business plan 2002-2003

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contentsSection Page

1 Introduction 1

2 Environmental analysis 3

3 Corporate objectives and milestones 8

4 Programme analysis 13

5 Resource management 24

List of Appendices 30

Table

One Appraisals team staffing profile 2002–2004 14

Two Appraisals new initiatives 14

Three Collaborating Centres and Support Units 16

Four Guidelines team staffing profile 2002–2004 16

Five Communications new initiatives 21

Six Communications team staffing profile 21

Seven Research and development initiatives 23

Eight Institute staffing profile 2002–2003 26

Nine Institute funding framework 2002–2003 27

Ten Recurring budget allocations 2002–2003 28

Eleven Non-recurring budget allocations 29

1.1 The National Institute for Clinical Excellencewas established in April 1999 to promoteclinical excellence and the effective use ofresources in the health service in Englandand Wales. The Institute is a Special HealthAuthority and is accountable to the Secretaryof State for Health and the Welsh AssemblyGovernment for its resources, delivery of itswork programme and the guidance pro-duced for the NHS.

1.2 This Business Plan sets out the Institute’s spe-cific objectives, targets and performancemeasures for the financial year 2002–2003and its plans for meeting them. These objec-tives and plans have been informed by ouroverall purpose and the policy context inwhich we work. These issues are outlined inSection 2, together with an assessment of thechallenges and opportunities the Institutefaces in the coming year.

1.3 Section 3 sets out the Institute’s corporateobjectives for the year and what they willdeliver and the supporting quarterly mile-stones. Section 4 describes the various compo-nents of our work programme, for exampletechnology appraisals and clinical guidelines,and explains how each area will contribute tothe delivery of our objectives. These planshave been developed in consultation with theInstitute’s staff. Finally, Section 5 sets out theresource framework for the year ahead.Further details are provided in the appendices.

1.4 The Board has agreed the following keyobjectives for the Institute’s activity:• contribute to the improvements in the NHS

set out by the Government and the WelshAssembly Government in their responses tothe Kennedy report

• issue 22 new and three review technologyappraisals, covering 79 individual technolo-gies and representing 51 appraisal units

• issue five clinical guidelines and three can-cer service guidance documents

• take responsibility for the Safety andEfficacy Register for New InterventionalProcedures

• complete the restructuring of theConfidential Enquiries

• establish the Citizens Council to advise onthe value judgements that underpin theInstitute’s work

• achieve an efficiency gain by absorbing theeffects of inflation

• review how the Institute’s work pro-grammes can operate more efficiently.

1.5 The Business Plan will be used by the Board toset personal objectives for the Institute’s staff,to monitor progress and to account to theSecretary of State and the Welsh AssemblyGovernment for the Institute’s performance.The Plan is also intended to inform our stake-holders of our plans for the year ahead.

1introduction

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2environmental analysis

2.1 Policy context

2.1.1 The Institute was established in April 1999 toset clinical standards as part of a comprehen-sive quality framework for the NHS. TheInstitute’s role has been reinforced by propos-als included in the plans for the NHS inEngland and Wales published in 2000 and2001. In both NHS plans it is clear that theInstitute is expected to make a major contri-bution to the development of high-qualityhealth services in England and Wales.

2.1.2 The Institute’s role in setting clinical standardshas been further reinforced by the govern-ment’s response to the recommendations ofthe Kennedy Report. The Department ofHealth and the Welsh Assembly Governmenthave stated that:

“NICE is the foremost body in providingauthoritative clinical guidelines and technol-ogy appraisals.”

2.1.3 The Institute welcomes the proposals madeby the Government and the Assembly in theirresponses to the Kennedy Report. Many ofthese will have a direct impact on our workand will be addressed throughout the comingyear. These include:• a more independent role for NICE to set evi-

dence-based standards for day-to-day clini-

cal practice, and make recommendations onthe clinical and cost effectiveness of newtherapies for introduction into the NHS

• transfer of responsibility to NICE for provid-ing the oversight and scrutiny needed forthe introduction of new interventional pro-cedures

• strengthening of the Commission forHealth Improvement (CHI) to take on therole of inspection of NHS organisations andservice providers against the standards setfor the NHS, including NICE guidance.

2.1.4 In addition, it has been agreed that responsibil-ity for promoting clinical audit and undertakingnational audits will transfer to CHI.

2.1.5 The Department of Health and the WelshAssembly Government have issued directionsto NHS bodies to fund health technologiesrecommended by NICE from January 2002 inEngland, and from March 2002 in Wales.

2.1.6 The NHS is changing rapidly. Service deliveryis now the responsibility of health authoritiesin Wales and primary care and hospital trustsin England. Clinical standard setting andmonitoring will be undertaken by nationalbodies, including NICE, CHI and the NationalPatient Safety Agency (NPSA), and locally bythe strategic health authorities. The Instituteis fully prepared for this change.

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2.2 House of Commons Health SelectCommittee Inquiry

2.2.1 In January 2002 the House of CommonsHealth Select Committee initiated an Inquiryinto the Institute and the extent to which theInstitute had made progress towards theobjectives outlined in A First Class Service.

2.2.2 This Inquiry has not yet reported. The finalreport may make recommendations theInstitute will need to consider in 2002–2003.

2.3 Selection of topics for the Institute’swork programme

2.3.1 The Department of Health and the WelshAssembly Government select topics for theInstitute’s work programme.

2.3.2 In March 2002 the Department of Health andthe Welsh Assembly Government released aconsultation document proposing changes inthe process of topic selection for the Institute.

2.3.3 The Institute welcomes this initiative and willwork with the Department and the Assemblyin implementing the necessary changes.

2.4 Partnership working

2.4.1 The Institute’s role in setting clinical standardsfor the NHS cannot be successfully carried outin isolation from its stakeholders. The Institutewill continue to work with them to ensurethat its guidance is informed by the perspec-tives of those who will use it and those whowill be affected by it.

2.4.2 In 2002–2003, the establishment of theCouncil for Healthcare Quality will help tosupport this work. The Kennedy Report rec-ommended this new body and theDepartment has agreed to establish and fundit in 2002. The Council will bring together

the Institute, CHI and the NPSA to ensureeffective coordination of their activities.Other organisations may also be involved.The Institute welcomes the opportunity tocontribute to the work of the Council.

2.4.3 The Institute will address a number of specificissues in 2002–2003. These include:• expanding the National Guidelines and

Audit Patient Involvement Unit to cover thetechnology appraisals work programme

• establishing the Confidential EnquiriesAdvisory Committee, which will includerepresentatives from the NPSA and CHI

• developing joint management team meet-ings with relevant national organisations,including CHI, the NPSA, the ModernisationAgency and the Social Care Institute forExcellence

• including primary care organisations as for-mal consultees in the technology appraisalswork programme

• holding technology appraisal appeals inpublic (pending the outcome of the consul-tation initiated in January 2002)

• involving trusts and primary care organisa-tions in testing the implementation of clini-cal guidelines

• agreeing new terms of reference for thePartners Council.

2.4.4 The Institute’s guidance is directed to theNHS in England and Wales. The Institute val-ues the links that have been developed withthe Health Technology Board for Scotlandand the Scottish Inter-Collegiate GuidelinesNetwork. The Institute will continue to workclosely with these organisations and toexplore opportunities for joint workingwhere appropriate.

2.4.5 The Department for Health, Social Servicesand Public Safety in Northern Ireland con-sulted on its quality strategy in 2001 anddecisions about future working arrangementsbetween the Institute and the NHS in

Northern Ireland are expected in 2002. Wewelcome the opportunity for closer collabo-ration with colleagues in Northern Ireland.

2.4.6 The Institute will work with lay representativeson its Appraisal Committee to pilot the con-cept of a health technology patient impactassessment. The assessment, which isdesigned to better explore the effectivenessof a technology from the patient’s perspec-tive, will be used, if successful, to inform theAppraisal Committee’s consideration of tech-nologies in future appraisals.

2.5 Challenges and opportunities

2.5.1 The Institute continues to face a challengingagenda. The guidance we produce impactsdirectly on service provision, the use of NHSfunds and the range and quality of care pro-vided by the NHS. Expectations of us arehigh, from the Department and the Assemblywho set our work programme and provideour funding, from our stakeholders, and fromthose who receive and use our guidance. Weare very conscious of the need to meet theexpectations they have of our work.

