Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Professor Aidan Halligan, Director of Clinical Governance for the NHS (NC 68)

  1.  In response to the Health Select Committee's invitation to submit written evidence on the progress of the National Institute for Clinical Excellence (NICE) in achieving the key goals envisaged in A First Class Service, I would like to offer the following contribution.

  2.  My role within the Department of Health is as Director of Clinical Governance for the NHS in England. I am also Head of the NHS Clinical Governance Support Team (CGST), which is now part of the NHS Modernisation Agency. Clinical governance is the delivery mechanism to ensure that local healthcare delivery is patient centred, safe and of high quality.

  3.  Prior to the establishment of the National Institute for Clinical Excellence, there was a significant unmet need around a coherent programme of activity that would develop guidance on clinical effectiveness. NICE's role in setting clear standards of service and, in particular, the development of clinical guidelines offers a very credible summation of the state of knowledge on a particular condition at a particular time. This development has effectively overcome a significant barrier to the introduction of best practice and innovation that had hitherto been widely recognised across the service.

  4.  The NICE appraisal process is widely recognised as the best possible methodology available given the very real constraints on achieving a "perfect" evidence platform. There existed a very real sense that if the service was to wait until "perfection" in process was achieved, there would never have been a start made on implementing clear standards of service to secure tangible patient benefit. NICE is widely regarded as having achieved significantly around this crucial objective. It is true to say that NICE is providing clear and credible guidance and has ended confusion by providing a single national focus.

  5.  Clearly, NICE is still in its developmental stage and is looking to ensure that the guidance provided will be locally owned and acted upon in the appropriate manner to ensure patient benefit. One of the most common findings by the Commission for Health Improvement (CHI) in their clinical governance reviews is that guidance from NICE and elsewhere is only partially, or sometimes not at all, implemented. It is my view that NICE has anticipated this issue with its recent survey of the way it disseminates and communicates information and guidance. Our work within the CGST is to support NHS organisations in implementing clinical governance and so create the strategy, commitment and capacity which will assist effective implementation of national policies and guidelines.

  6.  Clearly, there is still much to be done by all of the parties involved in this area of the healthcare system but NICE has made a credible start in tackling the issues the Committee has identified.

  7.  NICE has been particularly concerned with patients, users and the public's perspectives. This is a central feature and critical success factor for effective clinical governance.

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Prepared 8 July 2002