National Advisory Body Research Articles

Navigating high-cost medicines: summary of the Guiding Principles for the governance of high-cost medicines in Australian hospitals.

High-cost medicines (HCMs) can be clinically impactful for individual patients but are also subject to variable funding mechanisms. Public hospitals and health services are often asked to fund HCMs, but inconsistent processes frequently create large variations in care. CATAG (Council of Australian Therapeutic Advisory Groups) is the Australian peak national advisory body for the quality use of medicines in hospitals and health services, with all states and territories collaborating to support Drug and Therapeutics Committees (DTCs). CATAG has developed national Guiding Principles to assist DTCs to effectively govern HCMs. An established process for the development of CATAG Guiding Principles was undertaken to develop these Guiding Principles. This includes the formation of an Expert Advisory Group (EAG) comprising individuals with recognised expertise, development of draft principles and stakeholder consultation from within the CATAG membership and externally. All feedback was discussed, and changes were agreed upon. The final version was approved by the EAG and CATAG members. This document represents a summary of the seven Guiding Principles developed, covering the areas of governance, application and assessment, communication, training and resourcing. Although many outstanding priorities still exist, including the development of national coordination regarding HCM assessment, these Guiding Principles offer a basis to navigate this complex area.

Battered by Geopolitical Winds, Bulgaria Struggles to Restart Much Needed Reforms

Battered by Geopolitical Winds, Bulgaria Struggles to Restart Much Needed Reforms

Preventing vitamin D deficiency during the COVID-19 pandemic: UK definitions of vitamin D sufficiency and recommended supplement dose are set too low

There is growing evidence linking vitamin D deficiency with risk of COVID-19. It is therefore distressing that there is major disagreement about the optimal serum level for 25-hydroxyvitamin D (25(OH)D) and appropriate supplement dose. The UK Scientific Advisory Committee for Nutrition has set the lowest level for defining sufficiency (10 ng/ml or 25 nmol/L) of any national advisory body or scientific society and consequently recommends supplementation with 10 micrograms (400 IU) per day. We have searched for published evidence to support this but not found it. There is considerable evidence to support the higher level for sufficiency (20 ng/ml or 50 nmol/L) recommended by the European Food Safety Authority and the American Institute of Medicine and hence greater supplementation (20 micrograms or 800 IU per day). Serum 25(OH)D concentrations in the UK typically fall by around 50% through winter. We believe that governments should urgently recommend supplementation with 20-25 micrograms (800-1,000 IU) per day.

Developing a National Patient Transfer Letter for use by both the Nursing Home (NH) & Acute Hospital (AH) Sectors

Background: This project was initially undertaken by the Department of Medicine for Older people in two Academic Teaching Hospitals in Dublin. It is led by two Clinical Nurse Specialists in Gerontology and is supported by geriatricians in both sites. It has recently gained the support of the Irish Hospice Foundation (IHF) Nursing Homes Ireland (NHI) and National Clinical Programme for Older People (NCPOP). Problem: Information sent from local nursing homes to the acute hospital Emergency Department often lacks the information required to provide safe quality care to the older person in an emergency situation. Hence, members of the interdisciplinary team spend inordinate amounts of time contacting these NH’s in order to obtain basic information that will support important care and treatment decisions in the acute setting for this complex, frail patient group. Information on medications, infection status, diet, cognition, functionality, advanced care planning are essential if we are to determine patient need. Assessment of problem and analysis of its causes: A prospective audit was carried out in 2011 to assess the problem outlined above in which 35 transfer letters from 29 different NHs were reviewed. A questionnaire was used to assess 24 aspects of information been received at the point of hospital entry. A template transfer letter was devised from the questionnaire to capture demographic information, baseline medical information, physical information and the cognitive status of the patient being transferred to hospital from each NH. The template was sent at the end of the audit period to all Directors of Nursing in each NH. All were requested to send feedback on the template so it could be modified for phase 2 of the project. Intervention: As a result of the consultative process a new transfer document was developed. Support from the national advisory body Nursing Homes Ireland (NHI) was ascertained. In order to enhance accessibility and promote usage, the document was made available on both hospital websites and a care planning database ‘Epicare’ which is used by 60% of NH’s nationally. Strategy for change: From the outset of the project in 2011, we consulted with Directors of Care from NH’s through NHI; in order to ascertain that: 1) the proposed content of the Transfer letter was appropriate and, 2) that updates on the transfer document were communicated to reflect national standards / guidance. Measurement of improvement: Continuous audit cycles (4) and on-going consultation with NH’s; allowed us measure improvements in the quality of transfer information. In 2015, 62% of NH were using the standardised template document (n=37) a decrease from 73% in 2012. However, baseline demographic & medical information was well documented, as were Functional Scores (90-100%). Other Results show improvements & areas for concern Effects of changes: Improvements in transfer communication meant clinicians in Acute Hospitals (AH)’s and NH’s spent less time looking for information deemed vital to patient care. One of the challenges was that NH’s wanted more information on the document at each stage of the consultation process. Its’ success as a single page document at local level allowed the document to trialled at regional level with funding support from the IHF. 189 NH’s were contacted and 83% (81 replies) used the document and reported it to be useful and comprehensive. Lessons learnt: The document is currently undergoing an integrated consultation process between both the NH & AH Sectors for National application with the support of NCPOP. Other stakeholders challenge its single page status and its’ scope has been be broadened to include other areas of the residential care sector. Quality of transfer information from AH to NH will need to be considered following this phase as requested by NH’s. Messages for others: A single page document with key information that represents patient need is vital during transitions of care. It helps reduce incidences of missed care through the provision of appropriate information between healthcare stakeholders. Consultation with Directors of Care or Clinicians from both NH & AH respectively is essential on behalf of NH patients to ensure that the information been transferred is satisfactory and that patient need is been met through appropriate transfer of information when developing or using a standardised template.