2.5.2 The work programme for the Institute isincreasing. The volume of appraisals and clin-ical guidelines in production represents thelargest programme of original clinical guid-ance development ever attempted by a

national healthcare system. In addition, theInstitute has been asked to take on new ini-tiatives and has welcomed the opportunity todo so. However, we recognise that this levelof activity places high demands upon ourstaff and others with whom we work. Weneed to ensure that we have the staff andsystems in place to deliver the agreed workprogrammes within agreed timescales and ata consistently high level of quality. We alsoneed to establish the capacity to respond toincreased demand and unplanned changes.We will increase the capacity of the existingNational Collaborating Centres and willestablish an additional Collaborating Centre.We will explore options to increase thecapacity of the technology appraisal pro-gramme and review how the Institute’s workprogrammes can operate more efficiently.

2.5.3 The Institute is now 3 years old and has estab-lished a team of highly qualified and specialiststaff. As the work programme continues togrow, we need to ensure that we maintain anappropriate establishment, provide suitablesupport and accommodation for our staff andhave in place effective recruitment and reten-tion strategies. In 2002–2003 we will expandthe Institute’s staff to support the delivery ofour work programmes and will review ouraccommodation needs. The Institute is com-mitted to the implementation of theImproving Working Lives standard. The Boardhas identified an executive director and a

“The Council will bring together the Institute, CHI and the NPSAto ensure effective coordination of their activities. Other

organisations may also be involved. The Institute welcomes theopportunity to contribute to the work of the Council.”

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non-executive director to secure implementa-tion of the human resources framework andaction plan approved in November 2001.

2.5.4 The Institute recognises the importance of arobust and rigorous process in the delivery ofall our work programmes. It is vital that ourguidance is credible and respected by all thosewho use it. The procedures described in theprocess manuals that we have published forthe technology appraisals and clinical guide-lines work programmes should provide thisassurance. An important guarantee of qualitylies in the calibre and dedication of the expertswho form our independent advisory commit-tees and groups. They give their time freelyand the Institute continues to be extraordinar-ily grateful for their contribution to its work.

2.5.5 Further work will be undertaken in2002–2003 to develop a technical manual forguideline developers as part of the clinicalguidelines work programme and to establisha process manual for the register for newinterventional procedures. The Institute willalso explore opportunities for furtherimprovements in methods and will invest inspecifically commissioned research and devel-opment projects where appropriate.

2.5.6 The Institute was founded on the principlethat it would be likely to work more effec-tively by maintaining a small central team andcreating a network of relationships with pro-fessional, academic, patient/carer and NHSorganisations from which it could seekexpertise and advice. Consequently, theInstitute commissions work from a range oforganisations, including the six NationalCollaborating Centres and two Support Unitsestablished in 2001, the four nationalConfidential Enquiries, and the NationalCentre for Reviews and Dissemination andthe National Prescribing Centre, which pro-duce the effectiveness publications. Otherservices are also provided to the Institute on acontractual basis: for example, financial serv-ices from the Chelsea and WestminsterHealthcare NHS Trust. These arrangementsenable the Institute to benefit from a widerange of expertise and input but they alsoneed to be supported by clear expectations ofservice delivery, good liaison and communica-tions, appropriate performance monitoringand sound contractual agreements. TheInstitute will continue to work with its partnerorganisations to ensure that these arrange-ments operate effectively.

2.5.7 The Institute will work with CHI to transferresponsibility for its clinical audit functions.We will provide appropriate support to thestaff involved and will seek to minimise theeffects on the work programme.

2.5.8 The strategy for the development of thenational Confidential Enquiries, agreed by theBoard in November 2001, will be imple-mented in 2002–2003. The Institute recog-nises the challenges this poses for theEnquiries: all face change of some degree andthe Institute will support the Enquiries as theyadapt to the new arrangements.

2.5.9 The Institute’s new responsibility for the assess-ment of selected new interventional proce-dures is an exciting development. The Institutewelcomes this extension of its role and willwork closely with the surgical community andother stakeholders to establish a system thatsupports innovation and protects the interestsof patients and clinicians. We will seek to clar-ify with the Department of Health, the WelshAssembly Government and the devolvedadministrations in Scotland and NorthernIreland their expectations of the volume ofwork and outputs and will establish a rigorousand robust system to meet these objectives.

2.5.10 We will continue to work with patients andtheir carers to ensure their participation in,and confidence with, our plans for placingthe patient’s perspective at the heart of ourprogrammes. Important initiatives in2002–2003 include:• expanding the National Guidelines and

Audit Patient Involvement Unit to cover thetechnology appraisals work programme

• holding technology appraisal appeals inpublic (pending the outcome of the consul-tation initiated in January 2002)

• piloting the development of a patientimpact assessment for the appraisals workprogramme

• establishing the Citizens Council.

2.5.11 The Institute has developed solid workingrelationships with the pharmaceutical andmedical device industries and their represen-tative bodies. The Institute remains consciousof the contribution these organisations maketo its work programme through the submis-sions they prepare for technology appraisalsand the comments they make on draft clini-cal guidelines. Along with health professionaland patient/carer organisations, the industryis also consulted when the Institute reviews

its processes and methods. The Institute val-ues its relationship with these groups andremains committed to working constructivelywith them.

2.5.12 We will act on the conclusions of the dissemi-nation review to ensure that our methods ofinforming the NHS about our advice areappropriate and support implementation. Wewill also continue to support research into theimplementation of our guidance.

“These arrangements enable theInstitute to benefit from a widerange of expertise and input butthey also need to be supported byclear expectations of service delivery,good liaison and communications,appropriate performance monitoringand sound contractual agreements.”

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3.1 Corporate objectives

3.1.1 Twenty-two new and three review technologyappraisals will be issued, covering 79 individ-ual technologies and representing 51 appraisalunits. The new arrangements for publishingthe Appraisal Consultation Document on thewebsite will be implemented. The consultationon the appeals process will be concluded andthe recommendations will be implemented.The appraisal team will be strengthened and aDecision Support Unit will be commissioned toprovide additional input to the assessment ofcost effectiveness.

3.1.2 The two remaining guidelines the Instituteinherited from the Department of Health willbe issued and three guidelines from the newlycommissioned programme will also be issued.In addition, three cancer service guidancedocuments will be issued and the guidelinesteam will be strengthened.

3.1.3 New processes and methods to enable thesafety and efficacy of selected interventionalprocedures to be assessed will be introduced.

3.1.4 The changes to the organisation of and fund-ing for arrangements of the four nationalConfidential Enquiries will be implemented.The merger of the Enquiries into stillbirthsand deaths in infancy and into maternaldeaths will take place on 1 April 2003. Achief executive for the merged Enquiry willtake up post in April 2002 and will overseethe transition.

3corporate objectivesand milestones

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3corporate objectives and milestones

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3.1.5 A Citizens Council will be established. Its rolewill be to advise the Institute and its advisorygroups on the value judgements that under-pin the Institute’s work. It is anticipated thatthe Council will meet twice each year.

3.1.6 The Government and the Assembly’sresponses to the Kennedy report reinforcedthe Institute’s role in the NHS. They alsounderlined the importance of effective jointworking among the national organisationscharged with the responsibility for setting andmonitoring standards of care. The Institute’ssenior team will reinforce and extend theexisting arrangements for managing its rela-tionships with these organisations.

3.1.7 PRODIGY is potentially a useful tool for dis-seminating the Institute’s guidance. In previ-ous financial years the Institute held fundingfor guidance within the PRODIGY system. TheInstitute will continue to make its guidanceavailable to PRODIGY for inclusion in thePRODIGY guidance. However, the Institutewill no longer actively manage this process.The Institute will have a role in ensuring thatthe processes used by the PRODIGY guidanceauthoring team to develop their guidance arerobust. In fulfilling this role the Institute willmonitor periodically the approach being used.The Institute will set in place arrangements toundertake this new role.

