NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SPECIAL HEALTH AUTHORITY BUSINESS PLAN

Transcription

1 NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SPECIAL HEALTH AUTHORITY BUSINESS PLAN 2011/2012 to 2014/15 FINAL National Institute for Health and Clinical Excellence 1 Business Plan FINAL

2 Contents 1. Introduction 2. Vision and transition 3. Drivers for change 4. Resource assumptions 5. Programmes and objectives 6. Business plan for Appendices National Institute for Health and Clinical Excellence 2 Business Plan

3 NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE BUSINESS PLAN 2011/12 to 2014/15 Draft Introduction 1. This plan sets out our strategic objectives for the full planning period, together with objectives and performance measures for the financial year It has been informed by discussions with our sponsor branches in the Department of Health, the NHS Operating Framework, planning advice to the Arms Length Bodies and by the plans set out in the health White Papers, published in In the case of the White Papers, we have taken account of the fact that some of the proposals they contain are subject to consultation and legislation. We have also had regard to the views and suggestions from people working in the NHS, from the public and patients, and from the industry and academic partners with whom we work. 2. From April 2011, NICE will take responsibility for the work of both the National Prescribing Centre (NPC) and the National Electronic Library for Medicines. The functions of these organisations will be reviewed during 2011/12, and consideration given to appropriate alignment and branding from April The activity plan for the NPC for and is attached at Appendix The Institute is aware that health and social care face a significant change in both the architecture for commissioning and delivering services, and in the level of funding available to it over the next 3-5 years. Although frontline services will see some real terms growth, it will be modest. Our plans for supporting the NHS to recognise these changed circumstances and are geared to helping the service achieve a high standard of care through the careful and targeted use of its resources. We also recognise that the resources available to the Arms Length Body sector will reduce and that this will have a significant impact on how we work and what we provide. This Transition Plan makes a start on setting out how we intend to respond to these changes. Vision and transition 4. Our purpose is to improve the quality and productivity of healthcare, public health and social care. National Institute for Health and Clinical Excellence 3 Business Plan

4 5. We will work to support of the uptake of guidance and high quality evidence by encouraging and motivating changes in practice and by providing practical support tools. Through NHS Evidence, we will also provide support for decision-makers across health and social care and a process for quality assuring sources of information. 6. Our aim is to be the principal UK resource for evidence-based practice, commissioning and local decision-making, in health and social care, including practical support to help put our recommendations into practice. Originally established in April 1999 to set clinical standards, as part of a comprehensive quality framework for the NHS, our role was extended in 2005 to include advice on effective and cost effective public health practice. In 2008, we were asked to produce quality standards, derived largely from our clinical guidelines and to take responsibility for reviewing the clinical and health improvement indicator set in the primary care Quality and Outcomes Framework. At the same time, our existing technology evaluation programme was extended and we added more capacity to evaluate medical devices and diagnostics. NHS Evidence, a resource for decision-makers in health and social care was launched in This new service includes the BNF, the principle prescribing resource for the NHS, the provision of access to journals, a service provided by NICE on behalf of the Strategic Health Authorities, and UK PharmaScan, the UK database of drugs in development. 7. Following the publication of the 2010 NHS and Public Health White Papers, all these products will be available to a radically new NHS and social care architecture in which general practitioners will lead the design and commissioning of health services, with a nationally defined set of outcomes being used to set the ambition for improvements in the quality and consistency of care. 8. Our guidance and other advice and the quality standards derived from it are made widely available to ensure they are easily accessible to a range of users, with NHS Evidence as the flagship resource for this purpose. We will continue to work with the research community to help the quality and focus of the evidence base for NICE guidance and other advice, and the methodology for developing it. We will extend it to social care in 2012, subject to legislation. 9. NICE international enables the Institute to share its experience of using evidence to inform health policy, with foreign governments and other public and private sector entities operating outside the UK. NICE regards its unique experience as an asset which, applied selectively in non-uk settings, has the potential to bring improvements in the quality and impact health system resource allocation and management. NICE International delivers on this ambition, for NICE, through fee for service work for selected clients and by pursuing UK Government foreign policy objectives in National Institute for Health and Clinical Excellence 4 Business Plan

