Website of the Department of Health

NICE guidance: drug-eluting stents for coronary heart disease

The National Institute for Health and Clinical Excellence (NICE) issued final guidance to the NHS for the technology appraisal of drug-eluting stents for coronary heart disease on 23rd July 2008.  On the basis of advice from NICE and the NHS Purchasing and Supply Agency (PASA), the Department of Health has extended the period within which NHS organisations are required to make funding available to implement NICE's guidance from 3 to 12 months and published management guidance to support implementation.  The management guidance and NICE guidance can be accessed through the links below.

• DH management guidance for NICE guidance on drug-eluting stents for coronary heart disease
• NICE guidance on drug-eluting stents for coronary artery disease (opens new window)

NICE guidance: Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome (OSAHS)

The National Institute for Health and Clinical Excellence (NICE) published its technology appraisal on this matter on 26th March 2008.  NICE has advised the Department of Health that the recommendations require an increase in the number of appropriately trained NHS professionals, additional equipment and facilities (such as oximetry equipment and more places available at sleep medicine centres) in order to adequately diagnose, treat and monitor OSAHS. For this reason it will not be possible to implement the guidance within the timescale of the 3 month mandate.

Based on its assessment of the implications, NICE has suggested that it will take 12 months for the NHS to be in a position to fully implement the guidance on continuous positive airway pressure for the treatment of obstructive sleep apnoea/ hypopnoea syndrome. We have considered this advice and have decided to extend the direction requiring the NHS to fund treatments recommended in NICE technology appraisal guidance in line with the period recommended by NICE. 

Outcomes such as cardiovascular disease, cerebrovascular disease and stroke are associated with OSAHS and have potentially considerable health resource implications.  Local NHS managers should take positive and early steps to plan for and develop these services to ensure they are conforming with NICE’s guidance by April 2009.

NICE guidance is based on a thorough assessment of the available evidence and is developed through wide consultation with stakeholders.  The NHS will need to comply with this guidance in order to meet Core Standard 5a of Standards for Better Health, the national standards for all NHS services (which states that "Health care organisations ensure that they conform to NICE technology appraisals...").

• NICE guidance TA 139: Sleep apnoea - continuous positive airway pressure (CPAP) (opens new window)
• Amendment Directions

NICE guidance: Cardiac resynchronisation therapy for the treatment of heart failure

The National Institute for Health and Clinical Excellence (NICE) published its guidance on this matter on 23 May 2007. The guidance provides additional treatment options for some of the groups of people covered in NICE technology appraisal guidance No. 95, on implantable cardioverter defibrillators (ICD).

NICE has advised the Department of Health that, the recommendations require an increase in the number of cardiologists and clinical staff who are trained in CRT, and in the number of implantation centres.

Based on its assessment of the implications, NICE has suggested that it will take 18 months for the NHS to be in a position to fully implement the cardiac resynchronisation therapy (CRT) guidance. We have considered this advice and have decided to extend the direction requiring the NHS to fund treatments recommended in NICE technology appraisal guidance.

This 18-month waiver recognises the compulsion on local services to improve pacemaker and ICD access rates, and allows the service to plan for the training and facilities that are needed for CRT. The benefits from this new technology should be recognised and embraced, and local managers should take positive and early steps to plan for and develop these services to ensure they are available by the target date of November 2008.

The NHS will need to comply with this guidance in order to meet Core Standard 5a of Standards for Better Health, the national standards for all NHS services (which states that "Health care organisations ensure that they conform to NICE technology appraisals...").

• View the amendment to the Direction for this appraisal
• NICE guidance: Cardiac resynchronisation therapy for the treatment of heart failure (opens new window)

NICE guidance: Parent-training/education programmes in the management of children with conduct disorders

The National Institute for Health and Clinical Excellence (NICE) published its guidance on this matter on 26 July 2006.  NICE has advised the Department of Health that, the organisations involved in implementing this guidance e.g. health, social services, education, youth justice system, will need to establish partnerships and provide training before they can commence facilitation of these programmes as envisaged in the guidance. Based on its assessment of the implications for these agencies, NICE has suggested that it will take two years for the NHS to be in a position to fully implement the guidance. We have considered this advice and have decided to extend the direction requiring the NHS to fund treatments recommended in NICE technology appraisal guidance.

The NHS will need to comply with this guidance in order to meet Core Standard 5a of Standards for Better Health, the national standards for all NHS services (which states that "Health care organisations ensure that they conform to NICE technology appraisals...").  We envisage that when considering your approach to the implementation of NICE's guidance on parent-training/education programmes, you will wish also to be informed by Standards 2 & 9 of the National Service Framework for Children, Young People and Maternity Services, the ten year programme designed to improve services.  Standard 2 is focused on supporting parenting and Standard 9 on the mental health and psychological well-being of children and young people. We also envisage that Primary Care Trusts, together with their commissioning partners and local CAMHS providers, will develop local implementation timetables to ensure that this guidance is delivered within the set timescale.

