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    Equality and Health Inequality Assessment template for methods and process changes

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    7 Impact and mitigation

    Impact and mitigation for protected characteristics or wider determinants of health

    Protected characteristic or wider determinant of health

    Impact

    Mitigation

    Age

    • NICE guidelines do not cover all clinical areas and conditions. Inclusion of TA (Technology Appraisal) guidance into a NICE guideline aims to increase adoption of technologies in the NHS. Some populations may be indirectly disadvantaged because they are not covered within a NICE guideline.

    • Implementation of the severity modifier in CHTE (Centre for Health Technology Evaluation) raised concerns as to whether there would be limited scenarios in which older populations could qualify for the modifier. Similar concerns could be raised again where this is considered as part of integration. However, initial exploration of this issue in the TAs which have a severity modifier applies suggests that there is no unfairness on the basis of age for the design of the severity modifier.

    • NICE have mapped all Technology Appraisal Guidance to relevant NICE guidelines. No evidence for systematic bias on the basis of age for topics not covered by a NICE guideline have been identified. Mitigating against this occurring in the future could include appropriate links to surveillance (system intelligence/monitoring) and prioritisation activities within NICE. Prioritisation will consider updates or expansion of existing NICE guidelines or commissioning a new guideline where this will add value to the NHS.

    • NICE will continue to monitor the implementation of the severity modifier in the Technology Appraisal programme. Where applicable NICE will also monitor the application of severity modifiers within NICE guidelines.

    Disability

    Disabled people are likely to be the largest group affected by the approach to integrating NICE technology appraisal recommendations into NICE guidelines. Under the Equality Act 2010, disabilities include progressive conditions such as cancer, multiple sclerosis or HIV, NICE is aware that most conditions considered by the Technology Appraisal programme relate to some form of disability. Incorporating and integrating TAs in treatment pathways within guidelines will support uptake of clinically and cost-effective treatment options.

    See 'comments across all equality strands' below

    Race or ethnicity

    None identified

    N/A

    Gender reassignment

    None identified

    N/A

    Marriage and civil partnership

    None identified

    N/A

    Pregnancy and maternity

    None identified

    N/A

    Religion and belief

    None identified

    N/A

    Sex

    None identified

    N/A

    Sexual orientation

    None identified

    N/A

    Socioeconomic status

    None identified

    N/A

    Inclusion health and vulnerable groups

    None identified

    N/A

    Comments across all equality strands

    For all groups, incorporating treatments specified in NICE technology appraisals within treatment pathways in NICE guidelines is expected to support more rapid uptake of new treatment options.

    When a treatment specified in a technology appraisal is integrated within a guideline there is the potential for access to that treatment to be reduced or removed, depending on the findings of the analysis when the treatment is compared with other treatment options. This may not constitute a negative impact since the intention of the analysis is to identify the most clinically and cost-effective treatments that should be offered to patients. However, there is at least the potential for people to be offered treatments that are not as clinically effective but ultimately more cost effective.

    Conversely, by making recommendations about the most cost-effective treatments that should be offered, this should reduce the prescribing of treatments that are no longer cost effective and so increase the availability of and access to more clinically and cost-effective treatments for patients.

    By aligning methods across the Centre for Health Technology Evaluation and the Centre for Guidelines, this should support consistency in decision-making between Centres within NICE.

    When considering all treatment options through an integration approach, it is proposed that NICE guidelines will look to include treatment hierarchies where possible to ensure that all treatment options could still be offered. The only instances in which the funding requirement will be removed, and the treatment not offered will be when it is found to be not clinically or cost effective for any population or sub-population.

    The NICE guideline development process itself is subject to an equality and health inequalities assessment process and so specific equalities issues will be considered for every NICE guideline into which NICE technology appraisal recommendations are integrated. The Technology Appraisal evaluations themselves will also have been subject to equality impact assessment, and these will be considered during integration, further supporting consistency in decisions across NICE.

    Equality considerations raised during the original TA guidance or in the guideline development process will be taken into account when deciding when and to whom particular treatments should be offered.