Is NICE delivering the goods?

Implementation of guidance issued by the National Institute for Clinical Excellence (NICE) has been mixed, according to a study in this week's BMJ.

Researchers assessed the response of the NHS to 12 pieces of NICE guidance reflecting a range of drugs, devices, and procedures, different care settings and cost consequences.

Some clinical practice changed in line with NICE guidance. For example, prescribing of taxanes for cancer and orlistat for obesity grew rapidly after NICE guidance had been published.

Uptake of drugs for Alzheimer's disease and guidance for the removal of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance.

No change was apparent in surgical procedures and use of medical devices, such as hearing aids, hip replacements, hernia repair and colorectal cancer surgery.

The adoption of guidance seems more likely when there is strong professional support, a stable and convincing evidence base and adequate funding, say the authors. Healthcare organisations should also be encouraged to set up formal mechanisms for handling guidance, they conclude.

NICE has recently woken up to the potential problems regarding the implementation of its guidance in the NHS by appointing an "implementation tsar," writes Professor Nick Freemantle in an accompanying commentary.

Achieving real change in clinical practice is clearly a necessary part of the remit of NICE, Without this vital step, the resources currently used to support the NICE enterprise would be better spent on care of patients. So, rather than give up on the task of modernising the way the NHS uses healthcare interventions, we should look at a variety of ways to make NICE more effective, he concludes.

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