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NICE publishes new quality standards for lung cancer and hip fracture
Each year sees more than 40,000 new cases of lung cancer diagnosed in the UK, and there are 35,000 deaths from the disease each year, more than breast cancer and colorectal cancer combined. It is the second most common cancer in men and women, and the leading cause of cancer death in men and womeni. Its prognosis is poor; 5 year survival rates in England are 5.2% for men and 7.5% for womenii. There is evidence that outcomes vary within the UK, which may be explained by variations in the standard of care.
There are around 70-75,000 hip fractures each year in the UK, with figures expected to rise as a result of the ageing population. Although more common in later life, they can happen at any age. Outcomes for patients with broken hips can be poor, with one in three dying within 12 months. Most of these deaths are not due to the fracture itself, but are an indication of the high prevalence of pre-existing illnesses in such patients. Hip fractures cost medical and social care an estimated £2 billion every year to treatiii.
The new quality standard for lung cancer consists of 15 quality statements that describe high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with lung cancer. These include ensuring people are made aware of the symptoms and signs of lung cancer through local coordinated public awareness campaigns that result in early presentation and that people presenting with one or more symptoms suggesting lung cancer are referred within 1 week of presentation for a chest X-ray or directly to a chest physician who is a core member of the lung cancer multi-disciplinary team. It also states that people with known or suspected lung cancer should have access to a named lung cancer clinical nurse specialist who they can contact between scheduled hospital visits.
The new quality standard for hip fracture includes 14 quality statements which encompass the whole hip fracture pathway. It states that people with hip fracture should have their surgery performed on the day of, or the day after, admission. People with hip fracture should also be offered a physiotherapist assessment the day after surgery and mobilisation at least once a day unless medically or surgically contraindicated. The standard also states that people with hip fracture be offered a multifactorial risk assessment to identify and address the risk of future falls, and provide individualised intervention as appropriate.
Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Lung cancer is the leading cause of death from cancer in the UK and despite major advances in treatment over the past ten years or so, there is still evidence of variations in the standard of care patients receive. This quality standard clearly sets out what healthcare professionals should do and what patients should expect from them. NICE is today also publishing a new quality standard on hip fractures. Affecting around 75,000 people each year, they are more common than people might expect. Because of the ageing population and the expected rising numbers of people experiencing such fractures, it is important that there are clear standards in place that can aid healthcare professionals in the treatment and care of those affected.”
Professor Mike Morgan, Chair of the British Thoracic Society, said:“The British Thoracic Society is pleased to endorse the NICE quality standard for lung cancer. The burden of disease and mortality levels remains unacceptably high within the UK, which has poor outcomes when compared with equivalent healthcare systems in Europe, Australia and Canada. These quality standards should provide the basis for improving the standard of care and ironing out the high levels of variation of provision.”
Professor Audrey Paterson, Director of Professional Policy at the Society and College of Radiographers said: “We welcome this quality standard and are confident that it will improve the care patients receive when they fracture a hip. Although imaging is not addressed in the standard, almost all patients that experience a hip fracture will meet a radiographer during their care pathway, often more than once. We are pleased, therefore, to support this standard and know that it will aid radiographers in delivering excellent care to this group of patients.”
The new quality standards are available on the NICE website from 9:00am on Friday 30 March at: http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp
Cancer Research UK (2011), lung cancer UK incidence statistics, available at: http://www.cancerresearchuk.org
Office for National Statistics – Cancer survival by cancer network, patients diagnosed in 1996-2009, followed up to 2010, available at: http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-241176
British Orthopaedic Association (2007), the care of patients with fragility fractures. (Guideline Ref ID: BOA2007), available at: http://www.bgs.org.uk/index.php?option=com_content&view=article&id=338;bluebookfragilityfracture&catid=47;fallsandbones&Itemid=307
About the quality standards
1. The new quality standards are available on the NICE website from 9.00am on Friday 30 March at: http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp
2. NICE quality standards (QS) are a set of specific, concise statements and measures that act as markers of high-quality, clinical and cost-effective patient care. They apply nationally in health and social care, and are developed from the very best available evidence, such as NICE guidance or other NHS Evidence-accredited sources. Quality standards are produced with the NHS and social care, along with their partners, service users and carers. They are a pivotal part of the new NHS Outcomes Framework, an overview of aims and objectives in improving patient outcomes in the NHS.
3. There is more information on NICE quality standards at: http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp
4. Quality standard topics are referred to NICE by ministers on the advice of the National Quality Board, a group of representatives from health and social care, committed to improving quality in the NHS and overseeing the reforms aimed at improving care. Further information on the National Quality Board can be found at: http://www.dh.gov.uk/en/Healthcare/NationalQualityBoard/index.htm
5. The British Thoracic Society is an endorsing organisation for the quality standard on lung cancer. It is a professional membership organisation. It has 2,800 members, who work in respiratory medicine, related health care professions and respiratory care. A registered charity, its primary objective is to raise standards of care for people who have respiratory disease. Its guideline production process has been accredited by NHS Evidence. Further details can be found at: http://www.brit-thoracic.org.uk
6. The Society and College of Radiographers is an endorsing organisation for the quality standard on hip fracture. Further details can be found at: http://www.sor.org/
1. The NICE clinical guideline (CG124) on hip fracture: the management of hip fracture in adults is available at: http://publications.nice.org.uk/hip-fracture-cg124
2. The NICE clinical guideline (CG121) on lung cancer: the diagnosis and treatment of lung cancer is available at: http://publications.nice.org.uk/lung-cancer-cg121
1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies – guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
3. NICE produces standards for patient care:
quality standards – these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
Quality and Outcomes Framework – NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.
4. NICEprovides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
National Institute for Health and Clinical Excellence (NICE), 30.03.2012 (tB).