3.1.8 The Institute will also review how its workprogrammes can operate more efficiently.

3.1.9 The Institute will absorb the effects of infla-tion as an efficiency gain.

3.2 Quarterly milestones

3.2.1 April to June• Issue six new technology appraisals.• Issue one audit.• Agree response to the Department of

Health and the Welsh AssemblyGovernment consultation papers on topicselection for the Institute’s work pro-gramme.

• Initiate consultation on the proposedarrangements for the assessment of thesafety and efficacy of new interventionalprocedures.

• Agree with CHI the transfer of the auditfunction and establish a project plan withagreed milestones that can be monitoredseparately.

• Initiate the appraisals and guideline topicsreferred by the Department of Health andthe Welsh Assembly Government.

• Expand the membership of the GuidelinesAdvisory Committee.

• Complete the feasibility phase of thepatient impact assessment project.

• Establish a Confidential Enquiries AdvisoryCommittee and appoint a Chair.

• Appoint a Chief Executive for the newConfidential Enquiry for Maternal andChild Health.

• Review IT support to the Institute and man-age associated action plans.

• Establish and implement an action planrelated to data protection issues.

• Establish a Board-approved race equalityscheme.

• Complete the dissemination and communi-cation review pilots.

• Publish a compilation of Institute’s guid-ance.

• Publish the Business Plan and CorporatePlan.

• Launch the NICE intranet.

3.2.2 July to September• Issue eight new appraisals and two reviews.• Issue two inherited guidelines.• Issue two cancer service guidance docu-

ments.• Issue one audit.• Expand the capacity of the existing

National Collaborating Centres.• Invite tenders and award a contract for the

pilot phase of the patient impact assess-ment project.

• Invite tenders and award a contract for theDecision Support Unit.

• Agree arrangements for the assessment ofthe safety and efficacy of interventionalprocedures following consultation.

• Agree a strategy for the creation of theConfidential Enquiry for Maternal andChild Health.

• Apply for Investors in People accreditation.• Publish the annual report and accounts.• Publish the Welsh Language Scheme.• Launch the Citizens Council.• Launch a new project management system.• Review the website.• Agree a revised communications strategy

(including a review of the effectivenesspublications).

• Hold joint management team meetings withCHI, NPSA and the Modernisation Agency.

3.2.3 October to December• Issue three new appraisals.• Issue two guidelines and the first part of

the Palliative Care Guidance.• Issue one audit tool.• Publish a technical manual for the clinical

guideline development process.• Increase the capacity of the National

Guidelines and Audit Patient InvolvementUnit.

• Establish a process for the future updatingof guidelines.

• Conduct the annual Staff Attitude Survey.• Carry out the annual review of the Service

Level Agreement with the financial servicesprovider.

• Hold the Clinical Excellence 2002 confer-ence in Birmingham.

• Publish a compilation of Institute’s guid-ance.

• Introduce an on-line ordering facility to thewebsite

• Become a corporate member of the PlainEnglish Campaign and work to attain theCampaign’s Crystal Mark for the informa-tion the Institute produces for the public.

• Hold a joint management meeting with theSocial Care Institute for Excellence.

3.2.4 January to March• Issue five new technology appraisals and

one review.• Issue one clinical guideline.• Establish an additional Collaborating

Centre.• Produce process manuals for the assess-

ment of the safety and efficacy of interven-tional procedures.

• Secure Improving Working Lives accredita-tion

• Prepare corporate and business plans forapproval by the Board and publish them.

“PRODIGY is potentially a useful tool for disseminating theInstitute’s guidance. In previous financial years the Institute heldfunding for guidance within the PRODIGY system. The Institute

will continue to make its guidance available to PRODIGY forinclusion in the PRODIGY guidance.”

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4programme analysis

4.1 Appraisals

4.1.1 The technology appraisal programme producesappraisal guidance documents of a uniformcharacter. The outputs consist of original (new)appraisals and reviews of original guidance.

4.1.2 The Institute will issue 25 pieces of guidancebetween April 2002 and March 2003. Themix of original and review guidance antici-pated in 2002–2003 is set out below; detailsare provided in Appendix A.• 22 new technology appraisals issued• 3 review technology appraisals issued• 25 total technology appraisals published

covering 79 individual technologies

The number of new topics initiated in2003–2004 will depend upon the referralsmade by the Department of Health and theWelsh Assembly Government and their timing.

4.1.3 The Institute has agreed with the Departmentof Health and the Welsh AssemblyGovernment methods for measuring the out-put of the technology appraisals programmein a way that takes account of the size of theindividual topics under review. Each topic willbe measured as a number of appraisals units,relating to the time taken by the Appraisal

Committee to consider the topic before issu-ing the Appraisal Consultation Documentand the Final Appraisal Determination. Thus,a topic that relates to a single interventionwill be allocated 1.5 units of AppraisalCommittee time while larger topics, perhapsreviewing the use of a number of drugs in aparticular area, will be allocated a highernumber of units. The Appraisal Committeehas capacity to consider 2.5 appraisal units atone meeting, with the capacity for 55 unitsthroughout the year. This method was devel-oped in 2001–2002 and will be used in2002–2003 to plan the delivery of theappraisals work programme. The technologyappraisals due to be issued in 2002–2003represent 51 appraisal units.

4.1.4 The Institute is aware that the demand fortechnology appraisals will continue toincrease, and will explore means of increasingthe capacity in the appraisals work pro-gramme, to be discussed further with theDepartment of Health and the WelshAssembly Government.

4.1.5 In delivering the appraisals work programme,the Institute aims to ensure that the followingobjectives are met.• The Institute appropriately influences the

topics selected for appraisal.• The appraisal process demonstrates evi-

dence of methodological rigour and quality. • Assessment reports meet the Institute’s

requirements through effective collabora-tion with the National Collaborating Centrefor Health Technology Assessment andinternational partners.

• The Institute’s staff provide effective sup-port to meet the needs of the AppraisalCommittee and the reasonable expecta-tions of stakeholders.

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4.1.6 The staff providing support to the appraisalprogramme work under considerable pressureto deliver a high-quality service in a complex,challenging and changing environment. Theappraisal process has become increasinglycomplicated and the number of technologiescovered in each appraisal has risen. TheInstitute has reviewed the workload of theteam and is proposing to expand its capacityin two stages in 2002–2003 and in2003–2004, as shown in Table One. Thesechanges are necessary to manage the currentworkload and to deliver improvements in thequality of the service.

Table One: Appraisals team staffing profile 2002–2004

Staff Current WTE 2002–03 WTE 2003–04 WTE

Programme Director 1.00 1.00 1.00

Team Leader 2.00 2.00 2.00

Technical Lead 6.00 9.00 11.50

Information Specialist 1.00 1.00 2.00

Clinical Audit Specialist 0.40 0.50 0.50

Project Manager 2.00 2.00 2.00

Administration Assistant 2.00 3.00 3.00

Total 14.40 18.50 22.00

WTE = whole time equivalent

Table Two: Appraisals new initiatives

New initiative Cost Funding source

Patient impact assessment £27,000 BudgetSee Section 4.1.8 below

Decision Support Unit £100,000 BudgetSee Section 4.1.9 below

Equity methods £15,000 NRDevelopment of an operational model forincorporating equity issues into committeediscussion and decision making

NHS impact £15,000 NRMarket research with NHS staff tounderstand what will be of most benefitto NHS implementers

Technical consistency review £10,000 NRReview of previous appraisals to developstandard approaches for technical issuesfaced in appraisals

New pharmaceutical appraisals £10,000 NRReview different operating models forthe appraisal of new pharmaceuticals

Utility panel project £70,000 NRA pilot study to evaluate the use of astanding group of non-professionals toprovide valuations of health states usingscenarios derived from clinical studies

Total funding from recurring budget £127,000 Budget

Total additional non-recurring funding required £120,000 NR

NR = non-recurring funds, carried over from 2001–2002 underspend if available

4.1.7 The Institute recognises the need to continu-ally develop and enhance the appraisalprocess. There are a number of initiatives thatthe Institute would like to pursue to improvecertain aspects of the guidance produced andthese are outlined in Table Two.

4.1.8 In 2002–2003, the Institute will undertake apilot patient impact assessment in collabora-tion with lay representatives on theCommittee, patient groups and an academicunit. The aim of the pilot is to devise anappropriate methodology for the develop-ment of a patient impact assessment and toconsider how this can be incorporated intothe independent Appraisals Committee’s con-sideration of evidence.

