Like all clinicians I want to know that guidelines are as good as they can be and this is why I became involved in the NICE Accreditation Programme. This programme has a straightforward premise: it sets out to raise the standard of guideline production using a simple idea—that we can ensure consistency in quality by evaluating the processes used in the development of guidance.
NICE accreditation and quality standards
The Government’s legislation on healthcare and social care makes it clear that the primary purpose of the NHS is to improve the outcomes of healthcare for all.1 It also states that progress on outcomes will be supported by quality standards, developed by NICE for the NHS Commissioning Board. NICE quality standards provide definitions of high-quality healthcare and social care to patients, carers, the public, healthcare and social care professionals, commissioners, and service providers.2
The quality standards are derived from NICE and other guidance accredited by the NICE Accreditation Programme. This new name for the NHS Evidence Accreditation Scheme, which was launched in 2009, reflects the new, broadening role of the programme.
Although implementation of NICE quality standards is not mandatory, they have an important role and the Government is clear that, together with essential regulatory standards, quality standards will provide patients using the NHS with an expected national level of consistency.
- the confidence that healthcare professionals have the best available evidence for patient care
- guidance producers with a real opportunity to have a positive impact on healthcare.
How NICE accreditation works
To achieve NICE accreditation, guidance producers are assessed on a case-by-case basis, against criteria in six domains, based on the internationally recognised Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for developing robust guidance.3
Guidance producers must demonstrate clearly that they are implementing rigorous processes to develop guidance, for example:
- clear use of language in guidance
- inclusive stakeholder involvement
- processes for external peer review.
Organisations whose processes meet these high standards are recommended for accreditation by the NICE Accreditation Advisory Committee. Further details on the NICE Accreditation Programme can be found at: www.evidence.nhs.uk/accreditation
Accredited organisations can display the Accreditation Mark on guidance that is produced to the approved process (see Box 1, below)—this ‘seal of approval’ gives healthcare and social care staff confidence that the information has been developed to a quality process, and reassurance that it will help them deliver the highest standards of patient care.
More than 40 guidance producers have applied for accreditation over a period of 3 years—this is an excellent start. However, we can do much more in the drive to raise the standard of guidance production. Therefore, I would urge everyone who has yet to apply for accreditation to take that step.
For those guidance producers who may have some reservations about participating, it is important to understand that the NICE Accreditation Programme is a positive process. It is not about success or failure. It is about guidance producers taking the opportunity to test their processes to ensure that their guidance is as good as it possibly can be. That is what we are all in the field of evidence-based medicine for—to strive continually for excellence, both in the guidance we produce and the quality of care this guidance encourages.
Accreditation is not designed or intended to be an onerous procedure. Instead, it is a valuable process to help discover where improvements can be made, with impartial advice from an independent expert committee.
Organisations who have taken part in the programme, whether they have achieved accreditation or not, have found it a positive experience because they receive extremely valuable feedback. The British Thoracic Society and British Transplantation Society were among the first organisations to put themselves forward for accreditation. Although, understandably, they were disappointed when they did not achieve accreditation the first time round, they embraced the tenet of the programme positively, took our feedback on board, and put themselves forward again to be considered by the programme. Recently, I was delighted to inform both societies that they have now achieved accreditation. Both organisations deserve real credit for the way in which they responded to their initial disappointment and for their determination to strengthen their processes for the benefits of patients.
In Box 2, (see below), the British Thoracic Society Deputy Chief Executive, Sally Welham, explains how the organisation worked towards gaining NICE accreditation.
I hope their approach is followed by others—from organisations who did not achieve accreditation to those who have yet to participate in the accreditation programme. I know that all guidance producers have the same will to achieve the best possible care.
A future vision
I have immense pride in the progress we have made to date, as evidenced by our new role in the development of quality standards and the interest that we have received from guidance producers around the world. The NICE Accreditation Programme has already achieved international recognition and is currently being applied to guidance developed in other countries.
However, it is the future potential for how this programme could continue to grow that is really exciting. My vision is for this to be a continuous programme of development for all guidance producers, which sets the standard for the rest of the world to follow. We have a real opportunity to make the UK the world leader in guidance production. For this vision to be realised, we need the guidance community to continue embracing the programme. In this way, we can make a real difference to patient care—that is what we all want to achieve.
|Box 2: Case study—British Thoracic Society and a testimony to improved guidance production|
As the professional body of respiratory specialists, the British Thoracic Society (BTS) has been producing clinical guidelines in the UK for over 20 years. Recently, the organisation made significant investment in the development and management of its guidance development process and gained NICE accreditation. The BTS Deputy Chief Executive, Sally Welham spoke to NICE about the journey.
‘In 2009, when we learned that NICE had not accredited BTS for its processes to produce its clinical guidelines, we were naturally disappointed. Much work had already taken place to improve our guidance development process and although we understood that this was not necessarily a reflection on the content of the guidance, but rather a lack of a documented process, it was still disheartening. However, we regarded this as an opportunity to gain expert advice on how we could further strengthen our methods and this clearly identified the areas on which we needed to focus our attention.
‘The original Standards of Care Committee (SOCC) policy document for the development of BTS guidance was not a "step-by-step” guide, and therefore lacked some important detail around how clinical questions were formulated and the processes used to gather and synthesise information. Before reapplying for accreditation, we produced a new guideline production manual to ensure that the process was documented in sufficient detail, including areas such as how evidence is searched and categorised. The SOCC now undertakes a yearly review of the manual.
‘We also strengthened our manual by setting out clear criteria for patient and professional involvement in guideline groups as well as professional and lay representation on the SOCC, with a clear outline of their roles. We have also been working with the Royal College of Physicians Clinical Standards Department to set up a formalised training programme for the Chairs of new guideline groups. This includes a tutorial session prior to the first guideline meeting as well as more structured training sessions as part of the early meetings of the full group to aid confidence and understanding in areas such as critical appraisal.
‘By introducing a thorough peer review and public consultation process we have ensured that patient and carer views are incorporated in the guideline. The Society has recently established a Public Liaison Committee, which advises on lay and patient issues in relation to the work of the Society as a whole, as well as providing input to the SOCC and the guideline development programme.
‘We continue to produce materials to support the dissemination and implementation of our recommendations, and this important aspect has been enhanced through the recent improvements made to the BTS online audit system, and the Society’s new Learning Hub that includes information on short courses as well as new e-learning modules aimed at underpinning more complex guidance. Our manual now describes the dissemination and publication processes, so that each guideline reaches the most appropriate audiences.
‘In relation to the work of the SOCC, the drive to improve and clearly document our processes has been a real learning curve—and has been warmly welcomed and robustly supported by the respiratory medicine professionals involved. So much so that a member of the SOCC told me that being involved in this work was some of the best professional development he has ever had.
‘We are delighted that in our resubmission, BTS met all of the 25 accreditation criteria. It has been hard work but worthwhile. Some elements of our guidance production process were at a high standard when we initially applied for accreditation; but, by systematically addressing all the gaps we can be confident that we will continue to improve the care of people with respiratory disorders. For patients and professionals relying on our guidance, this can only be a good thing.’
- Department of Health website. Equity and excellence: liberating the NHS. London: DH, 2010. Available at: www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117360
- National Institute for Health and Care Excellence website. NICE quality standards. www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp (accessed 2 May 2012).
- AGREE website. Introduction to AGREE II. www.agreetrust.org/about-agree/introduction (accessed 2 May 2012). G