Building the Next Bioethics Commission.

At every moment, somewhere in the world, a group of men and women are sitting around a table deliberating about an ethical issue posed by medicine and research, whether as a research ethics committee; a hospital or clinical ethics committee; a stem‐cell review committee; a gene transfer research committee; a biobank ethics committee; an ethics advisory committee for a medical or nursing association or nongovernmental organization; a state, provincial, national, or intergovernmental bioethics committee; or an ad hoc panel examining a particular development or case. However, the last national committee in the United States, the Presidential Commission for the Study of Bioethical Issues, held its final meeting at the end of August 2016 and closed its doors. Should we regret its departure? I believe that the United States would benefit from having another national bioethics advisory body, but I do not think that the commission should simply have continued under a new president in the same form. Instead, looking at the experience of that commission and its six predecessors—who they were, how they worked, the functions they served, and the problems they experienced—we can derive some useful ideas for anyone planning to build the next commission.

Implementation of the HbA1c IFCC unit — from the laboratory to the consumer: The New Zealand experience

In 2007, an international consensus statement recommended that HbA1c results should be reported world-wide in IFCC units (mmol/mol) and also the more familiar derived percentage units using a master equation. In New Zealand, the HbA1c IFCC units have been successfully implemented and used exclusively since 3rd October 2011 (following a 2year period of reporting both units) for both patient monitoring and the diagnosis of diabetes, with a diagnostic cut-off of ≥50mmol/mol.The consultation process in New Zealand dates back to 2003, well before the international recommendations were made. It reflects the close cooperation between the clinical and laboratory communities in New Zealand, particularly through the agency of the New Zealand Society for the Study of Diabetes (NZSSD), a key organisation in New Zealand open to all those involved in the care of people with diabetes and the national advisory body on scientific and clinical diabetes care and standards.There was a phased process of consultation designed to increase familiarity and comfort with the new units and the final step was coupled with the adoption of HbA1c as a diagnostic test with some evidence-based pragmatism around using the rounded cut-off.Genuine clinical engagement is vital in such a process.

Health technology assessments on human papillomavirus vaccinations in Europe: a survey from VENICE network

Background: VEnIcE II is a project funded in 2008 by the European centre for disease Preventionand control to collect information on the national vaccination programmes, to increase their knowledgeand to know the impact of new vaccines introduced in member states (MS). In 2006-2007, two vaccinesagainst human papillomavirus (HPV) were authorized in Europe.MEtHodS: an online survey was carried out to investigate the decision-making process undertakenregarding the potential introduction of the HPV vaccinations into MS national immunization pro-grammes as well as to investigate the modalities of implementation of the vaccination programmes.there were specific questions about health technology assessment and reports of the countries that hadcarried them out were reviewed.rESultS: In 21 of the 29 MS, the national advisory body recommended to introduce HPV vaccination intheir national immunization schedule and in 18 countries introduced it. only 6 countries have realizeda health technology assessments (Hta) report, each one with different methodology, but in all of themboth vaccines show positive evaluations.concluSIon: From the available Hta, HPV vaccination is cost-effective under the assumption of a life-long protection. Screening programme for cervical cancer and HPV vaccination programme should bealways complementary. organizational aspects need to be taken into account to improve the vaccina-tion. HPV vaccination should target girls before the debut of their sexual life. Instead HPV vaccinationof boys has not been demonstrated as bringing significant epidemiological benefits and has not beenshown as being cost-effective.

