadly defined as 'treatments, drugs or ways of caring for people with specific conditions or diseases, preventing ill health or promoting good health'.
Topic suggestions may originate from a number of sources including the general public, health professionals, carers, the Department of Health, the national clinical directors, the National Horizon Scanning Centre and also from within NICE itself..
Last September, following public consultation, NICE took over the topic suggestion and selection process from the Department of Health. The main purpose of this development is:
- To ensure that NICE's stakeholders - patients, healthcare professionals, public health partners, the wider NHS and manufacturers of healthcare products - have clear opportunities to make an input into the selection of topics.
- To help to ensure that NICE's work programme addresses topics of importance to patients and professionals and makes the best use of NHS resources.
- To integrate the selection of public health topics into the selection process.
- To improve the timescale for referral of topics to NICE.
In addition to being the principal point of contact for topic suggestions, NICE's new extended role means that it is now responsible for performing an initial sifting of topics according to the following key criteria:
- The burden of avoidable disease, disability, injury or early death associated with the topic.
- Whether the topic relates to a health-related government priority.
- The potential cost impact on the NHS or the public sector of the topic suggestion.
- The extent of any inappropriate practice, inappropriate variation in practice or inappropriate variation in access to clinical interventions and/or treatments (between geographical areas or social groups) relevant to the topic.
- Factors affecting the timeliness or urgency for guidance to be produced related to the topic.
Within the planning and resource directorate at NICE the processing of initial topics is undertaken by a newly appointed consultant clinical and public health adviser supported by information services. More detailed briefing notes are then generated on the topics that pass through this preliminary stage for assessment by one of seven topic selection consideration panels established by NICE..
Each panel is chaired by a national clinical director or senior practitioner; the panels prioritise the topics and their suggestions are passed to the Department of Health via a referral oversight group. The final work programme for NICE is then signed off by ministers.
Progress on the ground
Six months on it is clear that the new processes are working: topics are being collected, sifted, and prioritised speedily. However, it is also becoming evident that a purely reactive approach may not guarantee that NICE's programme will reflect the issues of greatest importance to patients, professionals and the broader NHS. The integration of the public health perspective into NICE has underlined the requirement to consider new NICE products in terms of the overall NICE work programme rather than simply focusing on individual topic suggestions in isolation..
Work is under way to match the institute's guidance programme with a range of indicators assessing levels of morbidity and mortality. For example disability adjusted life years (DALYs) have been developed under the auspices of the World Health Organisation in order to express the population burden of disease in a single measure..
In the DALY approach each state of health is assigned a disability weighting on a scale from zero (perfect health) to one (death) by an expert panel..To calculate the burden of a certain disease, the disability weighting is multiplied by the number of years lived in that health state and is added to the number of years lost due to that disease..
In figure 1 the numbers of NICE technology appraisals and clinical guidelines published between 1999 and 2006 were plotted against percentage of age-standardised DALYs...
Guided by this type of analysis the consultant clinical and public health adviser is currently forging new links with, among others, the royal colleges, specialists and specialist units, and the healthcare industry. The recently appointed NICE implementation consultants are also tapping into a rich vein of topic sources as they spend an increasing amount of their time in contact with front-line NHS staff..
Within NICE specific divisions such as information services and the patient and public involvement unit are seeking to assist with the more proactive identification of topics from public health sources and patient groups respectively. We are also looking to everyone, including the readers of HSJ, to help us and new topics can be suggested at: http://www.nice.org.uk/topicselection
Dr Nick Summerton is a consultant clinical and public health adviser
Kalipso Chalkidou is a research and development associate director
Peter Littlejohns is a clinical and public health director
Andrew Hoy is a research and development analyst