National Institute for Health and Clinical Excellence (NICE)
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How NICE could help the NHS save millions
The NHS could stand to save millions - at a time when healthcare budgets are being squeezed - by following NICE guidance, according to a review by the Institute.
Implementing NICE guidance can provide a way for primary care trusts (PCTs) in England to ensure that patients receive treatment that is proven to be both clinically and cost effective. Following NICE guidance can also free up resources and capacity that can then be channeled into other services.
The NHS, along with other public services, now faces perhaps the toughest financial climate it has ever had to encounter, and comes after a decade of investment.
In the 2010 budget, announced last month, the Department of Health stated that it will have to make £4.35billion of savings, as their departmental contribution towards £11billion savings that are being made across Government.
But a tightening of belts within the NHS should not signal a drop in the quality of patient care.
NICE has identified 19 sets of recommendations that if fully implemented by trusts could help to save millions of pounds. This list is based on costing work undertaken at the time the guidance is published and covers all clinical guidelines from January 2005 and technology appraisals from January 2006 that deliver a net saving.
Following NICE recommendations on the prescribing of drugs to control hypertension can deliver considerable savings by reducing the number of patients who go on to suffer a heart attack or stroke that requires treatment or hospital care. NICE estimates that £446,627 can be saved for every 100,000 patients that are treated in line with the hypertension guidance, resulting in an overall saving of over £200 million.
Encouraging women to use long-acting reversible contraceptives (LARCs) instead of the pill is another area that can produce significant savings. NICE has championed the use of LARCs since 2005 after figures showed that switching just 7 per cent of women from the pill to LARCs could save the NHS £100 million by reducing 73,000 unwanted pregnancies each year.
What’s more, there may be elements of other guidelines that will deliver savings, but in some circumstances, fully implementing the guidance requires investment. There are also other times when we know that guidance will improve patient care and deliver savings, but the data is not robust enough to allow us to quantify the level of savings.
To help trusts implement the guidance, NICE has developed a range of costing tools that allow individual NHS organisations and local health economies to quickly assess the impact guidance will have on local budgets.
Following NICE guidance can also help trusts and public health organisations in England to successfully achieve many of the goals set out in this year’s operating framework - a guide to the key priorities facing the health service in the year ahead.
For the third year in a row, the national priorities in the operating framework remain the same, providing important stability for trusts and public health organisations as they plan the delivery of services.
The five priorities continue to be: improving cleanliness and reducing healthcare associated infections, improving access through achievement of the 18-week referral to treatment pledge and improving access to GP services, keeping adults and children well, improving their health and reducing health inequalities; and preparing to respond in a state of emergency such as an outbreak of pandemic flu.
To help achieve these priorities, NICE has produced a spreadsheet that links the relevant pieces of NICE guidance to the corresponding operating framework indicators.
The indicator for reducing the number of people under the age of 75 who die from cardiovascular disease (CVD) is an excellent example of an indicator that spans a wide range of NICE guidance.
NICE lipid modification guidance recommends that a risk calculator is used to identify patients, aged 40-74, who are likely to be at a high risk of developing CVD. If a patient has an estimated 10-year risk of CVD greater than 20 per cent, then they should be offered statins to lower their cholesterol levels. There are a number of other pieces of cardiovascular guidance available on topics such as atrial fibrillation, familial hypercholesterolaemia and hypertension.
We also have public health guidance that supports reducing the CVD mortality in disadvantaged areas where the risk of death is higher than average, and commissioning guides, like the one on anticoagulation therapy service, to help put our recommendations into action.
Dr Alison Talbot-Smith, a consultant in public health at Hereford PCT, says: “NICE has produced a fantastic spreadsheet which signposts you to all the relevant NICE guidance for each operating framework vital sign. This makes life so much easier as it allows you to find all the relevant NICE guidance in one place without having to trawl the website.
“When developing services to meet the operating framework targets, the spreadsheet allows you to start by considering the NICE guidance, which is the best available evidence that we have.
“Before the spreadsheet, NICE guidance was only used in a piecemeal approach to achieving the aims of the operating framework. We now have a more comprehensive and streamlined approach. I have emailed the spreadsheet to all my colleagues in the PCT to use.”
Another initiative by NICE that will help the NHS to use resources most effectively is a new medical technologies programme which will provide much-needed advice on the effectiveness of new devices and diagnostics, paving the way for a more uniform and joined-up approach to their use in the NHS, speeding up their uptake by hospitals.
All of NICE’s cost-saving tools and information can be found here