APPPENDIX 16
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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