NICE’s Advisory Committee on commissioning indicators rejects targets in psoriasis and eczema (October 2014)

The NICE Clinical Commissioning Outcomes Indicator Set Advisory Committee (CCG OIS) met on 30th September 2014 in Manchester. The APPGS secretariat attended this meeting and noted the following:

The committee discussed the potential development of indicators for atopic eczema in children and psoriasis. It was decided to reject all potential measures that had been brought forward.

The committee emphasised it would only recommend those indicators that would be suitable for both primary and secondary care, and would reject those that would tend to be primarily aimed at primary care. In assessing whether to put forward indicators for recommendation, the committee looked at how feasible it would be to measure new indicators with existing data or data that might be available in the next year.

The Health and Social Care Information Centre (HSCIC) were asked to look at the proposed indicators and assess the feasibility of obtaining data for those indicators. HSCIC pointed out small volumes affect the robustness of standardisation – the standard population is the GP registered patient population in England. It said that from experience a sample of less than 10,000 cases in a year in England would not produce a direct age standardised indicator. This would mean HSCIC would not be able to produce a robust and comparable CCG indicator, as it would not have sufficient data to do so.

Eczema

Committee members prioritised three measures and asked HSCIC to look at the feasibility of producing these indicators. The measures were:

  • AE2.2 Stepped approach to management
  • AE9.1 Atopic eczema in children: Referral rate to specialist services for children with persistent atopic eczema
  • AE10.1 Children’s and carers’ experience of eczema care

HSCIC did not consider them feasible, saying there was no data available from hospital episode statistic (HES) or GP data. With regards to the latter, HSCIC said indicator AE10.1 would need to be commissioned by NHS England as part of the patient experience survey.

The committee highlighted the fact that 90% of the cases are managed primarily within primary care, which raises questions on whether referrals to secondary care would make a good indicator to measure recurrence.

Another issue raised was the fact that for cases treated in A&E, most were recorded in coding systems as “dermatological condition”. This made it very difficult to obtain reliable data for an indicator.

Psoriasis

The committee did not recommending the creation of any indicators for psoriasis.

Members of the committee rated three potential measures, asking HSCIC to look at the feasibility of producing these indicators. Proposed measures were:

  • PSO5.1 Psoriasis: Assessment for psoriatic arthritis
  • PSO6.2 Skin Disease: time off school or work due to skin disease
  • PSO6,3 Psoriasis: skin clearance

The committee noted that the proposed indicators would be primarily treated at primary care and did not have much to do with CCG commissioning.

For PSO5.1 there was uncertainty over who carried out assessments. It was deemed unlikely that GPs were recording annual assessments for psoriatic arthritis.

With regards to PSO6.2 the committee decided this would be a good indicator of disease severity and response, but it would be difficult to measure, as currently absence from work or school was recorded in many settings as an “illness” i.e. not specific enough.

The committee made a recommendation for HSCIC to potentially look at an indicator that would record patient experience and access to secondary care. This would cover access times, access rates and waiting times, correlating with access to secondary care. It was decided not to take this forward at present.

How the NICE Committee Prioritises Indicators…

The NICE CCGOIS Advisory Committee ranks indicators according to their feasibility and perceived importance. In total, 13 indicators for psoriasis and 11 indicators for atopic eczema were put forward initially by NICE for consideration and feasibility testing by the HSCIC. Only three for each condition were deemed appropriate for discussion at the 30th September meeting.

Indicators are then ranked according to feasibility using a scale of 1-9. Generally those achieving a score of 7 or more are taken forward for piloting and eventual inclusion on the CCGOIS (if the Committee consents to their development).