NICE...help please

Hello. i have seen it mentioned all over the place. What is NICE? i don't mean what does it stand for particularly but more what it is, what it does etc....

Thanks

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Reply 1

arcoxia

Wikipedia is your friend.

Reply 2

Democracy

National Institute for Health and Clincal Excellence

Reply 3

herecomestrouble

It is an institute that reviews whether particular treatments/drugs should be considered worthwhile by the NHS - they screen all treatments before release to the NHS.

Reply 4

i'm no superman

The National Institute for Health and Clinical Excellence releases clinical appraisals regarding the NHS and the potential treatment given to patients. They consider the benefit the treatment has to a patient, how long it lasts for - and more significantly, its cost-effectiveness.

You can find so much more about NICE here.

Reply 5

AEH

!MEna hits the nail there, what NICE do which no-one else does is cost-effectiveness studies, using tools such as the notorious/revolutionary/crucial Quality Added Life Years. Independent of the drug companies, health commissioning trusts and anyone else who buys or sells healthcare (Or believes they deserve an opinion on it for reasons beyond fathom, I'm looking at you Paul Dacre). Makes them really unpopular. But very important.

Reply 6

Phalanges

From what I understand, NICE basically acts as a screen which assesses the various drugs on offer and approves what it deems to be the most clinical- and cost-effective ones for NHS use.

But, as shown by all the links already posted, a little research goes a long way.

Reply 7

Chrrams

It has really all been said before... but you should really learn as much as you can about NICE; interviewers love when you mention it. It can apply to so many topics; you can easily relate it to current affairs, or to more basic schemes like PBR and PBC.

Reply 8

airtones

Once you get to med school stuff like NICE goes out the window (you just give the drugs your told to give). But, its one of those irritating little hurdles you should learn about for the interview.

Reply 9

AEH

I would agree and disagree with you airtones. I mean, you are restricted in your prescribing by your grade, your knowledge and the practices of your trust. But it is essential to know that these things aren't random and the things you feel confident with aren't an accident, they were designed by someone for a reason. Trust guidelines don't just call themselves into existence, they're some of the most contentious documents in the country.

I agree with you entirely in terms of student/junior doctor day to day experience, no-one thinks about the broader political implications of their choices every single time. But its still blasted important to know about and consider.

Reply 10

davey jones

NICE was originally the national institute of clinical excellence and is now the national institute for health and clinical excellence. it was originally set up to aid clinical governance (a term you should be able to define when discussing) which means it aimed to guide what treatments were the most effective and be the marker for best practice, this also meant deciding on the cost benefit of treatments. for example is treatment a is effective in 90/100 cases and cost 10p and treatment b is effective in 99/100 cases and cost £60, nice would obviously reccomend treatment A. this is when it gets complicated because NICE had to start doing these cost/benefit analysis which when the drug could save a life is effectively worthless. this has really bogged down nice as it was never meant to be doing this and consequently gets taken to court and often forced to reverse its decision. as it appears it is the public's NHS and the public demands it gets whatever it wants regardless of the cost or evidence of effectivness. see the cases regarding herceptin and the kidney cancer drug. nice guidance is also some of the most stringent and objective in the world, as such it takes a long time to come out and is copied by many other countries.

for example, cox 2 inhibitors are a notoriously contentious drug. seach for cox 2 and get

http://www.nice.org.uk/search/searchresults.jsp?keywords=cox+2&searchType=all read it and make an informed decision. thats the idea.

Reply 11

Toiletpaper8

New Labour, initiative which lacks power.

Reply 12

davey jones

i think the idea was a great one. its implementation towards forcing decisions rather than providing guidance is where the problems arose.

Reply 13

airtones

NICE gets a lot of flak for doing on a national scale what virtually every health care trust used to do on an individual basis. Its still vastly better than the earlier alternative.

Reply 14

arcoxia

Wikipedia is your friend.

Wow, someone just negged me for this, claiming 'you have no freinds'. Yes they did spell friends wrong.

Reply 15

Toiletpaper8

davey jones

i think the idea was a great one. its implementation towards forcing decisions rather than providing guidance is where the problems arose.

I think the opposite is true, and that's where the problem lies.

Reply 16

Renal

Toiletpaper8

I think the opposite is true, and that's where the problem lies.

You mean that you'd prefer decisions rather than guidance?

Reply 17

Toiletpaper8

Renal

You mean that you'd prefer decisions rather than guidance?

From what I gathered anyway, guidance creates inequality of treatment by different PCTs whereas decisions, fair or unfair would still maintain a "national" health service.

Reply 18

davey jones

well i can see that point, but inversely the epidemiology of an area's health differs geographically/socioeconomically. but if the body that compiles evidence and reccomendations for best practice gets bogged down in forcing decisions based on available funds rather than the real benefits of treatment then a conflict of interest occurs. the point of nice was an objective body of evidence. plus it renders the whole thing pointless when the public just challenge it in court and it comes down to the trusts not being able to afford it.