4.1.9 In addition, the Institute will commission thedevelopment of a Decision Support Unit. Theobjective of the unit is to meet the informa-tion needs of the Appraisals Committee byproviding support for the critical appraisal ofeconomic evaluations and the provision ofcost effectiveness models where appropriate.

4.1.10 Funding is not available to support all ofthese developments in 2002–2003. If non-recurring funding is available, or underspendsare identified throughout the year, the time-limited reviews identified in Table Two will beundertaken in 2002–2003.

4.2 Clinical guidelines

4.2.1 The clinical guidelines programme commis-sions the development of major disease orcondition-based guidelines using uniformcommissioning, development and validationmethods.

4.2.2 The publication of clinical guidelines antici-pated in 2002–2003 is set out below.• Two inherited guidelines

• Three newly commissioned guidelines• Three cancer service guidance documents

Further details of guideline production andwork in progress are set out in Appendix C.

4.2.3 Further announcements of the work pro-gramme are expected during the year and theInstitute expects to receive a number of addi-tional topics, which will increase the numberof guidelines in production by the end of theyear. This will be a challenge for the Institute,as the size of the work programme commis-sioned from the Department of Health andthe Welsh Assembly Government is alreadygreater than the capacity for guideline pro-duction currently funded. The measures thatwe intend to put in place to deal with this areset out below.

4.2.4 The primary objective of the clinical guidelinesprogramme is to produce high-quality guide-lines and associated audit advice, based onthe best available evidence, for patients andprofessionals in England and Wales. The fol-lowing objectives are essential to ensure theguideline process is valid, open and appropri-ately resourced.• To expand capacity for guideline produc-

tion through the existing NationalCollaborating Centres and other resources,including the commissioning of a newCollaborating Centre.

• To enhance the support for guidelinedevelopment through the NationalGuidelines and Audit Patient InvolvementUnit and the production of a technicalmanual by the National Guideline Supportand Research Unit.

• To provide effective programme coordina-tion through the NICE guidelines team.

4.2.5 The Institute established six NationalCollaborating Centres in 2002–2003 to sup-port the development of guidelines. TheCollaborating Centres are partnerships ofnational professional organisations, academiccentres and patient/carer representatives. Asthe demand for guidelines rises, it is intendedto increase the capacity in these CollaboratingCentres and to seek to commission an addi-tional centre by the end of the financial year.The Institute hopes to establish the newCollaborating Centre in Wales. In someinstances, the size of the guidelines in devel-opment is greater than expected, and addi-tional support is required to maintain thework programme and meet agreed deadlines.

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4.2.6 Table Three below sets out the current capac-ity of the Collaborating Centres, measured bythe number of concurrent guidelines in pro-duction, the proposed increase, the expectedadditional cost in 2002–2003 and the total

cost for 2002–2003. This represents a realisticassessment of the actual costs in this financialyear; for example, the additional CollaboratingCentre will be established in January 2003 andtherefore only the part-year effect is shown.

Table Three: Collaborating Centres and Support Units

National Collaborating Total capacity 2002–03 2002–03Centre or Support Unit increased budget total budget

Current New £’000s £’000s

Acute Care 2 3 138 388

Chronic Conditions 4 4 142 570

Mental Health 4 6 172 621

Nursing and Supportive Care 2 3 114 362

Primary Care 4 4 13 483

Women and Children 4 6 108 508

Additional Collaborating Centre 0 2 100 100

Patient Involvement Unit – – 91 200

Support and Research Unit 2 2 5 372

Totals 22 30 883 3,605

Variable Costs 192 563

Grand total 1,075 4,168

Table Four: Guidelines team staffing profile 2002–2004

Staff Current WTE 2002–03 WTE 2003–04 WTE

Programme Director 1.00 1.00 1.00

Senior Commissioning Manager 1.00 1.00 1.00

Commissioning Manager 2.00 3.00 3.00

Coordinator 2.00 2.00 2.00

Administration Assistant – 2.00 2.00

Total 6.00 9.00 9.00

4.2.7 The guidelines team within the Institute cur-rently consists of six full-time staff that man-age the guidelines programme, including pro-viding important links with the NationalCollaborating Centres and Support Units andcoordinating the guideline validation process.

An increase in the core staff is required toensure this support can continue in the faceof an expansion of the guidelines programmeand to establish and refine the guidelinedevelopment processes. The details are shownin Table Four.

4.2.8 Further changes are also planned in theguideline development process and these arehighlighted below.• Payment for patient representatives attend-

ing guideline development groups – thiscontributes to an overall increase in thevariable costs of guidelines by £192,000.

• Development of the stakeholder process.• Establishment of a process for the future

updating of guidelines.• Expansion of the Guidelines Advisory

Committee panels to support the increasednumber of guidelines in production.

• Improved website information.• Establishment of a process for piloting

guidelines before production.

4.2.9 The Department of Health and the WelshAssembly Government have discussed withthe Institute the development of a widerrange of guideline products. For example, theInstitute expects to receive a commission todevelop a set of patient safety protocols tosupport the implementation of the report AnOrganisation with a Memory. It is anticipatedthat the Institute will work closely with theNPSA to develop an initial set of safety proto-cols in 2002–2003. The Institute is alsoexploring the development of diagnosis-basedguidelines for use in emergency settings.

4.3 Clinical audit

4.3.1 The Department of Health and the WelshAssembly Government, following theirresponses to the Kennedy report, have agreedthat responsibility for the promotion of clinicalaudit and the undertaking of national auditprojects will transfer to CHI once it has thelegal powers to carry out these functions. TheInstitute will retain the responsibility for pro-viding audit advice in relation to the guidanceproduced from the appraisals and guidelineswork programmes.

4.3.2 The Institute intends to work closely with theCommission and the staff involved to ensurethat this transfer is smooth and does notcause disruption to current projects alreadyunderway. Good relations have already beenestablished with the Commission in this area,particularly as a result of the collaboration onthe production of Best Practice in ClinicalAudit, which was published in February 2002.

4.3.3 The timing of the transfer is currentlyunknown, which makes planning for

2002–2003 difficult. Appendix B providesdetails of the current audit projects, theirprogress and expected completion dates. TheInstitute intends to support these projectswithin the existing funds available for clinicalaudit but will not initiate any new projectsnor make any additional financial provisionfor further audit activity. It is expected thatthe non-pay budget for audit developmentswill transfer to the Commission, reducing theInstitute’s budget by £223,000. As it is notknown when these changes will occur, theyhave not been reflected in the financialassumptions set out in Section 5.

4.3.4 The Institute has a small audit team that willbe directly affected by this change. It isexpected that the roles of Audit ProgrammeDirector and Audit Development Manager willtransfer to the Commission and that thefunding associated with these posts will alsotransfer, reducing the Institute’s budget by afurther £104,000. The part-time post, whichhas been used in 2002–2003 to support thedevelopment of audit advice in appraisalsguidance, will be retained by the Institute andhas been transferred to the appraisals team.Again these potential resource adjustmentshave not been reflected in the assumptionsset out in Section 5.

4.4 Confidential Enquiries

4.4.1 The Institute aims to establish the newarrangements for the Confidential Enquiriesand to ensure that the findings from theirinvestigations can be translated into NICEguidance. The Institute will work with eachConfidential Enquiry and the newly estab-lished Confidential Enquiries AdvisoryCommittee to develop new methods toachieve this objective. The Institute will alsoagree a new contract with the ConfidentialEnquiries to provide 3-year rolling agreements.

“The Institute aims to establish the newarrangements for the ConfidentialEnquiries and to ensure that thefindings from their investigations canbe translated into NICE guidance.”

4programme analysis

1918

4.4.2 The National Confidential Enquiry into Peri-operative Deaths (NCEPOD) will broaden itsscope to include investigations into unex-pected medical deaths. The Enquiry willestablish the capacity to deliver two reportsper annum. This will require additionalresources to strengthen the administrativeand analytical team and to broaden the clini-cal input. In 2002–2003, this will require anadditional allocation of £255,000, rising by afurther £93,000 in 2003–2004 and by£64,000 in 2004–2005.

