NICE  welcomes new initiative to help NHS reduce spending on treatments that do
not improve patient care.
The National Institute for Health and Clinical Excellence (NICE) welcomes
today's announcement by Health Minister Andy Burnham asking NICE to launch a new
programme of work to help the NHS identify interventions that are not effective.
NICE will develop a new set of products to help the NHS make better use of its
resources by reducing spending on ineffective treatments, that is, treatments
that do not improve patient care or do not represent good value for money.
Moving away from ineffective practice will save money that the NHS can invest in
drugs and approaches to care that make a positive difference to patients' lives.
NICE will work in partnership with healthcare professionals working in the NHS
to identify topics that it would be useful to develop guidance on.
NICE will develop three new types of product:
• Technology appraisals and clinical guidelines aimed at reducing ineffective
practice. NICE will use its existing methods to give advice on the use of
technologies or approaches to care currently used by the NHS where evidence
suggests that current practice is no longer appropriate or effective and does
not improve patient care. For example, a clinical guideline could be developed
on how to manage sore throats in children. Antibiotics are known to be largely
ineffective, for example they will not work if it is a viral infection.
Antibiotics also encourage antibiotic resistance (the more bacteria are exposed
to antibiotics, the greater the chance that they will build up resistance to the
drugs). Guidance from NICE would make clear when it is appropriate to use
antibiotics, and when alternative treatments are more effective.
• Recommendation reminders. NICE will highlight recommendations from its
existing guidance that advise the NHS to stop an intervention that is
ineffective or poor value for money. For example, NICE will issue a reminder
that suitable patients with end stage renal failure should be offered the choice
between home haemodialysis or haemodialysis in a hospital or satellite unit.
Approximately 2% of the NHS budget is absorbed by treatment of patients with end
stage renal failure. Home haemodialysis is at least as clinically effective as
hospital haemodialysis. In 2002, only 2% of patients received haemodialysis at
home while around 10-15% of patients, given the choice, would opt for home
haemodialysis. The annual cost to the NHS of home dialysis is less than that of
hospital and satellite dialysis. If the number of patients receiving home
dialysis increased to 15% then the potential saving will be £9.7 million.
• Commissioning guides. NICE will offer practical advice for NHS
commissioners on how to commission routine services in line with NICE
recommendations. The guides will set benchmarks for commissioning and provide
data for local comparison with those benchmarks. An interactive spreadsheet will
help decision makers calculate the associated costs and savings involved in any
service changes. For example, NICE will develop a commissioning guide on upper
gastrointestinal endoscopy that advises commissioners on the standard clinical
specification for the services they routinely commission and is underpinned by
recommendations already published in the Institute's clinical guidelines on
dyspepsia and referral for suspected cancer.
Commenting on today's announcement, NICE Chief Executive Andrew Dillon stated:
"NICE already advises the NHS on when it should invest in new drugs and
treatments that work well for patients. It's common sense for us to also advise
the NHS on when it is appropriate to stop using treatments that don't benefit
patients or do not represent good value for money where there are better
alternatives available. I would like to encourage anyone who has suggestions
for topics that NICE should consider to let us know."
The new programme is supported by the Chief Medical Officer, Sir Liam Donaldson,
who suggested in his 2005 Annual Report that NICE should be asked to issue
guidance to the NHS on moving away from established interventions that are no
longer appropriate or effective, or do not represent good value for money. In
his report he stated that: "Although not easily quantifiable in financial terms,
these problems lead to the waste of time and limited resources, poor outcomes of
care, harm to patients and lost opportunities."
For more information call Fraser Woodward on 020 7067 5905 and 07879 846787.
1. NICE is the independent organisation responsible for providing national
guidance on the promotion of good health and the prevention and treatment of ill