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NICE can help NHS maintain public trust

National guidance must never replace GPs’ clinical judgement in individual cases

Louise Prime

Tuesday, 13 October 2015

The NHS and social care services must continue to maintain public trust and the National Institute for Health and Care Excellence can help them meet that challenge, its chair said this morning. Professor David Haslam told delegates at NICE’s annual conference in Liverpool that at a time when constrained NHS budgets are coinciding with increasing levels of multimorbidity and escalating demands on the NHS, it was more important than ever to maintain trust by finding the most clinically and cost-effective ways of delivering improved care.

This, he said, is where NICE comes in. He said: “To maintain trust, we have to make sure that we continue to provide the best service to people. We must strive to improve. There are real challenges in this, not least because of constrained budgets.”

However, he insisted, doctors should always be allowed to use their own training and experience to interpret guidance and make decisions with individual patients.

Professor Haslam pointed out that more and more people are living with long-term health conditions rather than “easily curable illnesses” and that this takes up 70% of the health service budget. At the same time, he said, “many people want to be more informed and involved with their own care. They want to be supported as they strive to live healthier lives and in making decisions about the medicines they take.”

Although he accepted that this country is too diverse for a ‘one-size-fits-all’ care model to be applied everywhere, he called for eradication of unacceptable variations in care. He claimed that NICE has a key role in using the best available evidence and knowledge to meet the challenge of finding local answers to delivering healthcare – and, in the process, both saving the NHS moving and improving care.

He said: “NICE guidelines give a population-level steer on what the most clinically and cost-effective ways are to treat different diseases and conditions. Nationally, the guidance helps the NHS make sure that it’s getting the best value for taxpayers’ money.

“But it is essential to remember that on an individual level, our recommendations might not always be appropriate for individual patients. The guidance is not intended to replace a doctor’s clinical judgement or the joint decisions they make with their patients about their specific and individual needs.”

He went on: “Our job at NICE is to ensure clinicians and social care professionals are supported to give the very best care to people. Equally we understand that each discussion between a patient and their clinicians is unique.

“NICE guidance is a gold-standard which professionals should take very seriously. But the role of the clinician is to interpret our guidance together with their training and experience in the interests of the patient before them.”

Professor Haslam also discussed how the NHS could meet the challenge of rising levels of multimorbidity, which no longer occurs only among the old. He said: “It is prevalent among younger people who eat too much, exercise too little, have poor diets, drink too much and smoke. They may also have depression.”

He announced: “Next year, NICE will publish a clinical guideline that considers the assessment and management of multimorbidity. As a GP, I consider this issue to be hugely important for the NHS and the people whose lives it seeks to improve. Effective management of obesity, lipid levels and blood pressure, as well as helping people to stop smoking, drink less or become more active, can make a very real difference to preventing heart disease and stroke.”

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