5 international health systems development, in other settings for which cost recovery is not appropriate. Managing the transition 10. We assume that our grant-in-aid funding from the Department of Health (the majority of our income) will reduce by 27% over the planning period, in line with the Department s overall resource reduction. Such a significant reduction in resources cannot be implemented without significant re-engineering of our outputs and activities. This will require detailed discussions with the Department of Health to establish its priorities, which we have not yet had the opportunity to hold. What we have been able to do in this draft is to set out our strategic objectives for the planning period and detail our business objectives for We have described how we have achieved an 11% cash reduction, to deliver a balanced budget for , within which we believe we will be able to maintain the current programme configuration and levels of activity (see Tables 2 and 3 and Appendix 3). 11. Our financial assumptions (see Table 1) assume further reductions of 11% in and 5% in , to reach a steady state position. Our approach to delivering the savings necessary to achieve a balanced budget through the transition period will be based on the following approach. 12. During 2011, we will enter into discussions, with our sponsor branch, the NHS Commissioning Board, Public Health England and the Department of Health to agree the nature and volume of outputs they want from us. We will prepare proposals to inform these discussions, based on our best assumptions about what we believe the health and social care system will need by the end of the planning period. 13. We will review and re-engineer the methods and processes for producing our existing range of guidance and advice, to take out as much cost as possible, while maintaining the quality and robustness of the product. We will identify and take advantage of opportunities to share resources across programmes. 14. As we integrate new areas of work, beginning with the National Prescribing Centre, the National Electronic Library for Medicines, in 2011, and the development of social care standards in 2012, we will take full advantage of the existing infrastructure, including eliminating activity overlap to minimise the unit cost of the outputs from these programmes. 15. We will review the structure and the cost of our external contracts, for evidence generation and guidance development to achieve a meaningful contribution to the reduction of our cost base. In doing this, we will consider and take opportunities for bringing work (and National Institute for Health and Clinical Excellence 5 Business Plan

6 people) currently outsourced, in house, where the savings which can be achieved justify doing so. 16. We will complete our transition to full digital production and dissemination of our guidance. From May 2012, we will begin to present all our guidance and advice (NHS, public health and social care) in the form of disease and condition pathways, or populations and settings where appropriate, which we will maintain from our guidance and advice-generating programmes. Drivers for change 17. These are challenging times for the NHS and the wider health and social care communities, but following NICE guidance and using our other advice can ensure that organisations deliver quality care for patients, and show service providers how they can best spend their limited resources. NICE has always been focused on providing guidance and advice on the most effective way to use NHS resources. We are committed to supporting commissioners and providers, local authorities and organisations in the wider public and voluntary sector to make the best use of their money, setting out the case for investment and disinvestment through our guidance programmes and our other advice. From identifying specific recommendations that can save money, to advice on reconfiguring to support disinvestment from clinically ineffective services, NICE has a range of products and services to help realise savings that can be reinvested into patient care, and are highlighted alongside other evidence-based QIPP examples on NHS Evidence. 18. The NHS is committed to enabling the public to influence the development and delivery of health services and the 2010 NHS and Public Health White paper, together with their companion consultation documents restate this commitment. The Institute has, from its inception, actively encouraged the involvement of patients, carers and the public (organisations and individuals) in the development and implementation of our guidance and advice. Our Citizens Council provides a public perspective on NICE decision making processes. In recent years, the Institute has broadened opportunities for public scrutiny of NICE decisions by holding meetings of our advisory bodies in public. 19. The Institute is conscious of its impact on the industries which support the delivery of high quality care. We are aware, too, of the extent to which the guidance we produce, particularly on new health technologies influence reimbursement decisions in other parts of the world. As the UK economy moves out of recession, the life sciences industries will emerge as an even more important engine for growth. We will make sure that the way we work contributes to the long term health of the UK life sciences industries, through fair and objective National Institute for Health and Clinical Excellence 6 Business Plan

