Health and Social Care Bill

Memorandum submitted by the National Institute for Health and Clinical Excellence (HS 01)

1. Introduction

NICE is the organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. We are also responsible for providing quality standards for the NHS, managing NHS Evidence (a service providing easy access to high quality clinical and non-clinical information from accredited sources about health and social care), and for reviewing and developing clinical indicators for the quality and outcomes framework (QOF) for primary care services.

2. The Bill puts NICE at the heart of the Government’s plans for the NHS and social care. The emphasis on outcomes as the main way for the NHS to develop and improve its services will require a careful analysis of the evidence for effective – and cost effective – practice. NICE is well placed to support the development of outcomes at a national and a local level through its work in developing clinical and public health guidelines and the quality standards which are, largely, derived from them.

3. This memorandum briefly refers to the main areas covered on the face of the Bill relating to the work of NICE. Much of the detail will be provided through secondary legislation, which we anticipate will cover matters such as the status of our existing guidance, after we become a non-departmental public body and the continuation of our current programmes of work, which are not referred to specifically in the Bill . We look forward to engaging in that process in due course.

4. Establishment and General Duties (Part 8: 216-217)

The Bill states that NICE will be re-established as a non-departmental public body rather than our current status as a special health authority. As our role is expanding into providing guidance for the social care sector (see below), our name will change to the National Institute for Health and Care Excellence.

5. Quality Standards (Part 8: 218-220)

NICE quality standards are sets of specific, concise statements that define high-quality, cost-effective care across a disease, condition or clinical area, and are derived from the best available evidence.

These quality standards will form part of an integrated suite of support and guidance from NICE, all derived from the same evidence base, which will help those who are commissioning or providing health and social care to achieve the best outcomes for their patients and clients, with the resources they have available. We will make sure that the indicators in the GP Quality and Outcomes Framework (QOF), which provides up to 20% of GP income, are consistent with those parts of our quality standards that relate to primary care. Similarly, we will ensure that the indicators for the proposed Commissioning Outcomes Framework (which will be used by the NHS Commissioning Board to help hold GP consortia to account), will be consistent with both the quality standards and the QOF. All of these products will dovetail, where appropriate with our proposed work in developing social care standards. In this way, we will be able to achieve a degree of integration and consistency, in the resources and incentives for achieving high quality health and social care, which has not been possible in the past.

For the potential of this integration to be fully realised, it is important that the health and social care system receives a clear signal, from Government, about how it expects it to respond to NICE standards and our other advice. For this reason, we welcome the Bill’s provision to set in statute the use of NICE quality standards and in particular that the Secretary of State must have regard to the quality standards prepared by NICE (Part 1(2)). We recognise that the Bill signals a move away from targets and other central controls towards an outcomes-based approach to guiding and incentivising good quality care. In this new environment, commissioners and providers of social care, in addition to using the guidance and advice we provide, will want to make sure that the decisions they make are informed by good quality evidence, where it is available. NHS Evidence, provided by NICE, offers access to almost 200 sources for health and social care decision-makers.

6. NICE, social care and public health services (Part 8: 218 and 221)

The Bill states that NICE’s role will be expanded to cover social care in England. We will work with and through the social care sector to bring together the evidence on best practice, and publish quality standards in social care which can guide effective and efficient services and commissioning. We recognise the importance of the opportunity to work directly with those providing and using social care and we will make sure that our approach to engaging with them and developing standards and other advice for them, whilst acknowledging the importance of effective joint working with the NHS, also recognises the distinct and unique characteristics of social care.

Our role will also include preparing quality standards for public health services and giving advice, guidance, information and recommendations on matters connected with public health services. We will work to re-orientate our public health programme so that we can give strong support to the new public health systems as defined in the Bill.

7. Commissioning guidance (Part 8: 225)

We welcome the provision in the Bill that the NHS Commissioning Board may direct NICE to develop commissioning guidelines. These will be based on the quality standards developed by NICE, and will be part of the arrangements, referred to earlier, that will enable GP consortia to be held to account for the outcomes they achieve, value for money, and fulfilment of duties on equality and partnership working. As with our quality standards, these commissioning guidelines will promote joint working across health, public health, and social care.

February 2011