Failure of a NHS organisation to implement NICE clinical guidelines ought to be a rare decision that may be publicly justified given that NICE clinical guidelines are carefully costed and evidence based at a time when the NHS is handed the task of improving quality of care whilst at really similar time saving 30 billion by 2020. NICE clinical guidelines are developed after a thorough systematic review and metaanalysis of the evidence from research, economic modelling of key recommendations in the NICE guideline, and extensive iterative consultation with service users, carers, a multidisciplinary group of primary and secondary care clinicians, iteration with national and international academic experts, and iteration with national organisations. Any member removes themselves from any decision that every meeting.
Look, there’re also concerns about other potential conflicts of interest similar to the promotion of professional disciplinary problems and individual or groups of individuals’ professional interests on NICE clinical guideline development groups.
In the United States, a survey found that 71 of chairs of clinical policy committees had financial conflicts of interest while 84percentage of doctors have expressed concern about industry influence over clinical guidelines.
NICE itself is publicly funded as a non departmental public body of the Department of Health in the United Kingdom. By the way, the legitimacy of a clinical guideline and mistrust of it can arise when an organisation developing the guideline or key members of the committee or panel devising the guideline have conflicts of interest raising concerns about bias in favour of the interests.
Part of the salary of the author is a paid as Director of Research for the National Institute for Health Research Collaboration for Leadership in Applied Health Research East Midlands. It’s a well-known fact that the mandatory implementation of NICE clinical guidelines as the minimum standard of care offers the prospect of delivering many of us are aware that there is evidence particularly in mental health that NICE guideline care improves recovery and service user experience.
Over adherence to NICE guidelines can be associated with a lack of ‘patient centred’ care, poor clinical outcomes, and poor service user experience unless clinicians use their judgement and listen to patient preferences when they apply NICE guideline care.
While lithium remains amid the main approaches to ‘long term’ management, acute bipolar depression is usually treated with a range of medication.
With a peak age of onset between 13 and 30years of age. It’s the 18th leading cause of years lost due to disability. Acute mania is treated with antipsychotic drugs that differ in their clinical effectiveness and acceptability.
Look, there’s accumulating evidence for the effectiveness of psychological treatments for bipolar depression and longterm management.
Bipolar disorder is a serious mental illness and a long period of time condition characterised by recurrent episodes of mania or hypomania and depression lasting for 2weeks interspersed by periods of being well or less severe symptoms.
Standardised mortality ratios for all causes, cardiovascular disease and respiratory disease and suicide are all increased when coupled to the condition. On top of this, quite a few changes to practice proposed in the National Institute of Healthcare and Clinical Excellence Clinical Guideline for Bipolar Disorder in 2014 challenge ‘long standing’ clinical practice, antidepressants apart from fluoxetine with olanzapine are not recommended to treat acute bipolar depression. Some technology would enable NICE clinical guideline care to be delivered more widely, mobile phone apps enabling ‘selfcompletion’ of standardised measures of severity of depression. Known these may need clearer justification and separation in the NICE clinical guidelines between aspirational or development, and mature recommendations, plus investment and a timetable for implementation from NHS England for key recommendations that require investment, NICE clinical guidelines contain a mixture of aspirational or developmental and mature recommendations.
Now look, the biggest problem for technology companies in working with the NHS is the complexity and unpredictability of decisionmaking on commissioning and utilisation of technology within it.
Mandatory implementation of NICE guidelines the problem is complex. They may raise expectations of health professionals beyond their ability to deliver care given financial and similar constraints, inform articulate rather than disadvantaged patients on how to obtain the care they seek for increasing health inequalities, and restrict health professionals from personalising care when necessary, particularly in the face of other mental and physical comorbidities, while NICE clinical guidelines might reduce variability in care.
Author has no financial competing interests. Author was a member of the NICE Clinical Guideline Development Group for Bipolar Disorder in 2006 and chaired the NICE Clinical Guideline Development Group for Bipolar Disorder that has published a comprehensive update. Clinical guidelines consider the care pathway for a condition from primary care to secondary care. Known not Scotland and Northern Ireland, where the devolved government sets health policy, nICE was formed in 1999 by the United Kingdom government to develop national standards of healthcare to reduce variation in clinical care across different parts of England and Wales. Did you hear about something like that before? Only some technology appraisals are mandatory for implementation by publicly funded healthcare organisations, namely the National Health Service in England and Wales. NICE Quality Standards to produce clinical guidelines by systematically identifying the most up to date research evidence and costing its main recommendations for healthcare organisations and professionals to follow in England and Wales. Then again, nICE now produces different kinds of guidance types. Most governments, including those of England and Wales, need to improve healthcare but at reduced cost. As although NICE clinical guidelines must be carefully considered when developing strategies, responsibility for the implementation of NICE clinical guidelines is shared in accordance with the Health and Social Care Act whether they are junior staff taking professional examinations or senior health professionals who are consultants in the topic of the clinical guideline facing appraisal and revalidation.
NICE clinical guidelines are often not considered in local commissioning of healthcare unless public health clinicians and more senior commissioners or national organisations are involved.
It is unclear who makes these decisions in every healthcare body and there definitely is no lines of accountability or transparency in their decision making.
On top of other policies, nICE guidelines on ‘selfharm’. Dual diagnosis. Despite the passing of the Health and Social Care Act in 2012 in England requiring all healthcare organisations to consider NICE clinical guidelines in commissioning, delivering, and inspecting healthcare services, healthcare organisations in the National Health Service may ignore them with little accountability and few consequences. So there’s no mechanism to ensure that healthcare professionals know or consider them. Actually, they give clinicians and patients a nonprescriptive basis for deciding their care. NICE clinical guidelines, including those regarding bipolar disorder, remain variably implemented. Barriers to their implementation include the lack of political and professional leadership, the complexity of the organisation of care and policy, mistrust of can be seen as overreliant on the results of randomised controlled trials that often exclude a bunch of the patients that the guideline will be applied to and extrapolate average group effects to individuals.
a real poser of central importance is therefore more frequent review by NICE of its evidence base for its recommendations, perhaps by an ongoing ‘meta analysis’ and a standing committee to review NICE clinical guidelines if there’s sufficient evidence to potentially overturn recommendations and issue an update to the guideline.
Such variation may not matter provided the guideline is used only as a starting point for clinical ‘decision making’ rather than constraint of patientcentred care, clinical guidelines for bipolar disorder and similar conditions vary considerably in what they recommend.
For instance, the recent NICE guideline on psychosis and schizophrenia had been criticised being that its recommendations on cognitive behaviour therapy for schizophrenia became more directive despite no updated review of research evidence since 2009. It is box 3 summarises the potential harms resulting from the mandatory implementation of NICE clinical guidelines. Usually, despite efforts to achieve objectivity, consensus among clinicians, patients, and carers, and transparency of ‘decision making’, criticism of NICE guideline recommendations remain.
Knowledge and practice in line with NICE clinical guidelines is usually required for good or outstanding ratings of the effectiveness of care when providers of health services are inspected by the Care Quality Commission. Surprisingly, satisfactory care delivered by healthcare organisations in England does not necessarily require the demonstration of knowledge and practice in line with NICE clinical guidelines in spite the fact that they cover patient safety, equity of access to care, and clinical and cost effectiveness.