Dear All
The Audit Commission has issued a national report on financial management and how it can affect of the implementation of guidance from the National Institute for Health and Clinical Excellence (NICE).
The report was produced in conjunction with NICE and concludes that greater implementation of NICE guidance will only be achieved if NHS bodies improve their financial management arrangements. 

The report provides a series of recommendations to NHS bodies and NICE, such as appropriate planning, costing, budgeting and monitoring processes to support the implementation of NICE guidance. 
The report can be viewed via
http://www.audit-commission.gov.uk/reports/NATIONAL-REPORT.asp?CategoryID=&ProdID=CC53DDFE-42C8-49c7-BB53-9F6485262718&fromREPORTSANDDATA=NATIONAL-REPORT&page=index.asp&area=hplink
Best wishes
David McDaid
LSE Health and Social Care

Press Release 8 September
A national report published today (8 September) by the Audit Commission concludes that greater implementation of NICE guidance will only be achieved if financial management improves. 
Hospitals and primary care trusts (PCTs) could bring greater fairness, better cost-effectiveness and clinical excellence to the NHS if they followed some straightforward steps, according to the report, Managing the Financial Implications of NICE Guidance. 
NICE attempts to increase levels of fairness and cost-effectiveness in the NHS by making recommendations to individual NHS bodies across the country about whether specific drugs or treatments, typically those with higher costs, should be used. 
There are particular weaknesses in relation to clinical guidelines, such as treatment for heart failure or diabetes. Many NHS bodies involved in the Commission's research perceived cost to be the major barrier to implementation. 
	James Strachan, Chairman of the Audit Commission, said: 
	'NICE plays a major role in ensuring high-quality patient care across the NHS which is both equitable and good value for the taxpayer. But NICE guidance is not being systematically implemented across the country. There will always be competing priorities for funding, but surprisingly our report shows that it is not actually cost which is the root of the problem. What would make all the difference, and is readily achievable, is improved financial planning and better communication between finance and clinical staff.' 
The report identifies a number of weaknesses in financial management arrangements that are hindering implementation, including: 
*	a lack of financial planning for the implementation of NICE guidance; 
*	insufficient communication between finance and clinical staff; 
*	the omission of NICE guidance costs in financial plans; and 
*	uncertainty about the implications of Payment by Results (PbR) for the funding of NICE guidance locally. 
Implementation rates would be improved if appropriate planning, costing, budgeting and monitoring processes were in place. Individual trusts and PCTs can take a series of simple steps to achieve this. 
Without such arrangements it is unlikely that NICE guidance will be systematically implemented and variations in quality of care across the NHS reduced. The introduction of the Healthcare Commission's Annual Health Check will require NHS bodies to declare whether they comply with the government's Standards for Better Health, which includes compliance with NICE guidance. Boards should not sign off that they comply with this standard unless they have in place the kind of arrangements that this report sets out.' 
NICE recently produced a number of cost templates to help with integration of its guidance at a local level, but the Audit Commission is concerned that awareness of the templates needs to improve and that improvement is required in financial planning, forecasting and budgeting for the implementation of the guidance. 
The Commission's report recommends that: 
*	NICE should raise awareness of its cost templates with NHS bodies; 
*	NHS bodies should know which NICE guidance is inside or outside the PbR tariff, and, where guidance is not covered by PbR, they should ensure that funds are available to implement guidance; 
*	NHS bodies should have in place clear organisational processes to support the implementation of NICE guidance, including close links between clinical and financial staff; 
*	PCTs and trusts should develop monitoring systems to ensure that NICE guidance is being implemented and that the treatments recommended by NICE and being paid for are indeed being provided; and 
*	NHS bodies should be aware of forthcoming guidance and assess draft guidance to determine the existing level of compliance and likely financial impact of implementation. 
	Andrea Sutcliffe, NICE Deputy Chief Executive, said: 
	'We welcome this report and the recommendations made by the Audit Commission to improve financial management in the implementation of NICE clinical guidance. The report demonstrates that good financial planning, joint clinical involvement and clear leadership will support the successful implementation of NICE clinical guidance, which is so important in improving the quality of care for patients. NICE already provides costing templates to support the NHS and is currently preparing a guide on how to implement NICE guidance successfully across the NHS, which also highlights the importance of good financial management.' 
The Commission's new report recognises that the implementation of the guidance is challenging and that local funding can be an issue, but it also contains examples of good practice, where trusts have successfully implemented and monitored NICE guidance.