Sustaining GAVI-supported vaccine introductions in resource-poor countries

Since 2000, GAVI provided essential support for an unprecedented increase in the use of hepatitis B (HepB) and Haemophilus influenzae (Hib) containing vaccines in resource poor countries. This increase was supported with significant funding from international donors, intended to be time-limited. To assess the sustainability of this important expansion of the global access to vaccines, we reviewed supply chains, financial resources for procurement and decision-making in countries that introduced hepatitis B or Hib vaccines with GAVI support. During the period studied, the types of vaccine products supplied fluctuated rapidly in relationship with the number of suppliers and availability of more combination products. The price of the cheaper vaccines decreased while that of pentavalent DTwP-HepB-Hib remained stable. In average, vaccine introduction was associated with an increase of national programs budget, with new vaccines representing more than half of that increase, while the part of GAVI contributions to the budget went from 25% to 46%. Less than 20% of the vaccine introductions were decided by a national advisory body. Strengthening supply chains, adjusting funding schemes and increasing national ownership will be key to the sustained use of hepatitis B and Hib vaccines and the eventual addition of other important vaccines where they are the most needed.

Managing the intractable: Communicative structures for management of hexachlorobenzene and other scheduled wastes

This paper explores issues of governance and decision-making structures associated with the problem of hexachlorobenzene (HCB) waste at Botany in New South Wales. From a government perspective, the problem is ‘downstream’ of a well-known national controversy over whether Australia should have a high-temperature incinerator (HTI) to ‘dispose’ of such scheduled wastes. The 1992 decision not to proceed with HTI followed an extensive process of public consultation, which, against the expectations of industry and government, saw the emergence of Australia-wide community opposition. Alternative national management plans were formulated for the treatment of several types of organochlorine waste, with the scheme of these plans first approved in 1993 by the Australian and New Zealand Environment and Conservation Council (ANZECC). The HCB Management Plan is one of three such plans (the others being for PCBs and organochlorine pesticides). With this, ANZECC established the Scheduled Waste Management Group comprising government officials, and the National Advisory Body (NAB) made up of stakeholders. Officially the NAB had oversight of the HCB problem until 2002 when it was disbanded. As a result of the HTI experience, new community consultation protocols were introduced in association with the alternative management plans. For HCBs, which are confined almost entirely to Orica's Botany site in southeastern Sydney, this led to the establishment of the Community Participation and Review Committee (CPRC), a representative body with review and advisory functions. This paper draws conclusions from this history about government processes of decision making, the role of individual and institutional actors, the central importance of trust, and the democratisation of risk management. Using concepts delineated by McDonell [1991. Toxic waste management in Australia: why did policy reform fail? Environment 33(6), 11–13, 33–39; 1997. Scientific and everyday knowledge: trust and the politics of environmental initiatives. Social Studies of Science 27, 819–863.] we identify swings towards, then away from institutionalised trust. Across two decades, government and industry have placed faith in centrally controlled mechanisms for public participation, hoping to garner trust and legitimate privileged technological solutions. On the ‘backswings’, these processes have seen public trust dissipate in the face of government misunderstanding of the opportunities for effective bureaucratic interventions.

Demand for human allograft tissue in Canada

There is relatively little known about the demand for allograft tissues in Canada. The Canadian Council for Donation and Transplantation (CCDT) is a national advisory body that undertook a comprehensive "market survey" to estimate surgical demand for human allograft tissues in Canada. The report "Demand for Human Allograft Tissue in Canada" reflects survey results sent to 5 prominent User Groups. User Groups were identified as orthopaedic surgeons; neurosurgeons; corneal transplant surgeons; plastic surgeons, specifically those at Canadian Burn Units; and cardiac surgeons (adult and paediatric surgery). The demand for allograft grafts was determined and then extrapolated across the total User Group and then increases in allograft tissue use over the next 1-2 years across User Groups were predicted. The overall response rate for the survey was 21.4%. It varied from a low of 19.6% for the orthopaedic survey to a high of 40.5% for the corneal survey. The estimated current demand for allograft tissue in Canada ranges from a low of 34,442 grafts per year to a high of 62,098 grafts per year. The predicted increase in use of allograft tissue over the next 1-2 year period would suggest that annual demand could rise to somewhere in the range of 42,589-72,210 grafts. The highest rated preferences (98% and 94%) were for accredited and Canadian tissue banks, respectively. This study represents a key step in addressing the paucity of information concerning the demand for allograft tissue in Canada.