4.4.3 In 2002–2003, NCEPOD activities will be asfollows:• Publish in November 2002 the results of the

study on deaths within 3 days of surgery.• Analyse the data collected for Who

Operates When. This is a repeat of the studyundertaken in 1995–1996, which revealedlarge numbers of operations performed byunsupervised junior surgeons and anaes-

thetists, particularly out-of-hours, which isbeing carried out to assess progress in thelight of changes in NHS organisation andthe training of junior doctors.

• Initiate two new studies – a study of thera-peutic endoscopic procedures carried outby surgeons, physicians, GPs or nurses, anda 6-month sample of medical patients(topic to be decided).

• Appoint additional staff to support theexpansion of the work programme.

4.4.4 The Confidential Enquiry into Suicides andHomicides by People with Mental Illness(CISH) will not produce a report in2002–2003 but its activities will be as follows:• Submit and publish ten academic papers

based on the findings reported in SafetyFirst, published in 2001.

• Maintain the collection of statistics on sui-cides and homicides by people with mentalhealth problems across the UK.

• Explore ways to provide feedback on findings

• Initiate new studies, collecting data from:– families of suicide victims seen in pri-

mary care or accident and emergencydepartments

– homicide near misses, those convicted ofserious violence

– sudden unexpected deaths of inpatientson mental health wards (in 2003–2004)

• Strengthen the project management func-tion to support expansion of the role andremit of the Enquiry.

Additional funds are required to supportthese developments – £179,000 in2002–2003, £261,000 in 2003–2004 and£31,000 in 2004–2005.

4.4.5 The Confidential Enquiry into Stillbirths andDeaths in Infancy (CESDI) will completeProject 27/28 and publish a focused report inOctober 2002. A new formalised approach tothe development of Enquiry recommenda-

tions will be initiated. The validity of panelassessments will be analysed by comparisonwith data from second panels. Data collectionfor the Diabetes Project will run from 1 March2002 to 28 February 2003.

4.4.6 The Confidential Enquiry into MaternalDeaths (CEMD) will complete its triennial col-lection of data in preparation for its report in2004. 2002 marks the 50th anniversary ofthe establishment of the CEMD.

4.4.7 The Institute will appoint a chief executive tolead the establishment of the new ConfidentialEnquiry for Maternal and Child Health.

4.4.8 Considerable savings are expected from thedevelopment of the new Confidential Enquiryfor Maternal and Child Health out of CESDIand CEMD. These savings will be used to sup-port the development of the whole enquiryprogramme. However, these will not be realisedin 2002–2003. The Institute has agreed to

maintain the development of NCEPOD andCISH and to support these developments in2002–2003 using non-recurring funds carriedover from 2001–2002. The balance will be sup-ported by the recurring budget.

4.4.9 The Institute will also take on the responsibil-ity for the direct funding of CISH, NCEPODand CESDI for Wales, previously provided bythe Welsh Assembly Government. The WelshAssembly Government will increase their con-tribution to the Institute’s budget to allow thischange to take place (Section 5.6.2).

4.5 New interventional procedures

4.5.1 The Department of Health and the WelshAssembly Government have agreed that theresponsibility for the Safety and EfficacyRegister for New Interventional Procedures(SERNIP), previously managed by theAcademy of Royal Medical Colleges, willtransfer to the Institute on 1 April 2002. TheInstitute will receive new directions from theDepartment and the Assembly to enable it toundertake this new function.

4.5.2 The primary objective in the first year will beto establish the remit, processes and methodsfor the programme. The Institute will seek toachieve this through:• consulting with stakeholders on the remit,

role and working practices for assessinginterventional procedures

• producing a process manual explaining howthe function will be delivered and organised

• establishing an advisory committee with anindependent chair and an appropriatemembership, ensuring that all relevant per-spectives are represented, including thepatients and their carers

• appointing a team to manage the pro-gramme and to provide support to theadvisory committee and the Board

• agreeing arrangements for the provision ofsystematic reviews and other technical sup-port required by the Institute and the advi-sory committee, including the collection ofdata for procedures under review

• establishing a communications plan to pro-mote the new arrangements for assessingnew interventional procedures and tosecure support from stakeholders.

4.5.3 The Institute will appoint a clinically qualifiedsenior manager as the Programme Director,as well as a Project Manager and an adminis-trative assistant to support the work of thisnew programme.

4.5.4 It is difficult to assess the workload involvedin 2002–2003. However, the Institute will, asa minimum, review all procedures currentlyincluded on the previous SERNIP register andmake a start on a new programme of work.

“Considerable savings are expected from the development of thenew Confidential Enquiry for Maternal and Child Health out of

CESDI and CEMD. These savings will be used to support thedevelopment of the whole Enquiry programme.”

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4.6 Communications

4.6.1 The Institute uses a combination of electronicmedia, traditional print media and partner-ship arrangements for the publication anddissemination of its guidance. In addition tothe targeted dissemination of individualproducts, the Institute produces regular com-pilations of its work. Dissemination activity in2002–2003 will be based upon the produc-tion of guidance from each of the Institute’smain work programmes and the launch ofnew initiatives. These are outlined in the rele-vant sections above.

4.6.2 In 2002–2003, the Institute initiated reviewsof the methods of publishing and disseminat-ing guidance and our approach to corporatecommunication. These reviews will be com-plete in March 2002 and pilot work and test-ing will continue until May 2002. A revisedcommunications strategy will be published inthe first quarter of the year, which will definethe strategic approach to corporate commu-nications and dissemination. The strategy willbe reviewed within 6 months of its launchand a report will be presented to the Board.

4.6.3 The Institute aims to achieve corporate mem-bership of the Plain English Campaign andwork to obtaining the Crystal Mark for theinformation the Institute produces for thepublic by December 2002.

4.6.4 The communication function will monitor andensure compliance with relevant NHS guid-ance and statutory and legal frameworks. Thiswill include a strategy for compliance withthe Data Protection Act and the RaceRelations (Amendment) Act, and agreementto and publication by September 2002 of theInstitute’s Welsh Language Scheme.

4.6.5 The Institute funds the effectiveness publica-tions published by the National PrescribingCentre and the Centre for Reviews andDissemination at York. Publication plans havebeen agreed.

4.6.6 The Institute will continue to maintain anddevelop its website. An independent techni-cal review of the website will be conductedbefore commissioning Phase V developmentin September 2002 with completionexpected by March 2003. Phase V develop-ments will include multilanguage capability,email alert enhancements, automatic key-word indexing, improved Welsh language

functionality, improved document loadingand on-line survey and discussion facilities.Other developments will include:• on-line consultation projects• on-line ordering of documents• internal discussion databases• functions supporting the register for inter-

ventional procedures.

4.6.7 The Institute will continue to develop its rela-tionship and partnership working with NHSorganisations that communicate and dissemi-nate products of the Institute’s work pro-

gramme (for example, NHS Direct, the NationalElectronic Library for Health and PRODIGY).

4.6.8 The Institute has identified a number of newinitiatives it would like to pursue in2002–2003 to support its communicationsactivity. These proposals are set out in TableFive. Recurring funding is not available tosupport these developments in 2002–2003. Ifnon-recurring funding is available, or under-spends are identified throughout the year, theinitiatives identified in Table Five will beundertaken in 2002–2003.

Table Five: Communications new initiatives

Proposal Cost Comment£’000s

Conference exhibitions 94 Provide presence at high-profile events

Multilingual patient information 150 Pilot production of patient information in relevant ethnic languages

Continuing medical education 40 To support implementation of guidance through education programmes

Email alerts 120 To promote dissemination of guidance to doctors

Integrated electronic dissemination 40 To pilot electronic authoring tool

Total 444

4.6.9 The communications team will be expanded in2002–2003 to support these increased levelsof activity. Table Six sets out these proposals incomparison with the current establishment.

Table Six: Communications team staffing profile 2002–2004

Staff Current 2002–03 2003–04WTE WTE WTE

Communications Director 1.00 1.00 1.00

Communications Executive 4.00 6.00 7.00

Technical Writer/Editor 2.00 2.00 3.00

Knowledge Manager 1.00 1.00 1.00

Website and Intranet Administrator – 1.00 1.00

Coordinator 1.00 1.00 1.00

Total 9.00 12.00 14.00

“The Institute will continueto maintain and develop

its website. Anindependent technical

review of the website willbe conducted before

commissioning Phase Vdevelopment in

September 2002 withcompletion expected by

March 2003. Phase Vdevelopments will includemultilanguage capability,

email alertenhancements, automatic

key-word indexing,improved Welsh

language functionality,improved documentloading and on-line

survey and discussionfacilities.”

