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What has NICE achieved five years on?

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VOL: 19, ISSUE: 10, PAGE NO: 6

Mary McClarey, is Non-Executive Director, National Institute for Clinical Excellence and Head of Development - Research and Education, Plymouth Primary Care Trust

Mary McClarey, is Non-Executive Director, National Institute for Clinical Excellence and Head of Development - Research and Education, Plymouth Primary Care Trust

It is five years since the National Institute for Clinical Excellence (NICE) was born.

Even before its birth there was speculation about its future, encompassing:

- Its nature - 'nasty'?, 'dictatorial'? (Lancet, 1999)

- Its preferences - focusing on cost-effectiveness with limited reference to the organisations and decision makers locally? (Rosen and Gabbay, 1999)

- Its ethics and morals - rationing and easily manipulated by politicians? (Smith, 2000)

- Its life expectancy - short? (Smith, 2000)

- Its gender - male, as in men in grey suits? (Smith, 2000).

NICE was conceived in a climate of postcode prescribing, variation in practice and a dearth of nationally agreed guidelines (DH, 1997). The NHS expected it to save money and improve efficiency (Dean, 2000).

Doctors were less enthusiastic - they did not welcome interference with clinical practice. Nurses were unsure whether NICE would be able to capture the essence of nursing, as it would emphasise the scientific rigour and systematic reviews of evidence.

Today NICE has proved itself (not him or herself, although its workforce is only 18% male) to be a world-renowned force (Hill et al, 2003).

NICE was envisaged as the standard-setting arm of the clinical governance model, linked closely with national service frameworks and providing authoritative, robust and reliable guidance on current best practice (Hill et al, 2003). It was to be available for patients (involving them in decisions), health professionals and the public.

NICE has achieved or is working on the following:

- It has produced 73 appraisals on the use of over 190 individual products

- A further 44 appraisals (including six reviews) are in progress

- Nineteen completed clinical guidelines are made up of inherited and commissioned programmes

- A further 51 clinical guidelines are in development or set to start

- NICE has issued advice on 35 procedures and a further 95 are under review.

- A research and development programme has been set up to inform future guidance.

NICE and nursing
As a rapidly changing profession, nurses need to base their practice on the best evidence available. They need to monitor new practices carefully and change practice according to the results.

NICE guidance makes evidence and audit tools available, which nurses can use when roles change.

Its guidance, including that directed at patients, is invaluable. It is freely available online and in hard-copy form, in versions suitable for professionals, researchers and academics, and patients.

Its recommendations are based on the best evidence, and include clinical and cost-effective information, targeted and accessible to clinicians. Clearly we can look forward to a busy time for NICE over the next five years.

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