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An independent Appraisal Committee then looks at the evaluation report, hears spoken testimony from clinical experts, patient groups and carers.

They take their testimony into account and draw up a document known as the 'appraisal consultation document'.

This is sent to all consultees and commentators who are then able to make further comments. Once these comments have been taken into account the final document is drawn up called the 'final appraisal determination'.

This is submitted to NICE for approval. The process aims to be fully independent of government and lobbying power, basing decisions fully on clinical and cost-effectiveness.

There have been concerns that lobbying by pharmaceutical companies to mobilise media attention and influence public opinion are attempts to influence the decision-making process.

NICE carries out assessments of the most appropriate treatment regimes for different diseases. This must take into account both desired medical outcomes i.

The National Collaborating Centre appoints a Guideline Development Group whose job it is to work on the development of the clinical guideline.

This group consists of medical professionals, representatives of patient and carer groups and technical experts. They work together to assess the evidence for the guideline topic e.

There are then two consultation periods in which stakeholder organisations are able to comment on the draft guideline.

After the second consultation period, an independent Guideline Review Panel reviews the guideline and stakeholder comments and ensures that these comments have been taken into account.

The Guideline Development Group then finalises the recommendations and the National Collaboration Centre produces the final guideline.

In October Andy Burnham said that a Labour government could reduce variation in access to drugs and procedures by making it mandatory for commissioners to follow NICE clinical guidelines.

Where they have said something is effective and affordable, on what basis does a local commissioner withhold that from somebody?

NICE has a service called Clinical Knowledge Summaries CKS which provides primary care practitioners with a readily accessible summary of the current evidence base and practical guidance.

Under the Health and Social Care Act , NICE was given responsibility for developing guidance and quality standards for social care , using an evidence-based model.

NICE, along with the NCCSC, carries out a scoping exercise with a scoping group and with input from key stakeholders, at both a workshop and a public consultation, to ensure the guidance to be produced is focused and achievable.

A chairperson and members of the Guidance Development Group are appointed, and pose review questions which will enable systematic evidence reviews to take place, thus delivering the guidance and subsequent recommendations.

Service user and carer involvement takes place throughout, as well as public consultation on the draft guidance. This is submitted to NICE for formal approval and publication.

The entire process from pre-scoping to publication takes approximately 24 months. The guidance is then available to NICE standing committees to develop a quality standard on the topic.

The quality standard is developed using the guidance and other accredited sources, to produce high-level concise statements that can be used for quality improvement by social care providers and commissioners, as well as setting out what service users and carers can expect of high quality social care services.

The NCCSC is unique within NICE, in that it is the only collaborating centre to have responsibility for the adoption and dissemination support for guidance and quality standards in the social care arena.

Drawing on the expertise of SCIE and their partners within the sector, each of the guidance products and quality standards have a needs assessment carried out to determine the requirements for tools to help embed the guidance and quality standards within the sector.

These can include tailored versions of guidance for specific audiences, costing and commissioning tools and even training and learning packages.

As of August , NICE and the NCCSC had scheduled guidance delivery for five topics: domiciliary care , older adults with long-term conditions, transition between health and social care settings, transition from children's to adults' services and child abuse and neglect.

As with any system financing health care, the NHS has a limited budget and a vast number of potential spending options.

Choices must be made as to how this limited budget is spent. Economic evaluations are carried out within a health technology assessment framework to compare the cost-effectiveness of alternative activities and to consider the opportunity cost associated with their decisions.

NICE attempts to assess the cost—effectiveness of potential expenditures within the NHS to assess whether or not they represent 'better value' for money than treatments that would be neglected if the expenditure took place.

It assesses the cost—effectiveness of new treatments by analysing the cost and benefit of the proposed treatment relative to the next best treatment that is currently in use.

NICE guidance supports the use of quality-adjusted life years QALY as the primary outcome for quantifying the expected health benefits associated with a given treatment regime.

When combined with the relative cost of treatment, this information can be used to estimate an incremental cost-effectiveness ratio ICER , which is considered in relation to NICE's threshold willingness-to-pay value.

Over the years, there has been great controversy as to what value this threshold should be set at. Initially, there was no fixed number.

Patients score their perceived quality of life on a scale from 0 to 1 with 0 being worst possible health and 1 being best possible health.

On the standard treatment, quality of life is rated with a score of 0. Patients on the new treatment on average live an extra 3 months, so 1.

The quality of life gained is the product of life span and quality rating with the new treatment less the same calculation for the old treatment, i.

If the patient was expected to live only one month extra and instead of three then NICE would issue a recommendation not to fund.

The patient's primary care trust [ needs update ] could still decide to fund the new treatment, but if not, the patient would then have two choices.

