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Tuesday 29 November 2011

NICE Guidelines

For those of you not familiar with NICE (National Institute for Clinical Excellence), here is a description of what they do:

NICE quality standards are a set of specific, concise statements and associated measures. They set out aspirational, but achievable, markers of high-quality, cost-effective patient care, covering the treatment and prevention of different diseases and conditions.
Derived from the best available evidence such as NICE guidance and other evidence sources accredited byNHS Evidence, they are developed independently by NICE, in collaboration with NHS and social care professionals, their partners and service users, and address three dimensions of quality: clinical effectiveness, patient safety and patient experience.
NICE quality standards are central to supporting the Government's vision for an NHS focussed on delivering the best possible outcomes for patients, as detailed in the 2010 NHS White Paper Equity and Excellence - Liberating the NHS.
Quality standards will be reflected in the new Commissioning Outcomes Framework and will inform payment mechanisms and incentive schemes such as the Quality and Outcomes Framework (QOF) and Commissioning for Quality and Innovation (CQUIN) Payment Framework.
NICE quality standards enable:
  • Health and social care professionals to make decisions about care based on the latest evidence and best practice.
  • Patients and carers to understand what service they should expect from their health and social care provider.
  • Service providers to quickly and easily examine the clinical performance of their organisation and assess the standards of care they provide
  • Commissioners to be confident that the services they are purchasing are high quality and cost effective


The sad thing is that NICE have no teeth.  They set out the guidelines but there seems to be no legal obligation to follow them.  Why?  To me, it seems a waste of money to spend months, years even, developing these guidelines if no one HAS to follow them.  Sure, choosing to interpret and vaguely follows the guidelines makes commercial sense for those private companies, who are commissioned by the NHS to treat patients where there are no local NHS facilities.  By paying lip service to the guidelines, they make a huge amount of money by providing these services for the NHS.

However, my cynical side says that these private providers are businesses.  Thus, they are in it to make money.  By following the guidelines vaguely, rather than pursuing rigorously the aim of clinical excellence, they are able to draw out the process and raise their profits.  Now, that gets my goat.  We are talking about people here.  Sick people.  Those in the mental health arena deserve better treatment.  They also deserve not to be discharged for "non-compliance" with a treatment routine when they are mentally unable to comply.  Again my cynicism wonders if they are discharged from treatment before they are physically and mentally fit, to ensure that the "recovery" figures look good on the annual report and thus ensure that the PCT and other relevant bodies will continue to commission their services.

Here's some text lifted from the Academy for Eating Disorders website (http://www.aedweb.org/source/Charter/) :

THE RIGHTS OF PEOPLE WITH EATING DISORDERS AND CARERS
I   Right to communication/partnership with health professionals
II  Right to comprehensive assessment and treatment planning
III Right to accessible, high quality, fully funded, specialized care
IV  Right to respectful, fully-informed, age-appropriate, safe levels of care
V   Right of carers to be informed, valued and respected as a treatment resource
VI   Right of carers to accessible, appropriate support and education resources

Mental health patients deserve better treatment, for however long it takes.

3 comments:

  1. "Again my cynicism wonders if they are discharged from treatment before they are physically and mentally fit, to ensure that the "recovery" figures look good on the annual report and thus ensure that the PCT and other relevant bodies will continue to commission their services."

    Yes, I have to say that this thought has crossed my mind a fair few times over the years. In my case though, in the past, the discharge requirement has been merely "alive".
    The risk of having a patient who is "unable to comply with treatment" seems to be higher than the risk of discharging said patient back to her flat to live alone. I can only imagine that a death in their stats would look worse and be slightly harder to explain than a death post-discharge of, afterall, an uncompliant patient.
    Now that's truly some fecked up risk management going on there.

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  2. Rufty

    I can only imagine that a death in their stats would look worse and be slightly harder to explain than a death post-discharge of, afterall, an uncompliant patient.

    I reckon you are pretty "on the money" with that. Also, it seems quite commonplace to discharge non-compliant patients back to a NHS hospital, should their health become critical.

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  3. Completely agree. We all need to be shouting about this. If we humans as a species have made the decision to provide help for those who cannot help themselves (and I believe we have!), then those with mental illness must be included, and they must be given the most effective treatment available and for as long as needed.

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