Advisers to the nation

Health care leaders and researchers have united to create Canada's first national health advisory body. Modelled on the US Institute of Medicine, the Canadian Academy of Health Sciences (CAHS) will advise policy-makers, the public and public- and private-sector leaders. “Other countries have

The use of expert systems for decision support in manufacturing

Recent years have seen major changes within the manufacturing industry in the United Kingdom. The decline of traditional industries coupled with increased competition from abroad and the challenge presented by the removal of European tariff barriers in have all contributed to a greater awareness of the need for efficiency and flexibility within the United Kingdom manufacturing community. To help meet this challenge, a research initiative to develop the use of expert systems for decision support in manufacturing has been established at Sunderland Polytechnic in Northeast England. The project is a five-year cooperative study between U.K. manufacturing companies and the Polytechnic and is supported by funds from the National Advisory Body. At the end of the third year of the study (June 1990), 20 companies are cooperating in the project with a total of 15 research projects being supported. This article discusses the overall aims, objectives, and strategies behind the research project and presents an overview of some of the important elements of the project.

Development of a management information system at South Bank Polytechnic

Even before the Education Reform Act of 1988, the impetus towards a new era of better and more accountable management in the higher education sector had already begun. The National Advisory Body for local authority higher education had launched its study of ‘good management practice’ the University Grants Committee had made its first move towards selectivity in research funding; and the committee chaired by Sir Alex Jarrett had reported on efficiency and good management in the university sector.

Competitive Tendering in Higher Education?

This is the first in a series of three linked articles describing the major changes which are taking place in English public‐sector higher education as a result of the Education Reform Act 1988 and the replacement of the former National Advisory Body by the Polytechnics and Colleges Funding Council. Colleges in the sector are now free‐standing corporations, with new governing bodies heavily dominated by business interests. Government policy is to increase efficiency and value for money in the sector and thus to expand student numbers without a proportionate increase in costs. This article traces the first major acts of the new PCFC, especially the introduction of a new funding system, part of which brings competitive tendering into the state education system for the first time. The new system has posed significant new challenges to college management and could well be extended to schools and further education.

The Privatisation of British Higher Education

The publication of the British government's official White Paper, Higher Education: Meeting the Challenge, in April 1987 (DES, 1987a) pointed to a forthcoming major restructuring of the relationship between the state and higher education. The White Paper made numerous proposals, but the most significant were that the University Grants Committee (UGC) should be replaced by a University Funding Council, and the far newer National Advisory Body for Public Sector Higher Education (NAB) be replaced by a similar Polytechnics and Colleges Funding Council. In both cases this change of nomenclature indicates the increased involvement of industrialists and other non-academics in higher education planning, and changes in the extent and method of government support. Under the proposed schemes, the block grants to the higher education institutions will be abolished and replaced by multiple contractual agreements between individual institutions and the relevant Council for both teaching and research. The intention is that accountability for the use of public funds will thus be sharpened, and that the institutions become more efficient through competition for contracts in an open market. The institutions will also be encouraged to seek contracts from other sources and thus reduce their present dependence on public funding. The proposals in the White Paper signal dramatic changes in higher education. However, this watershed for higher education is part of a major restructuring of the whole of the British education system, which is to be initiated through the very wideranging 1987 Education Reform Bill, currently working its way through parliament (DES, 1987g). The details of the Bill are at present open to parliamentary amendment, but the huge majority which the present Conservative government enjoys will ensure that the main thrust of the resulting 1988 Education Act will remain much as is now intended. At the school level, the Act aims to give greater choice of schools to parents of pupils in maintained schools it will establish a core curriculum to be followed by all maintained schools, with regular testing of all pupils according to expected national standards of achievement at four separate ages; it will allow schools to make charges for some non-compulsory 'extras'; it will give far greater financial delegation to individual schools and greater powers to governing bodies; it will pave the way for the dismantling of the Inner London Education Authority; and, in what is the most dramatic change, will allow the possibility of individual schools opting out of local education authority ownership and control to become one of a new group of directly government funded, semi-independent, grant-maintained schools, run by charitable trusts. This article concentrates on the plans for higher education, but it is argued that

The National Advisory Body Planning Exercise 1987–88: A Shot in the Foot

AbstractThe National Advisory Body was established to advise the Secretary of State for Education and Science on the allocation of money to support advanced work in polytechnics and colleges. The committee system of NAB was representative of local authority and college interests and there was always a tension between NAB and the Department of Education and Science. The paper charts the decisions that were taken by NAB in progressing the 1987–88 planning exercise. The policy context of these decisions is analysed and the political consequences are discussed. The paper argues that the 1987–88 exercise was the wrong approach to the planning problems and that the resulting conflict with the Government destroyed the credibility of NAB.

