Hon Peter Dunne

Associate Minister of Health

4 March 2015

Opening Address – NICE 2015 Symposium on Health and Social Care,Te Papa Museum, Wellington

Tena koutou, tena koutou, tena kouto katoa

Greetings, greetings, greetings to all and every one of you. Thank you for inviting me to open this joint NICE-bpacnz symposium on guidelines and pathways and the roles that they have in the United Kingdom and New Zealand.

I would like to welcome you all to this event, and I would like to extend a particularly warm welcome to our visitors from NICE: Professor Sir David Haslam, Christine Carson and Nichole Taske.

I would also like to acknowledge Professor Murray Tilyard and his colleagues from bpacnz for putting this symposium together, and to thank all the speakers for their generous participation in the programme.

There is no doubt that the topic of today’s symposium is a very important one. The mushrooming development of clinical guidelines and pathways over the past 20 years or so has helped to improve the quality of health care throughout the world.

How have they done this?

It seems to me that the power of a good clinical guideline is very simple. At its best, it s a vehicle for delivering clear and simple recommendations, based on the best available evidence, to the very busy clinician in day-to-day clinical practice.

It clarifies which interventions are of proven benefit for a particular clinical context, and which ones are of little or no benefit, in a way that helps the individual clinician when planning care for individual patients.

Care pathways take guidelines and other sources of evidence and build them into a practical multidisciplinary tool for day-to-day use. The focus is on the patient's overall journey and the different tasks or interventions by different health professionals involved in the patient’s care are defined, optimized and sequenced.

In this age of an exponential expansion of information, it is virtually impossible for any one clinician to keep up to date with the latest scientific evidence about the prevention, diagnosis, treatment and longer-term management of particular health problems.

We therefore need processes that systematically digest this information and package it in a form that is practical and usable for the front-line clinician, and this is what clinical guidelines and pathways provide us with.

In this context, it is important to acknowledge NICE as a world leader. From its origins as a special health authority established in the late 1990s, it has gone from strength to strength.

Over the years it has established an international reputation for itself as an organisation which produces authoritative, unbiased, evidence-based and practical guidance for clinical decision-making.

I understand that there are now over 850 pieces of NICE guidance on a diverse range of topics, much of which is used throughout the world.

What are the strengths of NICE’s approach? Their guidelines are developed in line with very important principles:

· They keep in focus the aim of improving the quality of care for patients

· They critically assess how well the different ways of managing a specific condition work

· They assess whether the different ways of managing a condition are good value for money

· They set out clinical care that is suitable for most NHS patients with a specific condition

· They take into account the views of those who might be affected by the guideline – including healthcare professionals, patients and carers, health service managers, health care organisations, the public, government bodies and the healthcare industry

· They are based on the best available research evidence and expert consensus

· They are developed using a standard process and standard ways of analysing evidence

· They make it clear how they decided upon each recommendation; and

· They make it clear that the guidance is advisory, rather than compulsory, but should be taken into account by clinicians when planning care for individual patients

And what about bpacnz, the other partner in today’s symposium?

bpacnz has had more humble beginnings, but has made its own significant contribution to systematic and evidence-based practice in New Zealand. For example, it played a key role in creating the New Zealand Formulary, which began as an adaptation of the British National Formulary for practical use
in New Zealand.

bpacnz was established in Dunedin in 2003 to disseminate and communicate “best practice” evidence to General Practitioners throughout New Zealand. Since then it has held contracts for nationwide programmes with PHARMAC, DHB Shared Services, the Ministry of Health, individual DHBs and PHOs and other healthcare organisations.

These programmes have included the responsible use of pharmaceuticals, laboratory testing to improve clinical practice and support of the PHO Performance Programme. bpacnz is also a leading provider of Continuing Professional Development resources for health professionals in New Zealand.

I understand that today’s symposium is in part to acknowledge the agreement reached by NICE and bpacnz, which will allow bpacnz to contextualise NICE guidance for the New Zealand health sector.

This could be an important development if it leads to the delivery of the best available evidence to
front-line clinicians throughout New Zealand

I would therefore like to end my talk by throwing out a few challenges to this symposium:

· How can we ensure that published clinical guidelines lead to actual improvements in day-to-day

clinical practice and don’t simply lie on bookshelves, gathering dust?

· How can this guidance be integrated into real-time clinical decision-support tools and other software that is increasingly available for clinicians?

· How can we ensure that clinical guidelines and pathways are always up-to-date, without having to create a very large and expensive ‘clinical guidelines industry’?

In conclusion, I would like to emphasise how crucial it is to learn from each other. Today’s symposium is a great opportunity to share experiences of evidence-based practice in the two countries and to consider how the growing collaboration between NICE and bpacnz might enhance quality improvement efforts here in New Zealand.

I wish you well for a productive and informative day.

ends

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