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Making a difference: the impact of NICE's work

December 2020
Our chief executive, Gillian Leng.
Dear <<First name>>,

Over the last 20 years, NICE has established itself as a global leader in the development of evidence-based guidance for health and social care, using robust, transparent methodologies and processes. We have one of the biggest guideline programmes in the world, with topics covering a range of clinical conditions, social care and public health. But it is only by putting this advice into practice that it will make a difference to real people, to health outcomes and to equitable access to services.

To determine the impact that NICE guidance is having on the delivery of healthcare, we work with a range of system partners to draw on wide sources of data. One really important partnership is with the Healthcare Quality Improvement Partnership’s National Clinical Audit and Patient Outcomes Programme. Their work includes more than 30 national audits, many of which measure adherence to NICE guidance and quality standards to provide an excellent national overview. We also work closely with NHS Digital to develop an innovation scorecard, which illustrates the uptake of medicines and medical technologies in the NHS in England that have been recommended by NICE. 

Impact reports

Six times a year, we pull together all the available information on the impact of NICE guidance in a particular topic area. This includes national audits, journal papers, surveys and indicator frameworks. The resultant NICE impact reports provide a really informative story on the change in practice as a result of our guidance, and also highlight where improvements are still required. We actively disseminate these reports, and work with partners in areas identified for improvement. The reports are all available on the NICE website, covering 17 topic areas including maternity and neonatal care, respiratory conditions and end of life care for adults

Our most recent report focuses on prostate cancer, a condition that will affect 1 in 6 men during their lifetime. The report illustrates substantial improvements in the diagnosis and treatment of prostate cancer over the last 20 years, in part driven by recommendations in NICE guidance. We’ve produced several pieces of guidance about prostate cancer, including 2 quality standards, 3 clinical guidelines, 10 technology appraisals and 13 medical technology and interventional procedures guidance. 

One area that has seen a particular improvement is testing. Our guideline on prostate cancer recommends use of a multi-parametric MRI (mpMRI) scan as a first-line investigation for people with suspected, clinically-localised prostate cancer. For those who do have clinically-significant prostate cancer, the scan can help clinicians understand the location of the cancer and target a biopsy directly. This reduces the need for further biopsies and reduces the time taken to accurately identify the cancer. Multiparametric MRI is also cost effective as it reduces the number of biopsies performed. Additionally, cancers are more likely to be detected and identified earlier, reducing the need for further treatment. Our impact report shows that the proportion of mpMRIs performed before biopsy is increasing year on year. In 2017 only 37% were performed. This increased to 46% in 2018 and 87% in 2019.
NICEimpact report logo.
Across the UK, around 400,000 people are living with or after prostate cancer. Our latest impact report illustrates substantial improvements in diagnosis and treatment.

Budget impact

In some cases, implementation of our guidance has a positive effect on health and care budgets through the generation of efficiencies and cost savings. A good example of this is our medical technologies guidance on HeartFlow FFRCT. This is coronary physiologic simulation software used to analyse cardiac CT images. It is intended for use in patients with stable, recent onset chest pain and suspected angina. Although investing in this technology has an initial cost to the NHS in England (£25.1 million), there are significant capacity benefits from reduced invasive investigations and procedures (£34.2 million), resulting in an estimated net benefit of £9.1 million after 5 years. The Accelerated Access Collaborative has supported this technology and it has been included in their Rapid Uptake Products Programme in both 2019/20 and 2020/21.

Shared experience

While our impact reports are primarily based on data, our shared learning case studies showcase the impact of our guidance and standards within local health and care services. There are over 800 real life, practical examples on the NICE website, demonstrating how guidance and standards have been put into practice and the impact this has had on local services and people’s lives.

Each year we pick a selection of shared learning examples that deserve special recognition for our annual Shared Learning Awards. The awards are an opportunity to hear from those who are successfully using our products to help ensure better outcomes for people. Dr Liz Ewins, consultant psychiatrist at Avon and Wiltshire Partnership Mental Health Trust, was this year’s winner for her team’s work implementing prescribing guidelines for patients with a first episode of psychosis. I’d like to take this opportunity to congratulate Dr Ewins and indeed, all of this year’s finalists and highly commended entries. If you’d like to submit a shared learning example for our 2021 awards, please do so through our website.

And finally. . . 

2020 has been an unexpected year for all of us, with challenges we had not anticipated, with sadness for many. To use a much over-used word, it has been ‘unprecedented.’ May I take this opportunity to wish everyone a healthy, happy and prosperous 2021!
Gillian Leng CBE
Chief executive, NICE
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