293. Despite both the efforts of NICE and other organisations
to improve implementation and inspections by the Healthcare Commission
to determine levels of implementation, NHS bodies respond to NICE
guidance at different rates.
This means that new technologies are not available to all patients
and the highest standards are not used throughout the NHS.
294. There need
to be additional measures to improve the implementation of clinical
guidelines. There should be more help for PCTs to implement guidelines.
We recommend that the Department ensure that PCTs are aware of
the assistance that is available and develop other ways of helping
PCTs to plan and prioritise clinical guidelines.
measurement of guidance implementation is also needed. Self-assessment
is not enough. We recommend that the Healthcare Commission conduct
more in-depth inspections of this element of practice.
to the system of evaluating medicines and greater involvement
of experts in the technology appraisal and guideline development
processes should also result in guidance that is more acceptable
297. We also
recommend greater involvement of Royal Colleges and other professional
organisations in ensuring implementation. For instance, the approval
of trusts as training organisations could be linked to uptake
of guidance. Elements of clinical guidelines, particularly those
covered by technology appraisals, such as risk assessment of VTE
patients, should be mandatory.
298. To combat
public confusion over the status of technology appraisals and
other types of guidance, we recommend:-
made following technology appraisals should be referred to as
'NICE directives'; and
- Everything else should be referred
to as guidelines or guidance.
involvement of PCTs in NICE assessments and a re-examination of
the NICE cost per QALY threshold, which we recommend above, would
produce guidance which NHS organisations find more affordable.