7 evaluation of their products and by stimulating the NHS to adopt effective and cost effective products and services. Public expectations of NICE 20. As NICE guidance and advice extends its reach, beyond clinical practice and the NHS into social care, the expectations of people for whom NICE is working continue to rise. These demands are expressed both in terms of what we should offer, the way we go about producing our work and especially the timeliness of our advice. The demographics in the United Kingdom are both simple a gradual increase in the number of elderly people and complex problems for example, pockets of demand on maternity and paediatric services in areas which have experienced high levels of immigration in recent years. We know that some of our guidance and advice is more relevant in parts of the country with high numbers of low income families, or areas with a heritage of heavy mining or manufacturing industry. This means that the criteria we use to select topics for developing guidance and advice needs to recognise that burden of disease and the demands placed on social care for the population as a whole, whilst a useful start point in setting our agenda, has to be balanced with a good understanding of the way deprivation, migration, ethnic origin and geography create the need for health and social care. As the understanding of the determinants of ill health becomes better understood and that knowledge becomes more widespread, the opportunity we have to capitalise on our public health resource and in future, our understanding of the evidence for effective social care increases. We already know that investing in disease prevention and health promotion is good value for money. We will use our public health guidance and advice to support the new arrangements for public health in England to promote that message through new and existing forms of advice and a new tool for making the business case for investing in effective public health interventions. 21. What we offer has been enhanced by the creation of NHS Evidence. This programme has extended our functions beyond guidance production to providing a comprehensive evidence service for health and social care. This includes an on-line portal for easy access to evidence, accredited guidance and other products, and as part of NHS Evidence we commission evidence-based resources on behalf of the health service. Work to develop the digital presentation of all NICE products, including standards, will enable easy access through a pathway presentation on NHS Evidence and the NICE website, and will facilitate access through third party information intermediaries. 22. This plan, with its commitment to maintaining the best of our current portfolio in challenging financial circumstances, will enable us to support the health and social care communities in very challenging National Institute for Health and Clinical Excellence 7 Business Plan

8 circumstances. But the public and the organisations which speak for people with particular needs expect more of us. They want meaningful engagement. We have tried hard to offer that, recognising that the outcome will not always be what they would ideally like and that the interpretation of science is sometimes an unavoidably complex process. Nevertheless, through our methods and processes, which are becoming increasingly explicit about how the patient and public perspective should be taken into account, and through the excellent work of our Patient and Public Involvement Unit, we will continue to improve our engagement with patient and the broader public and we will build effective links with our new external partners in social care. We will also increase our efforts to communicate the purpose of NICE and its contribution to improving the quality and consistency of health and social care. The Changing NHS 23. The White Paper Equity and excellence, published in July 2010, describes a radically new architecture for the NHS together with a new, outcomes-based approach to driving improvements in the quality of care. The White Paper and the report of the review of the Department of Health s Arms Length Bodies puts NICE at the heart of the Government s plans for the NHS and social care. The emphasis on outcomes as the primary means of identifying the direction in which the NHS will travel in developing and improving 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. In addition, the next three years will be immensely challenging, financially for the NHS and other public sector bodies. There is little prospect of the real terms growth seen over the last 3 years being sustained. The NHS Chief Executive has indicated that the NHS will find between 15 billion and 20 billion savings in order to keep pace with the growth in demand from the public and the expansion in the potential of health professionals and the healthcare industries. NICE itself will need to demonstrate its value and will need to contribute significant efficiency savings. 24. At the same time there will be fewer targets and central directives, with the impetus for change shifting to the new GP consortia in their role as commissioners of most NHS care, working to achieve improvements in the quality and consistency of care, using our quality standards to deliver outcomes, set by the NHS Commissioning Board. Commissioning will continue to be a key mechanism, in both health and social care, for promoting change and improving standards. Given the difficult circumstances, commissioners and other local decision-makers will look to NICE, both for a signal that we recognise the changed world in which they - National Institute for Health and Clinical Excellence 8 Business Plan

9 and we - are operating and for the support they need in re-shaping their clinical and public health services to make the best of the resources they have available. We have already made clear that we understand that our guidance and advice will be released into a harsher financial climate and we have already begun to adapt our topic selection and guidance development processes accordingly. We will make sure that the opportunities for disinvestment from suboptimal care are as easily accessible as possible. Public health 25. The 2010 White Paper -, Healthy Lives, Healthy People: Our Strategy for Public Health in England - sets the tone, direction and outlines the broad structures for public health development in England into the future. The role of NICE is defined in the White Paper as providing Public Health England with authoritative independent advice on evidence of effectiveness and cost effectiveness for public health interventions on specific commissions from Public Health England. 26. The fine grained detail is yet to be determined. However, it s clear that we will need to review our current outputs in order to meet the needs of the new system. The new types of products we are likely to need to produce will include but not limited to: evidence briefings (digests of the highest quality evidence of effectiveness relating to a topic, a setting, a population or one of the five domains of the White Paper); evidence reviews (narrative summaries of a broad range of evidence and information about a topic, setting, population or domain); practice guides ( how to manuals of making interventions work at local level); evidence into practice reviews (descriptions of successful and unsuccessful implementation at local level). 27. These products will be evidence based, but the prominence of the science will be variable and tailored to the needs of the users. These advice products will have to be made available in forms which will be appealing and usable to audiences beyond the NHS in Local Authorities, where hitherto the reach of NICE public health guidance has been relatively limited. This is a highly segmented audience which includes elected members, officers and a range of professional groups including, environmental health, planning, education, children s services, and adult social care, amongst others. They will also have to be usable by GP Consortia where the level of public health knowledge is likely to be very variable. The changing regulatory system for health 28. The role of the main health regulator is important for NICE, through its mechanisms for inspecting against uptake and use of NICE guidance and other accredited evidence. Over the past 12 months, NICE has worked closely with the Care Quality Commission to inform its approach to regulating care providers. At the heart of the new National Institute for Health and Clinical Excellence 9 Business Plan

