National Institiue for Health and Clinical Excellence

Annual Review - 2012/2013
clinical guidelines

Ensuring high-quality, evidence-based healthcare

Our clinical guidelines provide recommendations to the NHS on the treatment and care of people with specific diseases and conditions.

Clinical guidelines are based on the best available evidence, and aim to help health professionals in their work, help patients make informed decisions about their care, and improve communication between patients and healthcare professionals.

So far we have published 158 clinical guidelines. This year we produced 19 clinical guidelines, covering a range of topics including:

  • Autism in adults, and children and young people
  • Acute upper GI bleeding
  • Headaches
  • Spasticity in children and young people
  • Opioids in palliative care
  • Psoriasis
  • Ectopic pregnancy

This year, we updated the manual for producing clinical guidelines following public consultation, and produced a summary for the new processes used for developing clinical guidelines, which take place from November 2012 onwards.

In October 2012, following an article published in the BMJ, NICE confirmed that it would be working on ways of ensuring NICE guidelines take into account multimorbidities.

Most people with any chronic condition have multiple conditions, and although the degree of multimorbidity increases with age, this applies to younger patients as well

The researchers warned that clinical decision making is more difficult in people with multimorbidity because clinicians and patients often struggle to balance the benefits and risks of multiple recommended treatments.

Dr Phil Alderson, Associate Director for the team at NICE responsible for guidlelines and one of the authors of the paper, said: “NICE will be working with the other authors on this paper to examine ways in which NICE clinical guidelines can be more helpful for making decisions in people with multimorbidity.

“This will build on experience and ideas used in, for example, the guideline on depression in people with a chronic physical illness and the links between guidelines that are presented in NICE Pathways.”

New guidelines on fertility

In February 2013, NICE updated its clinical guidelines on fertility, ensuring that more women experiencing fertility problems get the most appropriate and effective treatment as quickly as possible.

Infertility affects around 1 in 7 heterosexual couples, with both the number of people affected by fertility problems, and those seeking help for them, increasing over the past decade.

The rising number of people seeking help coincides with an increasing trend for couples to start families later in life, despite fertility declining rapidly with age especially after 35. In 2011, women who received fertility treatment were 35-years-old on average, and had been trying to conceive for around 4 years.

In the original fertility guideline, first published in 2004, NICE said that IVF treatment should not be recommended for women older than 39.

Under the updated recommendations, NICE says that under certain criteria, women aged between 40 and 42 years should be offered one full cycle of IVF with or without intracytoplasmic sperm, if they have not conceived after two years of regular unprotected intercourse, or 12 cycles of artificial insemination where six or more are by intrauterine insemination.

The updated guideline also recommends that IVF treatment should be made available for eligible women earlier than was previously recommended.

Women who are eligible for IVF can now receive treatment after two years of regular vaginal intercourse, or 12 cycles of artificial insemination, if they have been unable to conceive. This is one year earlier than in the previous recommendations.

In addition, the updated guideline contains several recommendations to ensure that only the most effective treatments are offered in a timely manner to people experiencing problems in conceiving.

Sir Andrew Dillon, Chief Executive of NICE, commented: "Whatever the cause, we know fertility problems can have a potentially devastating effect on people's lives; causing significant distress, depression and possibly leading to the breakdown of relationships.

"The good news is that, thanks to a number of medical advances over the years, many fertility problems can be treated effectively.

"It is because of these new advances that we have been able to update our guideline on fertility, ensuring that the right support, care and treatment is available to those who will benefit the most."


In October 2012, we confirmed that we shall be working on ways of ensuring our guidelines take into account multimorbidities

Fertility guideline podcast with Mr Tim Child