Central Government and Higher Education Planning 1965–1986

Abstract The development of a planning body for public sector higher education in England has created the potentiality for an integrated planning approach to university and non‐university higher education. Following a difficult birth, the National Advisory Body has worked with the University Grants Committee on a range of transbinary issues. The contrasting relationships between the Department of Education and Science and the two planning bodies is discussed and the need for further developments of the planning machinery debated. The arrangements for Wales and Scotland are also discussed.

Rationality and Policy-Making in Higher Education: The Case of the National Advisory Body

There is now a substantial literature on the concept of rational decisionmaking and a number of studies concerned with the application of rationality to particular cases and areas. The basis of the rational model of policy-making is that it involves the selection of alternatives which lead to the achievement of previously designated goals, and that the process is characterised by search and evaluation. H. A. Simon’s classic work (Simon, 1957) focused attention on the goal-oriented nature of organisational behaviour, while Allison, approaching the concept from the analysis of foreign policy, chose the rational as one of his three models, drawing attention to a lengthy tradition, based on national interests, upon which such an approach rests (Allison, 1971). Others have developed the study of ‘policy science’ based on ‘a main effort to reassert the role of intellectualism and rationalism in guiding human destiny’ (Dror, 1971), or have offered advice on a range of techniques or strategies which might improve the objective rationality of public policy (Wildavsky, 1966; Garrett, 1972). Heclo, in a seminal review article, categorised a programmatic approach which seeks to ‘identify policy with a set of programme choices, among which is sought the most efficient means of employing scarce resources’ (Heclo, 1972).

Higher Education, the State and the Economy: Anglo‐German variations on some topical themes

Problems in education have a habit of becoming crises. Walter Moberly published The Crisis in the University in 1949; Peter Scott gave us The Crisis of the University in 1984. Cynics might observe that in 35 years it is the preposition and not the proposition that has changed. Christopher Ball speaks in his opening paper in this special issue of the Oxford Review of Education of a broad crisis created by the failure of a triple alliance between the world of employment, the government and the education service in the United Kingdom. John Ashworth concludes his contribution by indicting the complacency in higher education which encourages each to guard his corner until the winds of change dissipate. W. D. Halls in his paper believes that the controversy about the function of the university has never been so acute. Never in the United Kingdom have the universities been under such threat from central government. Professor A. H. Halsey, in his 1984 Charles Carter lecture [1], warns of a future polarised society in which education becomes the main polariser. In the Federal Republic of Germany there has also been crisis. From the blackest 12 years of their long history the German universities emerged to face bravely the challenge of reconstruction and reintegration into the Western tradition in which they had previously played a leading role. Nearly 20 years of stability in education followed, until there was talk of 'catastrophe' with the publication of Georg Picht's Die deutsche Bildungskatastrophe in 1964. There followed the student troubles of 1967/8 when there were fears for the political and social stability of the nation. And now the crisis, as in the UK, is one of numbers and economics: how can a nation of 61 million continue to sustain a student population of 1.3 million? How can the Massenuniversitat continue to provide a university education which does not neglect the needs of individual students? Oxford provided the setting for the third in a series [2] of Anglo-German symposia in which current manifestations of the crisis in higher education in the two countries could be discussed. The present writers were jointly responsible for the organisation and some 35 educationists and other experts convened at Brasenose College from 19 to 22 March 1985 [3]. Included among them were, on the British side, the Chairman of the Board of the National Advisory Body for Public Sector Higher Education in England (the NAB), Mr Christopher Ball (Warden of Keble College, Oxford); the Vice-Chancellor of the University of Salford, Professor John Ashworth; and Professor A. H. Halsey, Director of the Department of Social and

The National Advisory Body ‐‐ The Polytechnic Administrator's Viewpoint of a Major British Development

The National Advisory Body ‐‐ The Polytechnic Administrator's Viewpoint of a Major British Development