10 system described in the 2010 NHS White Paper is a set of registration requirements focussing on safety and quality. Further changes to the existing arrangements for setting NHS standards will change as NICE quality standards begin to influence the commissioning work to be undertaken by GP consortia. These new quality standards, based largely, although not exclusively, on NICE guidance will build, over a 4 year period, into a library of around 150 publications, describing the core components of high quality care in a concise and measurable format. We will work with the Care Quality Commission to make the most out this and other guidance and advice from NICE in the new regulatory system. Social care 29. NICE social care quality standards will be commissioned by the Secretary of State for Health, who will take advice on the choice of topics and their prioritization from a consultative body. The first of these standards will be published in The Department of Health doesn t intend our quality standards to be prescriptive or directive. Instead, they and their associated supporting material will be tools for use in commissioning adult social care, dependent on circumstances and in conjunction with professional judgment. They will also help local people hold commissioners to account and support the role of the HealthWatch as a consumer champion. 30. Ministers want the standards to be flexible enough to support the social care context. Our social care standards will need to take account of personalisation, so that the evidence and the standards) are accessible enough to inform choice by the personal budgetholder as commissioner. They will need to be designed and presented in a way which meets the needs of the individuals who deliver social care and the organisations they work for. 31. The evidence for social care is both different from and less welldeveloped than in clinical practice and public health. There are fewer research centres and published studies, and less money for research. Studies tend to examine the nature of and outcomes from particular models or systems as they are used in practice, with an emphasis on user views and experiences, rather than the experimental approach familiar in health. Randomised studies with controls are rare, as is formal economic analysis. The results of research are distributed across a wide range of bibliographic databases, with varying standards, rather than being concentrated in primary databases such as Medline. The Social Care Institute for Excellence is the main producer of evidence-based practice guides in social care. We will develop a relationship with SCIE as we produce the new social care standards, taking advantage of SCIE s experience and reputation in social care. National Institute for Health and Clinical Excellence 10 Business Plan

11 32. The social care communities are already an important audience for any NICE guidance and advice that impacts on broader health issues, particularly from our public health programme. In the next three years, as the new arrangements for GP commissioning and their relationship with local authorities create stronger mechanisms for joint working between health and social care will emerge. Local authorities will become responsible for leading joint strategic needs assessments to help achieve coherent and co-ordinated commissioning strategies across the health and social care boundary Local authorities will also lead on prevention and health improvement, drawing on current NHS public resources, which will transfer to them. NICE guidance and advice, on clinical practice, public health and from 2012, social care standards, will provide an indispensible resource for local government and NHS leaders which will be responsible for making these new arrangements work. NHS Evidence, with its remit to support both health and social care, will provide rapid access to evidence and best practice advice. Health care industries 33. Much of what NICE does has an impact on the health care industries which supply the NHS. We are very conscious of the responsibility we carry when we advise the NHS on the use of health technologies and we know that what we say about them is often taken into account in health systems beyond the United Kingdom. For these reasons we regard the relationship we have with industries and individual companies as having equal importance with our other stakeholders and we will continue to work with the industry associations, in this country and abroad to build mutual respect and trust. 34. The Government s plan to introduce value-based pricing, set out in a consultation document published in December 2010, represents a potentially significant change in the relationship between the pharmaceutical industry and the NHS. The Government wants the prices paid for new drugs to more closely reflect the value they bring to patients, the NHS and in some cases to society as a whole. NICE will play its part at the heart of the new arrangements, continuing to undertake appraisals of the clinical and cost effectiveness of new drugs, alongside a new process of assessing the acceptability of their prices. 35. In 2011, we will make fully operational, a coordinated pathway for selecting and evaluating innovative devices and diagnostics, generating a new streams of guidance for the NHS. The result of this work will be an NHS that is better informed and better able to take advantage of clinically and cost effective devices and diagnostics. 36. We will continue to develop our Scientific Advice programme, a fee for service offering, which covers its costs through charges made to companies which take advantage of it. This programme allows National Institute for Health and Clinical Excellence 11 Business Plan

