1. NHS savings and NICE guidance: CSAS coordinated engagement with NICE Dr Mohit Sharma

3. Two PCTs randomly selected to be consultees to represent commissioners from the scoping stage to the appraisal determination

4. May be 30 other organisations involved

5. Appraisal committee meeting

6. Appraisal consultation document

7. Consultee PCTs

8. General public after 5 days (patients, public, clinicians and manufacturers)

10. As a result… Of the first 176 TAGs produced by NICE, no PCT input 7 PCT appeals against NICE guidance

11. Commissioning Support, Appraisals Service (CSAS) Service delivered by Solutions for Public Health (NHS Milton Keynes) Lead commissioner NHS Birmingham East and North Commissioned jointly by all English PCTs (152) Set up in July 2009, operational from September 2009

12. Rationale of CSAS Limited PCT capacity to release staff with the skills and expertise Infrequent involvement in the TAG process for an individual PCT Steep learning curve and tight timescales Random selection – selected PCT might not be the most the most appropriate for the topic

13. Aims of csas Service to enable PCTs to contribute to and influence NICE technology appraisal guidance Engagement and mentoring of consultee PCTs Training to help understand the NICE process Provide documents (evidence synthesis reports and critique of draft scopes) Enable PCT presence and contribution to NICE appraisal committees Support for appeals Develop a relationship with NICE

14. Appraisal consultation documents (ACD) These are released by NICE if the draft recommendation of the appraisal committee are likely to be ‘significantly restrictive’ Initially embargoed for 5 days (apart from consultee PCTs) 15 working days for all others to comment.

15. Commentary on ACDs Based on the evidence available and the defined scope of the topic Produced by CSAS and Bazian Provides a commissioner’s perspective Easy to read and digest Set out as required for the feedback form QA prior to dissemination Sent directly to all PCTs and disseminated through other routes (NPA, ADPH)

16. ACD commentaries to date

17. Results so far… Four ACD communications so far 2, 10, 14 and 13 responses …from 152 PCTs …but huge improvement on 0! Appreciative and constructive feedback from PCTs

18. The future NICE will survive the changes Commissioning organisations will continue to exist (though may have different forms) Pressures on the NHS to deliver savings will mount The issue of affordability will need to be considered though it is currently outside of NICE’s remit