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4.7 PRODIGY

4.7.1 During 2001–2002, the Institute agreed withthe Department of Health and the WelshAssembly Government that our contributionshould be to ensure that the processes usedby the PRODIGY guidance authoring team arerobust. Consequently, the Institute’s role inthe future will be to monitor periodically theapproach being used.

4.7.2 The Institute will not require the current levelof funding to undertake this revised functionand its allocation will be reduced by £880,000.

4.7.3 The Institute’s guidance will continue to beincorporated into PRODIGY. The existingPRODIGY guidance will continue to be main-tained until it is no longer required or isreplaced by new Institute guidance.

4.8 Board and corporate services

4.8.1 As the functions of the Institute continue toexpand, the Department of Health and theWelsh Assembly Government have recognisedthe need for an additional non-executivedirector. This will enhance the capacity of theexisting non-executive directors to participatein the management and strategic direction ofthe Institute. The additional non-executivedirector will have current or recent NHS man-agement experience.

4.8.2 An additional executive director will also beappointed. The new executive director willhave responsibility for specific aspects of theInstitute’s work programme and will have aclinical background. The new executive direc-tor will also take executive lead responsibilityfor specific topics in the appraisals and clini-cal guidelines work programme and will be amember of the Institute’s GuidanceExecutive.

4.8.3 Corporate services provide the efficient day-to-day running of the Institute’s corporate

and administrative functions, includingfinance, human resources and support to theBoard and to the Institute’s advisory commit-tees. As a result of the continued expansionof the Institute’s activities, an administrativeassistant will be appointed to support thework of the corporate services team.

4.8.4 The Institute will continue to work within theHuman Resources Performance Framework,incorporating Improving Working Lives andother initiatives, and we will ensure that ouremployment practices achieve relevant NHSstandards. A number of the Institute’s policiesand procedures are due for review in2002–2003 and the revised documents willbe presented to the Board during the year.

4.8.5 The Institute will also work towards securingaccreditation as an Investor in People todemonstrate our commitment to the develop-ment of our staff. The action plan establishedin response to the Process Mapping work car-ried out by District Audit in 2001 will also beimplemented. Regular reports will be made tothe Board.

4.8.6 The Institute will also establish a comprehen-sive set of procedures to support the manage-ment of corporate services, including finance,human resources and health and safety.

4.8.7 As a public sector organisation, the Institutehas a duty to promote race equality in all ouractivities and to implement the directions ofthe Race Relations (Amendment) Act 2000.An effective race equality scheme will beestablished by the end of May 2002 andprogress reports will be made to the Board.

4.8.8 Performance indicators have been agreed withthe Institute’s financial and human resourcesservices provider, Chelsea and WestminsterHealthcare NHS Trust, and will be monitoredthroughout the year at regular monthly meet-ings and in the annual review. The Institute’sperformance against the public sector pay-ment targets will be reported to the Board.

4.9 Citizens Council

4.9.1 The NHS Plan announced that the Institutewould establish a Citizens Council to supportits work and to involve the general public inour decision-making processes. Agreementhas now been reached with the Departmentof Health and the Welsh AssemblyGovernment, and the Citizens Council willhold its first meeting in 2002.

4.9.2 The Institute has established a Board commit-tee, which will oversee the establishment ofthe Council on behalf of the Board. The com-mittee will be responsible for choosing the top-ics the Council will consider, will receive theoutcome of the Council’s deliberations and willadvise the Board on how to incorporate theCouncil’s activity into the Institute’s work pro-gramme. A project manager has beenappointed by the Institute to manage thedevelopment of the Council. A part-timeadministrator will support the project manager.

4.9.3 The Institute will commission an appropriateorganisation to support the development ofthe Citizens Council. This organisation willassist in the recruitment of the members of theCouncil, ensuring that the Council is represen-tative of the English and Welsh populations.

4.10 Research and development

4.10.1 The Institute has established a Research andDevelopment Sub-Committee of the Board tooversee its involvement in research anddevelopment relevant to the Institute’s work,in collaboration with the Research andDevelopment Directorate (R&DD) of theDepartment of Health.

4.10.2 The following projects have been commis-sioned and initial reports will be made in2002–2003.

Table Seven: Research and development initiatives

Project Organisation Report schedule

Review of the impact of the Institute’s York University commissioned through Interim report May 2002, final reporttechnology appraisal programme the NHS R&DD September 2003

Scoping document on the use of MEDTAP May 2002quality-adjusted life year (QALY) measures

The value of a QALY Both projects to be commissioned in Both projects to be initiated in 2002conjunction with the NHS R&DD

The use of different types of information in making appraisal decisions

“The Institute will also establish a comprehensive set of proceduresto support the management of corporate services, including

finance, human resources and health and safety.”

24

5resource management

5.1 Risk management and controls assurance

5.1.1 The Institute is required to comply with thecontrols assurance standards that apply to theNHS. The aim of the Controls AssuranceProject is to help individual organisationsimprove their performance. Not all the stan-dards are applicable to the work of theInstitute, but the relevant areas are as follows:• risk management system• buildings, land, plant and non-medical

equipment• contracts and contractor control• fire safety• finance management• governance• health and safety management• human resources• information management and technology• professional and product liability• records management• security.

5.1.2 In 2001–2002, the Institute reviewed the out-come of the risk assessment carried out inMarch 2001 and implemented the recom-

mendations of the action plan. Further workwill take place in 2002–2003 in the followingareas:• strengthening health and safety arrange-

ments and contracts management• compliance with the new finance manage-

ment and governance standards• introduction of an integrated document

management system.

5.1.3 The Institute expects to receive the opinion ofits internal auditors of the baseline assess-ment and will act on the recommendations intheir report.

5.2 Human resources

5.2.1 In the development of the Institute’s plans for2002–2003, it has been recognised that anincrease in staff is required to ensure deliveryof the Institute’s work programmes. While theInstitute will remain a relatively small organisa-tion, the establishment will increase from thepresent level of 39.60 to 56.70 whole timeequivalents (WTE) by the end of March 2003.

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2726

5.2.2 Table Eight sets out the proposed changes inthe Institute’s establishment in 2002–2003.

In addition an additional non-executive direc-tor will be appointed bringing the total to 8(Section 4.8.1).

5.2.3 These appointments will be made throughoutthe year. The costs of this increase in estab-lishment will be met on a recurring basis fromthe total funding available to the Institute.

5.2.4 The Institute will also carry out a review ofthe salaries and pay structure of its staff.

5.2.5 The Institute remains committed to investingin its staff to support them in delivering anexcellent service, and a separate trainingbudget will be maintained.

5.2.6 The Institute will keep both the capacity of itsstaff and those who support its work closelyunder review.

5.3 Equal opportunities

5.3.1 The Institute is committed to equality ofopportunity in its employment practice. Wehave policies in place that will support ourefforts in this respect and we will keep theseunder review to ensure we are complying withrelevant legislation and best practice. We willmonitor our performance on a quarterly basis.

5.3.2 The Board will continue to receive regularreports covering a range of human resourcesissues, including equal opportunities monitor-ing, turnover, absence levels and delivery oftraining and development programmes.

5.4 Information technology

5.4.1 We are committed to exploiting the potentialof information technology – both in the waywe work and in the way our guidance is dis-seminated and made available to the NHS.We have made significant investments ininformation technology and will continue toexplore further developments in 2002–2003.

5.4.2 Developments in 2002–2003 will include:• an integrated project management system• an extension to the existing home working

arrangements• a renewal programme for IT equipment

over 3 years old.

5.4.3 The Institute will continue to provide thecomprehensive IT training programme estab-lished in 2001.

5.5 Accommodation

5.5.1 The Institute will carry out a review of itsaccommodation needs in 2002. The expan-sion of our work programmes means that thecurrent accommodation will be insufficient forour needs by the end of 2002.