12 companies to better prepare to present their case for adoption of their products in the event that they need to engage in one of our evaluative programmes. We will extend the opportunity to medtech companies and we will offer the opportunity to pharmaceutical companies to request joint advice meetings with the Medicines and Health Care Regulatory Agency and the European Medicines Agency. 37. In doing these things to support the life sciences industry and to ensure that patients have access to effective and cost effective treatments, we will need to maintain our independence and the objectivity of our evaluation processes. The impact of these changes 38. These changes across the NHS and social care raise important questions for NICE. In the NHS, how will GP consortia commission from a pluralistic provider base and how will price, quality and access be balanced in determining where contracts get placed? As commissioning shifts from PCTs to GP consortia, and develops in sophistication, what currencies, beyond prices and volumes, will it need to inform it? How will the tariff system develop and will it evolve from being procedure-based to recognising and resourcing package treatments for chronic diseases and conditions? 39. The answers to these fundamental questions will emerge during the next few years and will have a significant influence on what the Institute produces, how it is used, and by whom. However, it is clear that we will need to adapt to work with a health and social care system that: Is operating with limited real-terms growth, in health and no growth in social care and seeking significantly improved value for money through a variety of means, including more joined-up working and sharing of services and resources at local level; Is increasingly dependent on shared knowledge, delivered optimally; Will require a sophisticated commissioning structure, in both the NHS and local government, handling multiple influences and ownership; Offers choice to those using it, with that choice being defined in different ways in different settings 40. In a turbulent environment, it will be important for the Institute to retain some important characteristics, which will remain relevant regardless of the nature of the changes taking place: Unique contribution: clarity about the nature and purpose of the evidence-based products we provide; National Institute for Health and Clinical Excellence 12 Business Plan

13 Value: products that address the needs of the people, inside and outside the NHS and social care, who use our guidance and advice; Clear processes and methods: including transparency, rigour, inclusiveness and contestability; Delivery: providing guidance, related products and services in a timely and accessible fashion; Flexibility: the ability to respond flexibly to changes in the needs of the people and organisations we serve. 41. Wales, Scotland and Northern Ireland have each developed their own approach to the organisation and management of their health services. They use different combinations of the guidance and advice we produce in ways which reflect their priorities, the needs of their staff and the local resources they have available to inform evidencebased practice. We will tailor our relationship in each country and will ensure that we have effective working arrangements with the agencies which undertake complementary functions. During 2011/12 we will allocate time and resources to reviewing our service level agreement with Wales Scotland and Northern Ireland, to make sure that they are taking advantage of the range of our programmes that meets their needs. Resource assumptions 42. NICE currently receives most of its funding directly from the Department of Health, though this is likely to change as the NHS Commissioning Board is established and becomes responsible for funding our NHS facing programmes. This allocation has been subject to the requirement to make cost improvements over the past few years, which have typically been in the order of 3% per year on existing activities. During this time the DH has asked NICE to take on new activities and to expand existing programmes for which new funding has been provided. The total revenue budget grew from 34m in to 77m in As a result of the current Comprehensive Spending Review (CSR) the Institute expects significant reductions in the funds available. 43. The position is complicated by the fact that some 37m of the allocation was designated as project funded by the DH. The DH approved the application of this resource for recurring purposes but because it is project funds it was not recognised in the recurring baseline. This means that at present the formally confirmed baseline allocation for NICE for is 32.3m. However the DH acknowledges this issue and has asked NICE to assume that the project allocations will be made recurring and subjected to the same reduction requirements as the formal baseline. 44. The DH has not yet confirmed our indicative allocations for the transition planning period. However, we are assuming that NICE along with all other centrally funded DH activities should expect an National Institute for Health and Clinical Excellence 13 Business Plan

