In a previous post I promised to blog NICE CG190 ‘Intrapartum Care for healthy women and babies’– care during labour & childbirth (the national clinical guideline in England & Wales) chapter by chapter. Let’s have a quick look first at what NICE guidance is, and how it is made. (8 May 2016)
Making national guidelines for health and social care is a national process in which everyone has a stake. The public are people who use health and social care services – so what guidelines say will affect the choices you are given, the outcomes for you and the experiences you have. If you are a health or social care professional, the guidance will shape your work.
While there is no statutory duty for the NHS to implement NICE guidance, Clinical Commissioning Groups (CCGs) are under an obligation in public law to have regard to it, and to give clear reasons for any general policy that does not follow it. See the NHS Constitution (and my previous post about it) for further thoughts on the rights we have all have as users of the NHS in particular.
Everyone can contribute, including service users and the public, who can take part in NICE consultations during guideline-making by giving their views to charities, which can register as ‘stakeholder organisations’ to collect and send in comments.
In maternity, my particular area of interest as a lay representative , women as service users and/or advocates for service users serve on the guideline development groups as lay members.
CG190 #IPCare Care of healthy women and their babies in labour and birth. How did we make the guideline? Well the ‘topics for updating’ or ‘scope’, set by NICE in consultation with stakeholder organisations, and based on having searched for new research evidence published since the 2007 version of the guideline (notably the Birthplace study) was this:
Which resulted, after 3 years painstaking and through work in updated recommendations including these ten key recommendations (prioritised by the lay and clinician ‘invited’ members of the Guideline Development Group or ‘GDG’).
The ‘invited’ members, who are appointed in an open, ‘public appointments’-style process are not the only people involved though – this lists almost the full team (I hope – there were probably others involved in the technical and quality work.)
And here is the process.
We spent a lot of time looking at GRADE tables – the output from the many systematic reviews. Those of you keen to look at the ‘PICO’s will find them in Appendix E here. Of course, you can see all of our ‘working’ if you look at the Full Guideline and the Appendices together. It’s a great deal of material, but then the research literature is vast, and you can check what we did if you want to: nothing is hidden (you can also look at our ‘declarations of interest’ in the Full guideline, so that you know about us.)
NICE guidelines are written by interpreting the best available research evidence. That’s a way of saying ‘we didn’t make it up – what we did is based on systematic reviews of the research evidence on this topic’. Interpreting systematic reviews is a way to make sound recommendations, minimising bias, reflecting the research evidence. (There’s an excellent article here from Cochrane Consumers – What is a systematic review?)
There are various NICE products at the end of a guideline process – I have highlighted some of them here (there are more! do look under the ‘Tools and resources’ tab, and also note the linked Quality Standard).
Not sure where to begin? I would read the Information for the Public first, and the key priorities for implementation. After that, play with the ‘Pathways’ (link circled in red), which are handy flowcharts of everything in the guideline, linked to other relevant guidance.
My personal view is that the three most important sections in the published guideline are those I have highlighted on the slide above – planning place of birth; electronic fetal monitoring (use of ‘CTG’ machines); and the new birth culture recommendations. But it is all important!
I’ll be blogging the various chapters of our 2014 ‘update’ work to help you find a way in (I hope!) if you are already familiar with the 2007 guideline, and needing to get up to date. Or you might be reading NICE guidance for the first time, whether a healthcare professional or a member of the public.
Don’t forget that one way to begin is to allow an hour, make a a cup of tea, and read the recommendations through online here. Don’t expect to take it all in – just get a sense of what the guideline is about, and how it all fits together.
Images inlcuded above courtesy of Kate Evans @cartoonkate, Royal College of Midwives & NICE. With thanks to Sarah Fishburn, NICE Fellow, lay member CG190 who made the CG190 ‘wordle.’ (Any missed acknowledgements, please get in touch via @BerksMaternity)