He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider.

If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment.

Theoretically, it might be possible to draw up a table of all possible treatments sorted by increasing the cost per quality-adjusted life year gained.

Those treatments with lowest cost per quality-adjusted life year gained would appear at the top of the table and deliver the most benefit per value spent and would be easiest to justify funding for.

Those where the delivered benefit is low and the cost is high would appear at the bottom of the list.

Decision makers would, theoretically, work down the table, adopting services that are the most cost effective. The point at which the NHS budget is exhausted would reveal the shadow price , the threshold lying between the CQG gained of the last service that is funded and that of the next most cost effective service that is not funded.

In practice this exercise is not done, but an assumed shadow price has been used by NICE for many years in its assessments to determine which treatments the NHS should and should not fund.

The threshold it employs is not based on empirical research and is not directly related to the NHS budget, nor is it at the same level as that used by primary care trusts PCTs in providing treatments not assessed by NICE, which tends to be lower.

Some witnesses, including patient organisations and pharmaceutical companies, thought NICE should be more generous in the cost per QALY threshold it uses, and should approve more products.

On the other hand, some PCTs struggle to implement NICE guidance at the current threshold and other witnesses argued that a lower level should be used.

However, there are many uncertainties about the thresholds used by PCTs. The work that NICE is involved in, attracts the attention of many groups, including doctors, the pharmaceutical industry, and patients.

NICE is often associated with controversy, because the requirement to make decisions at a national level, can conflict with what is or is believed to be in the best interests of an individual patient.

Approved cancer drugs and treatments such as radiotherapy and chemotherapy are funded by the NHS without any financial contribution being taken from the patient.

In the case of cancer the Cancer Drugs Fund was set up in after complaints about NICE decisions on new and expensive cancer drugs with limited benefits.

NICE has been criticised for being too slow to reach decisions. On one occasion, the Royal National Institute of Blind People said it was outraged over its delayed decision for further guidance regarding two drugs for macular degeneration that are already approved for use in the NHS.

However the Department of Health said that it had 'made it clear to PCTs that funding for treatments should not be withheld simply because guidance from NICE is unavailable'.

Some of the more controversial NICE decisions have concerned donepezil , galantamine , rivastigmine review and memantine for the treatment of Alzheimer's disease and bevacizumab , sorafenib , sunitinib and temsirolimus for renal cell carcinoma.

Sign in with Facebook Sign in options. Join Goodreads. Quotes tagged as "body" Showing of 1, Scott, Wicked Lovely. If at my convenience I might break them, what would be their worth?

I hate this commercialism. Enjoy the ride. I am the hurricane setting fire to the forests at night when no one else is alive or awake however you choose to see it and I live in my own flames sometimes burning too bright and too wild to make things last or handle myself or anyone else and so I run.

Hear that people? Social norms and stuff…what good are social norms, really? I think all they do is project a limited and harmful image of people.

It thus impedes a broader social acceptance of what someone, or a group of people, might actually be like. Science says: the body is a machine.

Advertising says: The body is a business. The Body says: I am a fiesta. As a tattoo is grounded on living skin, so its essence emotes a poignancy unique to the mortal human condition.

Love it. Love it hard. Yonder they do not love your flesh. They despise it. They don't love your eyes; they'd just as soon pick em out. No more do they love the skin on your back.

Yonder they flay it. And O my people they do not love your hands. Those they only use, tie, bind, chop off and leave empty.

Love your hands! Love them. Raise them up and kiss them. Touch others with them, pat them together, stroke them on your face 'cause they don't love that either.

You got to love it, you! And no, they ain't in love with your mouth. Yonder, out there, they will see it broken and break it again. What you say out of it they will not heed.

What you scream from it they do not hear. What you put into it to nourish your body they will snatch away and give you leavins instead.

No, they don't love your mouth. You got to love it. This is flesh I'm talking about here. Flesh that needs to be loved. Feet that need to rest and to dance; backs that need support; shoulders that need arms, strong arms I'm telling you.

And O my people, out yonder, hear me, they do not love your neck unnoosed and straight. So love your neck; put a hand on it, grace it, stroke it and hold it up.

The dark, dark liver--love it, love it and the beat and beating heart, love that too. More than eyes or feet. More than lungs that have yet to draw free air.

More than your life-holding womb and your life-giving private parts, hear me now, love your heart. For this is the prize. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside.

They learn to hide from their selves. Rowling, Harry Potter and the Deathly Hallows. They lived in ugly places where there were only ugly things to do.

They didn't own doodley-squat, so they couldn't improve their surroundings.

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HYO MIN [효민] - \ Nice body

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