14 overall reduction in the order of 27.5% of the cash allocation in over the next 3 financial years. This may be varied for some functions or activities depending on Ministerial priorities and currently DH does not require NICE to produce a plan to this level of resource. Until longer term allocations are firmed-up NICE has been asked to plan for an 11% cash reduction in As well as having to make these cash reductions it will be necessary to fund any inflationary or other unavoidable cost pressures from within the reduced cash allocations. Although cost of living pay increases will be frozen most staff are contractually entitled to an annual pay increment which costs about 1m per year. With RPI inflation currently at 4.7% it is unlikely that inflationary pressures on non pay expenditure can be avoided. 46. Table 1 illustrates how the overall resource allocations would reduce over the 4 year planning period based on the information we currently have and on the assumption that the requirement to make a 27.5% cash reduction will apply in full to all funding sources. The analysis shows how the cash allocation might be expected to reduce with the confirmed 11% reduction from into Then assuming a similar reduction into with the balance to 27.5% the year after. The table also shows how the requirement to self-fund inflationary pressures would add to the real term reduction in resources so that the 27.5% cash reduction would equate to a real term reduction of some 34% by Table 1 Assumed funding over the transition period m m m m m Sources of funds Recurrent grant in aid - DH Additional funding - DH Other Income Capital charges Total existing funds NPC funding - DH Unconfirmed funding for NeLM and COF - DH Total funds Cumulative real cash reduction Cumulative % 11% 22% 27% 27% Unavoidable cost pressures pay increments non-pay inflation - 2% Total additional cost pressures Cumulative additional cost pressures Total cumulative real-term reduction Cumulative Savings Total cumulative real-term shortfall Cumulative % 13% 24% 29% 31% National Institute for Health and Clinical Excellence 14 Business Plan

15 Programmes and objectives 47. The central challenge for us over the next 3 years is to maintain the integrity and viability of as much of our programmes as we can, as we implement this substantial reduction in resources. In order to plan this change, we will need to engage with the Department of Health and the new NHS Commissioning Board, when it is established, to find out what they will want from us in the years ahead. We will set out the detail of our plans in the second edition of this plan, in Although we will make the most we can out of efficiency savings, to protect the current configuration of services, we will not be able to achieve a 27% reduction through cost improvement. We will need to re-shape and reduce the size our programmes as well. We will not be able to make these kinds of decisions without a clear understanding of what those who will be commissioning services from us want. Nevertheless, we will make a start, now, in developing the options for the ways in which we might change our current programme. 48. Our strategic objectives are summarised below. Appendix 1 sets them out alongside their success criteria. Maintain NICE as the primary standard-setter in healthcare, public health practice, and subject to legislation, in social care. Subject to legislation, develop the capability and the methods and processes for delivering evidence-based guidance and standards on social care. Provide and promote access to and uptake of NICE guidance and other evidence-based advice, at the point of need and in formats that facilitate rapid access and which are tailored to the needs of users. Ensure that those who commission for health and social care are provided with support to assess the efficiency and the effectiveness of their services, with particular emphasis on the use of outcomes Achieve a broader knowledge and appreciation of our purpose and our work, in the wider health system and in social care, and with the general public. Successfully manage the transition to non-departmental public body status (subject to legislation) and maintain the organisational capability to meet the demands placed on us, through the effective use of our resources. Improve knowledge and develop capability in the use of evidence to inform policy and practice, in the UK and in the international health and social care community. Secure the effective management of the Institute s resources, making cost improvements and re-shaping programmes in order to operate within a reducing resource envelope to 2014/15. National Institute for Health and Clinical Excellence 15 Business Plan

16 Work with industry associations and the Government to help promote sustainable growth in the life sciences industries. 49. The Institute s planning principles and objectives are set out below. The balanced scorecard, which sets specific targets based on the objectives agreed by the Board with the Department of Health and monitored on a quarterly basis, is attached as Appendix The Department of Health has issued transition planning guidance for Arms Length Bodies and the good practice outlined in this guidance has been incorporated into the development of this plan. 51. A key challenge for the Institute in developing this plan has been to achieve efficiency savings whilst maintaining the quality and outputs of our programmes. The details of how we have approached this and the savings we have made are set out in the section dealing with the Financial Plan for Main standards, guidance and advice programmes 52. We operate a range of programmes generating guidance and advice for the NHS and the wider public health community: clinical guidelines, interventional procedures, public health guidance, technology appraisals for pharmaceuticals and other medical technologies, quality standards and indicators for GP quality and outcomes framework. These programmes are supported by an array of implementation support materials and activities, and are complemented by a consultancy service, operating on a regional basis. In addition, we also offer access to NICE experience and expertise to international clients. The scope of our quality standards will grow to encompass public health practice and from 2012, we will extend them further include social care, both as part of broad health and social care topics and as social care-specific standards. We will also support the development of a commissioning outcomes framework, on behalf of the NHS Commissioning Board, for use by GP consortia. Analysis of our programmes and their position in the new health and social car system is set out below and summarised at Appendix Quality standards are a distillation of best practice, derived from the best available evidence, derived from NICE guidance or other sources accredited by NHS Evidence, to provide a set of specific concise quality statements and associated measures. They are an important driver for change in the new arrangements for commissioning and service delivery in the NHS and subject to legislation, will be so too, in social care, from 2012, and likely also in public health. 54. Technology appraisals and the related medtech advice programmes cover, medicines, devices diagnostics and procedures. NICE advises National Institute for Health and Clinical Excellence 16 Business Plan

