Evidence
Overview of 2019 surveillance methods
Overview of 2019 surveillance methods
NICE's surveillance team checked whether recommendations in excess winter deaths and illness and the health risks associated with cold homes (NICE guideline NG6) remain up to date.
The surveillance process consisted of:
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Feedback from topic experts via a questionnaire.
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A search for new or updated Cochrane reviews and national policy.
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Examining related NICE guidance and quality standards and NIHR signals.
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A search for ongoing research.
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Examining the NICE event tracker for relevant ongoing and published events.
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Literature searches to identify relevant evidence.
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Assessing the new evidence against current recommendations to determine whether or not to update sections of the guideline, or the whole guideline.
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Consulting on the proposal with stakeholders.
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Considering comments received during consultation and making any necessary changes to the proposal.
For further details about the process and the possible update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.
Evidence considered in surveillance
Search and selection strategy
We searched for new evidence related to the whole guideline.
We found 10 studies in a search for experimental studies, observational studies and systematic reviews relating to OECD countries, published between 23 September 2013 and 30 April 2019.
We also included:
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3 relevant reports (including policy documents) from a total of 4 identified by topic experts
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1 study identified through comments received after publication of the guideline
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3 UK studies that aimed to identify populations vulnerable to the consequences of cold temperatures and poorly heated or expensive to heat homes
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1 study that relates to UK policy
From all sources, we considered 15 studies to be relevant to the guideline.
See appendix A for details of all evidence considered, and references.
Ongoing research
We checked for relevant ongoing research; of the ongoing studies identified, 1 study was assessed as having the potential to change recommendations. Therefore, we plan to check the publication status regularly and evaluate the impact of the results on current recommendations as quickly as possible. The study is:
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A rapid evidence assessment commissioned by Department for Business, Energy & Industrial Strategy: Heat, energy efficiency, smart technology and health evidence review (expected winter 2019).
Intelligence gathered during surveillance
Views of topic experts
We considered the views of topic experts who were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to the guideline.
We sent questionnaires to 14 topic experts and received 6 responses.
The responses supported the current recommendations and agreed that they didn't need updating. Concerns were raised about issues with the implementation of the guideline and the challenges of engaging diverse local practitioners to address the activities outlined in the recommendations.
Views of stakeholders
Stakeholders are consulted on all surveillance reviews except if the whole guideline will be updated and replaced. Because this surveillance proposal was to not update the guideline, we consulted with stakeholders.
Comments were received from 5 stakeholders including; British Geriatrics Society, Dorset Council, National Energy Action, Public Health England (PHE) and the Royal College of Nursing. All 5 stakeholders agreed with the proposal to not update the guideline.
Following comments from topics experts, we asked stakeholders if they were aware of any local barriers and facilitators to implementing the NICE guideline. Helpful suggestions were received from 4 stakeholders and they were shared with the NICE system support for implementation team and PHE, to support implementation and support strategies for tackling excess winter deaths.
See appendix B for full details of stakeholders' comments and our responses.
See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.
Editorial amendments
During surveillance of the guideline, we identified the following points in the guideline that should be amended.
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Recommendation 3 refers to PHE's Cold weather plan for England 2014. The link is now outdated and will be amended to point to the main page of the plan. The year will also be removed as this report is usually updated annually.
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We will add a cross reference from recommendation 5 to the NICE guideline on flu vaccination: increasing uptake for further information about who is eligible for the free flu vaccination and increasing uptake among eligible groups in primary and secondary care.
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We will link to the implementation support resource, Health risks of cold homes : data sources to support local services tackling health risks of cold homes (Public Health England, January 2019), from the tools and resources tab of the current guideline.
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