Concerns around the evaluation methodology used by NICE were articulated in a report published by the Health Select Committee in its inquiry into NICE in 2007. The report's authors, led by Professor Michael Barkham, used this basis for a panel at our first conference with NICE's then Chair, Sir Mike Rawlins.
Although it is now recognized that over-reliance on RCT evidence will impair and distort guideline recommendations for psychological therapies NICE has not yet been able to find a way to synthesize other kinds of evidence of effectiveness. During 2011 we returned to this issue to agree a starting point for NICE to review its approach. A group of academics and experts issued a further report that enabled us to develop a consensus statement on evidence. We were also pleased to note that the American Psychological Association undertook a similar exercise in 2012 and has published its own consensus statement on evidence.
Evidence-based policy making across government has been given new impetus with the creation of What Works centers. This work is being advanced through new partnerships between academics, research institutions and Public Health England’s Mental Health Intelligence Network. We welcome researchers, policy makers, evaluation methodologists and others who support our Consensus Statement. If you would like to join our network see the signatory form below,
Jeremy Clarke CBE
Founding Chair, New Savoy Partnership
Consensus statement on the need for further research and methodological innovation to support the use of an increased range of evidence based psychological interventions in the development of NICE guidelines on psychological therapies
NICE guidelines have provided the evidence base for a major expansion in the provision of psychological therapies by the NHS. NICE is well regarded for its use of robust methods to evaluate the best available evidence. Concerns have been raised, however, about whether the range and balance of evidence considered and treatments currently recommended is too restrictive. On 29 September 2011 a group of experts met to discuss the need for further research and methodological innovation to support the use of an increased range of evidence based psychological interventions in the development of NICE guidelines on psychological therapies. A starting point for discussion was agreement that the evaluation of the effectiveness of psychological therapies by NICE must continue to be based on the best available scientific methods which demonstrate an open, fair, robust, and rigorous use of the best available research evidence.
The following priorities were agreed upon:
1. We call on Government, clinicians, academics and research funding bodies to work together to support investment in high quality research on psychological therapies. This would include encouraging funding bodies to invest in:
- Recommended areas for future research to address gaps in the evidence base through the use of well-conducted randomised clinical trials of both novel and under-researched psychological therapies to establish their efficacy (as identified in NICE guidance and by other stakeholders such as the NHS, professional bodies and patient organisations)
- Identifying innovative methods for analysing evidence from a range of studies including, for example, from high quality cohort studies, to consider in conjunction with the evidence obtained from efficacy studies
2. We will support and encourage professionals and patients to collect and report on routine outcomes so that:
- Professionals and patients have an opportunity to consider the effectiveness of a course of treatment in a collaborative manner as it is unfolding
- Patients can reflect on their own outcomes and help enable future patients to access therapies that have been most useful
- Professionals can ensure improved value for money for NHS services and help enable future patients to access therapies that have been most useful
3. We urge NICE to make best use of the new evidence that will emerge from this work to support:
- Patients in making informed choices on evidence based psychological therapies.
- Clinical commissioning groups in making intelligent decisions on commissioning an appropriate range of evidence based psychological therapies for their patients
- Providers in making well informed judgements on what evidence based psychological therapies to offer
Our intention is to build a wider consensus amongst academics, clinicians, professional bodies and mental health charities and others, and to use the agreed priorities and principles above as the starting point for undertaking work collaboratively to achieve further progress.
- Jeremy Clarke
Chair New Savoy Partnership
- Nancy Cartwright FBA, Professor of Philosophy LSE
- Sophie Corlett, Director External Relations, Mind
- Angela Coulter, Director of Global Initiatives, The Foundation for Informed Medical Decision Making
- Val Huet, Chief Executive Officer, British Association of Art Therapists
- Michael King, UCL
- Dr Sue Mizen, Medical Psychotherapist & Deputy Chair, Faculty of Psychotherapy, Royal College of Psychiatrists
- Nancy Rowland, Director of Research, Policy and Professional Practice, British Association for Counselling and Psychotherapy
- Professor Peter Stratton, Chair, UKCP Research Faculty
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