17 the NHS and patients on the clinical and cost effectiveness of the technologies reviewed and their optimal position in clinical practice. We only review a subset of the total number of new technologies offered to the NHS and we apply (jointly, with the Department of Health), selection criteria to decide which to appraise. Though technology appraisals recommendations are covered by a funding Direction from the Secretary of State, our recommendations are not instructions to practitioners, but they are expected to take them into account and patients access to what we recommend is guaranteed in the NHS Constitution. Our advice, though occasionally controversial, is valued by the NHS and we have evidence (through our web-based database) of their significant impact. We anticipate that we will continue to be expected to undertake this work, although its nature may change under the Government s proposals for valuebased pricing for pharmaceuticals. 55. Clinical guidelines consist of sets of recommendations on the appropriate treatment and care of patients with specific diseases and conditions. Though not covered by a funding Direction or the NHS Constitution, they are an important reference for patients, health and social care professionals and commissioners in the NHS. Like other NICE guidance, the recommendations in our clinical guidelines are assessed for both their effectiveness and cost effectiveness and they integrate other guidance outputs, such as technology appraisals, and interventional procedures, when these are relevant to the topic. Importantly, our clinical guidelines are also the primary source for our new quality standards. In order to complete the library of approximately 150 quality standards, we will need to selectively maintain and add to our guidelines catalogue, though we will review and adapt the approach we take to both reviewing existing guidance and creating new guidelines, in order to best serve the development of quality standards. 56. Interventional procedures are recommendations on whether diagnosis and treatment are safe enough and work well enough for routine use. An interventional procedure is one used for diagnosis or treatment that involves making a cut or hole in the body, entry into a body cavity or using electromagnetic radiation (including X-rays or lasers). Topics for this programme are referred by the health professionals who wish to use them and the outputs are applied with considerable consistency in the NHS and in the private health sector. The programme serves all 4 UK countries and we assume that the NHS Commissioning Board will wish us to continue to provide this service to practitioners and to GP Consortia in the future. 57. Public health guidance is currently delivered in 2 forms. Intervention guidance consists of sets of recommendations on actions, which are known to reduce the risk of individuals developing a disease or condition. Programme guidance contains recommendations for health professionals and those who work with them, on ways to National Institute for Health and Clinical Excellence 17 Business Plan

18 improve health and reduce health inequalities, as well as preventing mortality and morbidity. We recognise that the new arrangements being put in place for public health will result in changes to the audiences for our advice and the form in which it is presented. We are reviewing our approach in these respects and will engage with Public Health England and public health leaders in local government and the NHS as we do so. 58. Quality and outcomes framework (QOF) indicators help general practitioners and the health professionals who work with them to improve the quality and consistency of the services they provide, through a points based incentive payment framework that rewards the achievement of targets locally. Along with indicators for the proposed Commissioning Outcomes Framework, they will remain a key element in the drive for improvements in the quality and consistency of care in the NHS. 59. Commissioning Outcomes Framework. To develop a programme of work for the Commissioning Outcomes Framework (COF) supporting the NHS Commissioning Board that will align with the development processes of quality standards and Quality Outcomes Framework (QOF). COF will measure the health outcomes and quality of care (including patient reported outcome measures and patient experience) achieved by commissioning consortia. Indicators will be developed to measure the outcomes that can be substantially influenced by GP commissioning consortia as part of their commissioning activities. NHS Evidence 60. NHS Evidence is a new service launched in 2009 to help people from across the NHS and working in the wider public health sector to make better decisions by providing them with access to clinical and non-clinical evidence and other information of the highest quality. It will do this by engaging directly with healthcare and other professionals to identify accredit and disseminate evidence-based information. The service draws on a comprehensive range of information sources (including local experience), providing easy access to information that has traditionally been hard to find. Different types of information are brought together in an integrated portal accessible through a dedicated NHS Evidence website. Information is presented in a way that can be customised by users to meet their specific needs. 61. NHS Evidence aims to be the evidence resource of choice for NHS and over time, social care staff to access evidence and related information this will include both sources of research evidence and information on local experience (for example, evidence-based protocols). The system includes a simple search, built around a powerful search engine, as well as an advanced database search for National Institute for Health and Clinical Excellence 18 Business Plan