5.5.2 The Institute converted its committee roominto office accommodation in early 2002. Allmajor meetings are now held at externalsites, which has increased the costs of accom-modation pending resolution of our accom-modation needs.

5.5.3 In addition, we will continue to comply withrelevant health and safety regulations toensure the safety of all staff and visitors.

5.6 Financial framework

5.6.1 In 2001–2002, the Institute received£13,075,000 in recurring funding from theDepartment of Health and the WelshAssembly Government. In 2002–2003, thisrecurring budget will increase to

£14,725,000, including a specific allocationof £318,000 for assessing interventional pro-cedures, the Welsh funding for theConfidential Enquiries and the reduction ofthe budget for PRODIGY and the subsequentimpact upon the funding from the WelshAssembly Government.

5.6.2 Table Nine sets out the funding assumptionsfor 2002–2003.

Table Eight: Institute staffing profile 2002–2003

Team Current Increase Total SectionWTE WTE WTE

Appraisals 14.40 4.10 18.50 4.1.6

Guidelines 6.00 3.00 9.00 4.2.7

Audit 1.60 – 1.60 4.3.4

Confidential Enquiries – 1.00 1.00 4.4.7

Interventional Procedures – 2.50 2.50 4.5.3

Communications 8.00* 3.00 11.00 4.6.9

Board – Executive Directors 4.00 1.00 5.00 4.8.2

Corporate Services 5.60 1.00 6.60 4.8.3

Citizens Council – 1.50 1.50 4.9.2

Total 39.60 17.10 56.70

*The Communications Director is an Executive Director

Table Nine: Institute funding framework 2002–2003

Funding Department Welsh Assembly Totalof Health Government

£’000s £’000s £’000s

Recurring budget

Baseline 12,488 587 13,075Baseline increase 2,000 119 2,119Confidential Enquiries 143 143Interventional Procedures 300 18 318

PRODIGY reduction (880) (50) (930)

Recurring budget total 13,908 817 14,725

Non-recurring budget 800 800

Grand total 14,708 817 15,525

5.6.3 The Institute will continue discussions withthe Department of Health and the WelshAssembly Government to secure the increasesin funding required for 2003–2004.

5.6.4 A number of the new posts and initiatives in2002–2003 will take effect part way throughthe year. The budget allocations outlinedbelow (Section 5.7) reflect the part-yeareffect of these changes and the full-yeareffect. A further increase of £795,000 will bemet from allocations in 2003–2004 subjectto additional funding being available.

5.6.5 The Institute will also have access to£800,000 of non-recurring funds availablefrom the underspend in 2001–2002.

5.6.6 The Institute will operate within its fundingallocation, securing full value for money forthe resources allocated to it. The Institute willachieve an efficiency gain by absorbing theeffect of inflation.

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5.7 Budget allocations

5.7.1 The Institute has undertaken a detailedbudget setting exercise and the allocations toeach area are outlined in Table Ten.

Table Ten: Recurring budget allocations 2002–2003

2001–2002 2002–2003Increase pay Increase non-pay Total

£’000s £’000s £’000s £’000s

Work Programmes

Appraisals 722 186 159 1,067Appraisals consultees 173 173Audit 340 (13) 327Guidelines 3,770 70 935 4,775Interventional Procedures 100 220 320Confidential Enquiries 2,725 100 521 3,346Citizens Council 64 121 185Research and development 70 70

Sub-total work programmes 7,557 507 2,186 10,251

Infrastructure

Board and Corporate Services 1,650 117 196 1,963Pay progression 50 50Communications 2,495 113 365 2,973New initiatives budget 493 (493)

Sub-total infrastructure 4,638 280 81 4,999

Total 12,195 787 2,267 15,250

Further details are provided in Appendix D.

5.7.2 Table 10 reflects the fact that we have bud-geted in 2002–2003 for expenditure of£525,000 above the available recurrent fund-ing. This will largely be met from the carryforward from 2001–2002 (£375,000) and, ifnecessary, by delaying initiatives due to startin the final quarter of the year and delayingthe appointments for new posts. The mergerof CESDI and CEMD will produce savings inthe costs of the Confidential Enquiries in2003–2004.

5.7.3 The Institute will use the non-recurring fundsmade available as follows:• to support the non-recurring costs of mov-

ing to new premises and funding the useof external sites for meetings

• to support the non-recurring additionalcosts of the Confidential Enquiries that willbe met by savings from the merger ofCESDI and CEMD, which will be achievedby March 2003

• to support specific research projects iffunds are available.

This allocation of funds is set out in TableEleven.

Table Eleven: Non-recurring budget allocations 2002–2003

Expenditure £'000s

Confidential Enquiries 375

Rent 144

Moving – costs of fees, refurbishment etc. 281

Total 800

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list ofappendicesAppendix Page

A Technology Appraisal Programme 31

B Audit Work Programme 32

C Clinical Guidelines Work Programme 33

D 2002–2003 Budget Structure 34

E Board and Senior Management Team 36

Appraisal topic The clinical and cost Number of Appraisal First Appraisal Second Appraisal Anticipatedeffectiveness of technologies unit value Committee Committee launch

Use of inhalers in inhaler devices for treatment 9 2 September 2001 November 2001 April 2002older children of asthma in older children

Routine anti-D routine anti-D prophylaxis 1 1.5 November 2001 February 2002 April 2002for rhesus negative womenin pregnancy

Human growth human growth hormone 5 1.5 November 2001 March 2002 May 2002hormone (children) in children

Caelyx Caelyx (pegylated liposomal 1 1.5 January 2002 March 2002 May 2002doxorubicin hydrochloride)for ovarian cancer

Hip resurfacing metal-on-metal hip 4 1.5 January 2002 March 2002 May 2002resurfacing

Surgical treatments for surgical treatments for 1 1.5 February 2002 April 2002 June 2002people with morbid people with morbid obesityobesity

Computerised CBT computerised cognitive 6 3 February 2002 April 2002 July 2002behaviour therapy fordepression and anxiety

Ultrasonic locating ultrasonic locating devices 2 1.5 March 2002 May 2002 July 2002devices for the placement of

central venous lines

Photodynamic therapy photodynamic therapy for 1 1.5 March 2002 May 2002 July 2002age-related maculardegeneration

Breast cancer vinorelbine for breast cancer 1 1.5 March 2002 May 2002 July 2002

Human growth human growth hormone 5 3 March 2002 May 2002 July 2002hormone (adults) in adults

Review of glycoprotein glycoprotein IIb/IIIa inhibitors 3 1.5 April 2002 June 2002 August 2002inhibitors for unstable angina and

coronary syndromes (review)

Imatinib imatinib for chronic 1 1.5 April 2002 June 2002 August 2002myeloid leukaemia

Review of taxanes docetaxel and paclitaxel 2 3 April 2002 July 2002 September 2002for ovarian cancer for ovarian cancer

Home versus hospital home versus hospital 20 1.5 May 2002 July 2002 September 2002haemodialysis haemodialysis

Early thrombolysis early thrombolysis for 3 3 May 2002 July 2002 September 2002treatment of myocardialinfarction

Influenza amantadine, oseltamivir and 3 6 June 2002 August 2002 October 2002review of zanamivir forinfluenza

Electroconvulsive electroconvulsive 1 4 June 2002 August 2002 October 2002therapy (ECT) therapy (ECT)

Diabetes long-acting insulin 1 1.5 July 2002 September 2002 November 2002analogues for diabetes

appendix ATechnology Appraisals Work Programme

3332

Appraisal topic The clinical and cost Number of Appraisal First Appraisal Second Appraisal Anticipatedeffectiveness of technologies unit value Committee Committee launch

Tension-free vaginal tension-free vaginal tape 1 1.5 September 2002 November 2002 February 2003tape for stress for stress incontinenceincontinence

Insulin pump therapy insulin pump therapy 2 1.5 September 2002 January 2003 March 2003

Review of glitazones review of rosiglitazone and 2 1.5 October 2002 January 2003 March 2003for type II diabetes pioglitazone for type II diabetes

Patient education patient education models 1 1.5 October 2002 January 2003 March 2003models for diabetes for diabetes

Capecitabine and capecitabine and tegafur 2 1.5 November 2002 January 2003 March 2003tegafur uracil for uracil for colorectal cancercolorectal cancer