The amendment to the direction for this appraisal can be viewed here:

• Further Directions to Primary Care Trusts and NHS trusts in England concerning Arrangements for the Funding of Technology Appraisal Guidance from the National Institute for Health and Clinical Excellence (NICE) 2006
• NICE guidance TA102: Conduct disorder in children - parent-training/education programmes (opens new window)

NICE guidance (Technology Appraisal 97): Computerised cognitive behaviour therapy for depression and anxiety (Review of Technology Appraisal 51)

The funding direction for the National Institute for Health and Clinical Excellence (NICE) guidance on the above has been amended so that the NHS now has 12 months to make the funding available for all patients who are treated in line with this guidance.

• Further Directions to primary care trusts and NHS trusts in England concerning arrangements for the funding of technology appraisal guidance from the National Institute for Health and Clinical Excellence (NICE) 2006
• NICE guidance (Technology Appraisal 97): Computerised cognitive behaviour therapy for depression and anxiety (Review of Technology Appraisal 51) (opens new window)

Appraisal 83: Guidance on the use of laparoscopic surgery for inguinal hernia

The Department of Health has agreed to waive the 3 month direction for NICE Appraisal No 83, Guidance on the use of laparoscopic surgery for inguinal hernia.

NICE has concluded that laparoscopic surgery is a clinically and cost effective process; however it is recognised that it will take some considerable time for the NHS to build up its capacity to deliver this treatment.

The NHS is advised to continue with the managed introduction of this new surgical technique at a local level. As laparoscopic surgery is a specialised service it is recommended that primary care trusts should consider adopting a collaborative approach to planning the configuration of the service.

• Further Directions to Primary Care Trusts and NHS trusts in England concerning Arrangements for the Funding of Technology Appraisal Guidance from the National Institute for Clinical Excellence (NICE) 2004
• NICE guidance (opens new window)

Appraisal 68: Macular degeneration (age related) - photodynamic therapy

• National Health Service Act 1977: Further Directions to Primary Care Trusts and NHS trusts in England concerning Arrangements for the Funding of Technology Appraisal Guidance from the National Institute for Clinical Excellence (NICE)
• NICE guidance (opens new window)

Amendment to the Directions: Appraisal 57, Guidance on the use of continuous subcutaneous insulin infusion for diabetes (insulin pump therapy)

NICE published guidance on continuous subcutaneous insulin infusion for diabetes on 26 February 2003. The Direction requiring the NHS to fund treatments recommended by NICE within three months of publication of guidance has been extended to 12 months, as it would not be feasible to train sufficient healthcare professionals in the use of the insulin pumps within three months.

The NHS should, however, take over responsibility for funding the cost of consumables and, in due course, replacement pumps for the estimated 800 established users of insulin pump therapy for whom MDI with insulin glargine is considered inappropriate or proves to be inadequate to maintain adequate glycaemic control.

• A copy of the guidance is on the NICE website (opens new window)

Amendment to the Directions: Appraisal 60, Guidance on the use of patient-education models for diabetes

NICE's guidance on patient education in diabetes recommends that structured education be offered to all people with diabetes at the time of diagnosis and then, as required, based on a formal, regular assessment of need. The 3-month funding direction that accompanies all NICE Technology Appraisals was waived when the guidance was published in April 2003.

In working towards the Planning and Priorities Framework (PPF) target of having practice based registers and systematic treatment for people with diabetes by 2006, PCTs were asked to consider the introduction of structured education as an important element of a systematic treatment regime.

Update - 15 June 2005

Rosie Winterton, Minister of State for Health Services has today announced that the funding direction will be reinstated, so that the NHS will make funds available for patients to be treated in line with NICE's guidance from January 2006. More information on the announcement can be found by following the links below.

• A copy of the guidance is on the NICE website (opens new window)
• Download PPF - see under CHD (PDF, 62K)
• Diabetes
• Press Release - 15 June 2005 (Gateway reference 4982)
• Further Directions to primary care trusts and NHS trusts in England concerning arrangements for the funding of technology appraisal guidance from the National Institute for Health and Clinical Excellence (NICE) 2005

2003: Directions to Primary Care Trusts and NHS trusts in England concerning arrangements for the funding of technology appraisal guidance from the National Institute for Clinical Excellence (NICE)

• Full text of Directions