19 researchers and information scientists. Users can also browse evidence using topic trees, and customise the service based on their own preferences for example, to access evidence that is tailored to their needs, and to receive alerts about new information. 62. NHS Evidence has a formal accreditation programme to recognise guidance producers that reach the highest standards successful organisations are awarded an accreditation mark. This ensures users can readily identify the most trusted sources of evidence, and also drives up the quality of guidance production. 63. NHS Evidence is designed to meet the needs of users from across the NHS and social care, including (but not restricted to) clinicians, nurses, pharmacists, public health specialists, other practitioners and commissioners. The service is built on an open-access principle as much content and functionality as possible will be freely accessible. Access to some full-text content requires users to log on because of commercial arrangements with the information providers, although this is being kept to a minimum and the log-on process is as simple as possible. Patients and the wider public will be able to search NHS Evidence and access content (commercial arrangements permitting). 64. From April 2011, we will be responsible for a comprehensive portfolio of work programmes to provide medicines information to the NHS. This include a horizon scanning function for new drugs (UKPharmascan), plus information about new medicines, drug safety alerts and best practice prescribing advice. Most of this information is provided by functions that have transferred to NICE (the National Prescribing Centre and the National Electronic Library for Medicines). Prescribing advice is commissioned through the British National Formulary, and all information about licensed drugs is available through NHS Evidence Research and Development 65. We rely on collaboration with the research community to take forward the further research suggestions which emerge as we develop our guidance. The 2010 NHS White Paper calls for closer collaboration between NIHR and NICE in getting the proposals for further research, generated by NICE guidance development groups, prioritised for funding. This collaboration takes different forms and includes: Working with the National Institute for Health Research s technologies, public health and service delivery programmes to deliver the underpinning evidence for our guidance; Commissioning data collection and analysis where this is necessary to support decision-making by the Institute s advisory committees; National Institute for Health and Clinical Excellence 19 Business Plan

20 Developing a joint agenda for methodological research with research commissioners and funders; Stimulating the research community and its funders to address the important unanswered questions which remain outstanding as our guidance is developed. Encouraging new forms of knowledge exchange, bringing together practitioners and academic researchers to work in new ways from the agreeing of research questions through to applying research findings to practice. Implementation 66. NICE guidance and advice needs to be effectively implemented to have any impact on the health of the population and the quality of healthcare provided. Our job is to produce what s needed, when it s needed and then do all we can to encourage and support those who are in a position to apply it. To support this process, the Institute has a substantial programme of implementation support which we intend to develop over the next 3 years, to ensure appropriate support is provided for the new quality standards programme. 67. The implementation strategy has three broad aims, to: motivate and encourage change in practice by working through other organisations/mechanisms within the NHS and partner organisations to generate leverage ; provide practical support; and monitor uptake of the recommendations to inform future work. 68. NICE provides specific implementation support products in a number of areas, all with the aim of making implementation more straightforward at a local level. Some examples of generic support include a practical guide for organisations on How to guides on implementing guidance and changing behaviour, a Shared Learning database on the NICE website, and a forward planner on the our website to summarise our future work programme, provide indicative costs and highlight links with the tariff. We also have a team of implementation consultants to provide practical support and advice to NHS trusts and local authorities, particularly in relation to effective processes for implementation and information about NICE. 69. In topic areas where we publish quality standards, we will provide a package of support for commissioners. This will include a care pathway, with information about the underpinning evidence and guidance, audit support, a costing template and, in selected areas, a commissioning guide. 70. To monitor the uptake of guidance recommendations, NICE analyses data and collates published and unpublished reports to build up a comprehensive overview. This information is available on the NICE website in a database (Evaluation of Reviews of NICE Implementation Effectiveness, ERNIE). National Institute for Health and Clinical Excellence 20 Business Plan