Capecitabine for capecitabine for breast 1 1.5 November 2002 January 2003 March 2003breast cancer cancer

Osteoporosis prevention of osteoporosis November 2002 March 2003 June 2003

Osteoporosis treatment of osteoporosis January 2003 March 2003 June 2003

Immuno-suppressive immuno-suppressive regimens February 2003 April 2003 June 2003regimens for renal for renal transplantationtransplantation

New drugs for new drugs for bi-polar February 2003 April 2003 July 2003bi-polar disorder disorder

Menorrhagia endometrial ablation for March 2003 May 2003 August 2003menorrhagia

Anakinra for anakinra for rheumatoid March 2003 May 2003 August 2003rheumatoid arthritis arthritis

Newer drugs for newer drugs for epilepsy May 2003 July 2003 September 2003epilepsy (adult) (adult)

Newer drugs for newer drugs for epilepsy May 2003 July 2003 September 2003epilepsy (child) (child)

Guideline National Collaborating Centre Anticipated launchdate (estimated)

Diabetes type 2 – lipids and hypertension Primary Care August 2002

Diabetes type 2 – glycaemic control Primary Care August 2002

Schizophrenia Mental Health December 2002

Preoperative tests Acute Care December 2002

Head injury Acute Care February 2003

Infection control Nursing and Supportive Care April 2003

Multiple sclerosis Chronic Conditions June 2003

Heart failure Chronic Conditions August 2003

Pressure-relieving devices Nursing and Supportive Care August 2003

Eating disorders Mental Health September 2003

Hypertension National Guidelines Support and Research Unit September 2003

Depression Mental Health September 2003

Antenatal care Women and Children's Health (September 2003)

Fertility Women and Children's Health November 2003

Dyspepsia National Guidelines Support and Research Unit December 2003

Familial breast cancer Primary Care December 2003

Caesarean section Women and Children's Health January 2004

Diabetes Type 1 – adults and children Chronic Conditions and Women & Children's Health January 2004

Deliberate self-harm Mental Health (January 2004)

Chronic obstructive pulmonary disease Chronic Conditions February 2004

Falls Nursing and Supportive Care April 2004

Disturbed behaviour Nursing and Supportive Care April 2004

Lung cancer Acute Care (April 2004)

Anxiety - generalised Primary Care May 2004

Epilepsy Primary Care June 2004

Anxiety – specialised Mental Health Summer 2004

Cancer Service Guidance Centre Anticipated launch date (estimated)

Breast (update) University of Leeds July 2002

Urology University of Leeds August 2002

Haemato-oncology University of Leeds May 2003

Colorectal University of Leeds June 2003

Head and neck University of Leeds September 2003

Supportive and Palliative Care – Part A King’s College, London December 2002

Supportive and Palliative Care – Part B King’s College, London September 2003

appendix CClinical Guidelines Work Programme

Project Organisation End date

Myocardial Infarction (MINAP) Royal College of Physicians December 2002

Epilepsy (SUDEP) Epilepsy Bereaved May 2002

Diabetes (QUIDS) Diabetes UK July 2002

Primary care management of National Collaborating Centre for Primary care Autumn 2003coronary heart disease

Continence National Collaborating Centre for Chronic Conditions To be confirmed

Parenteral Nutrition National Collaborating Centre for Women and Children’s Health To be confirmed

appendix BClinical Audit Work Programme

3534

Budget 2001–2002 Change 2002–2003 Staff£ £ £ (whole time

equivalents)

Appraisals

Pay 641,663 186,190 827,853 18.50Non-payAppraisals Technical Support 80,000 (40,000) 40,000Developments 199,000 199,000Non-pay sub-total 80,000 159,000 239,000

Total Appraisals budget 721,663 345,190 1,066,853

Appraisal Consultees

Payments – 173,000 173,000

Total Appraisals Consultees budget – 173,000 173,000

Guidelines

Pay 327,816 70,214 398,030 9.00Non-payCollaborating Centres 3,092,000 1,076,025 4,168,025Guidelines Development 310,000 (172,389) 137,611Guidelines Technical Support 40,000 31,361 71,361Non-pay sub-total 3,442,000 934,997 4,376,997

Total Guidelines budget 3,769,816 1,005,211 4,775,027

Audit

Pay 116,959 (12,660) 104,299 1.60Non-payAudit developments 223,400 – 223,400Non-pay sub-total 223,400 - 223,400

Total Audit budget 340,359 (12,660) 327,699

Confidential Enquiries

Pay – 100,000 100,000 1.00Non-payCEMD 219,800 (69,800) 150,000CESDI 1,840,044 76,956 1,917,000CISH 265,132 179,275 444,407NCEPOD 400,000 255,000 655,000Project Management & CEAC – 80,000 80,000Non-pay sub-total 2,724,976 521,431 3,246,407

Total Confidential Enquiries budget 2,724,976 621,431 3,346,407

Interventional Procedures

Pay - 99,886 99,886 2.50Non-payCommittee Expenses – 20,000 20,000Systematic Reviews – 200,000 200,000Non-pay sub-total – 220,000 220,000

Total Interventional Procedures budget – 319,886 319,886

appendix DBudget Structure

Budget 2001–2002 Change 2002–2003 Staff£ £ £ (whole time

equivalents)

Research and development

Research – 70,000 70,000

Total research budget – 70,000 70,000

Board and Corporate Services

Pay 690,029 117,241 807,270 11.60Non-payAccommodation 315,000 315,000Advisory Committee expenses 130,000 29,000 159,000Communications 18,000 37,000 55,000Board and Partners Council 20,000 – 20,000Hospitality 9,732 3,000 12,732Information and Technology 84,000 22,489 106,489Photocopying 15,000 1,000 16,000Postage 13,500 1,500 15,000Service contracts 180,000 9,500 189,500Stationery 25,000 22,500 47,500Staff facilities 5,000 – 5,000Training 50,000 – 50,000Income (5,000) – (5,000)Travel and accommodation 100,000 40,000 140,000Advertising – 30,000 30,000Non-pay sub-total 960,232 195,989 1,156,221

Total Board and Corporate Services budget 1,650,261 313,230 1,963,491

Citizens Council

Pay – 63,889 63,889 1.50Non-payInfrastructure – 47,750 47,750Meeting support – 63,550 63,550Fee – 10,000 10,000Non-pay sub-total – 121,300 121,300

Total Citizens Council Budget – 185,189 185,189

Communications

Pay 301,550 112,994 414,544 11.00Non-payCorporate communications 232,000 67,000 299,000Dissemination 1,280,500 217,000 1,497,500Welsh Language Scheme 15,000 (4,000) 11,000Effectiveness publications 590,000 44,000 634,000Document management 25,000 – 25,000Clinical Excellence 2001 55,000 27,000 82,000Website 76,000 13,500 89,500Income (80,000) – (80,000)Non-pay sub-total 2,193,500 364,500 2,558,000

Total Communications budget 2,495,050 477,494 2,972,544

New initiatives budget 492,876 (492,876) –

Pay progression 50,000 50,000

GRAND TOTAL 12,195,000 3,055,095 15,250,095 56.70

36

Chair Professor Sir Michael Rawlins

Chief Executive Andrew Dillon

Non-Executive Directors Professor Tony Culyer CBEFrederick GeorgeMercy JeyasinghamDr Susanna Lawrence OBERoy Luff OBEMary McClareyVacancy

Executive Directors Professor Peter LittlejohnsAnne-Toni RodgersAndrea Sutcliffe

Programme Directors Gillian Leng Carole Longson David Pink

appendix EBoard and Senior Management Team

contacting NICENational Institute for Clinical Excellence11 StrandLondonWC2N 5HR

Telephone: 020 7766 9191Fax: 020 7766 9123E-mail: nice@nice.nhs.ukWebsite: www.nice.org.uk

N0154 1p 5k Sep 02 Oaktree PressDesign and layout by Westhill Communications

ISBN: 1-84257-220-2

Published by the National Institute of Clinical ExcellenceSeptember 2002

© National Institute for Clinical Excellence September 2002. All rights reserved.This material may be freely reproduced for educational and not-for-profitpurposes within the NHS. No reproduction by or for commercial organisationsis permitted without the express written permission of the Institute.