The NICE 2012 conference and understanding more about the role of ‘evidence’ in clinical practice

For two days this week I was up in Birmingham as an attendee at the NICE (National Institute for Health and Clinical Excellence) conference. I came away on Wednesday full to bursting point with information and felt a bit like an overloaded sponge which had taken on too much water and could no longer take anything else in. It was a fascinating two days giving me enormous insight into the inner workings of how a, now statutory, part of the NHS works. I also now understand (at least I think I do) the difference between guidance, pathways, quality standards and the QOF (quality outcomes framework). I also took away some comments and quotations which I have yet to really distil into anything meaningful for The Hysterectomy Association but they included the ‘fact’ that even though the NHS often recognises that it has in it’s hands a great product which can deliver fantastic patient benefit it still won’t buy it and I’m not sure I fully understand the politics around this one, but they do abound. According to Bruce Campbell (NICE committee chair) the emphasis should be on delivering plausible benefits to patients as the number one priority, with benefits to the NHS as the number two (ie lesser) priority. I’m not sure this happens in practice.

I also took away the fact that guidance from NICE is just that, guidance; the medical profession are not required to adhere to it or even to pay attention to it although there are considerable efforts being put into trying to encourage more medical practitioners to take it and use it. One of the problems that seemed to come up in presentation after presentation was the question of ‘value’ and how it is measured by the various teams. It seemed to usually come down to price rather than the patient benefits that Bruce Campbell was referring to. Some of the presentations from patient representatives on the various committees made reference to outcomes that they particularly look for when considering a new intervention and they included things like:

  • whether they were appropriate for the disabled or mobility compromised
  • if they were suitable for pregnant women
  • whether account had been made of ethnic and religious requirements (ie animal products)

It seems that equality is not always high on the agenda especially as one of the presenters suggested that the NHS had been created to treat the diseases of poverty but that it now seemed to spend more time and resource treating the diseases of excess. It was interesting to hear our own specialism highlighted in the opening plenary sessions though when Sir Michael Rawlins brought up the reduction in numbers of hysterectomies in recent years through interventions such as endometrial ablation, he highlighted this as a particular success and in one sense it is; however the number of women presenting for a hysterectomy after having had an endometrial ablation seems to increasing (anecdotal evidence). I’m aware that this may sound negative so far but in fact it is far from the case; there were many instances of real and lasting change. A great example was the statement by Henry Ashworth of the Portman Group that the drinks industry were committed to removing 1 billion units of alcohol from the market place and were actively working with the NICE guidance on the appropriate use of alcohol. He also told the conference that by next year 80% of all alcohol products will carry notification of units labels, rather like the smoking industry have done with cigarette packets.

There was also criticism of brands that promote themselves off the back of healthy living such as ‘bats and balls for schools’ whilst encouraging children to eat unhealthy food in order to get the tokens. One of the best presentations was about how the guidance around Ovarian Cancer was created and is now used. It now allows for faster and more accurate diagnosis by following a standardised procedure which takes account of the vagaries of any individual case as well. To complete this update I thought I’d link to all the guidance that is relevant to our website users and if you have any comments, please feel free to leave them below and between us we will change our world.



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