National Institute for Health and Care Excellence

Noted (AI summary) NICE declines to develop national guidance on propofol for short-term sedation in children on PICUs, stating that local protocols are more appropriate due to varying local prescribing issues. They suggest that NHS England or the Paediatric Critical Care Society could consider suggesting that all PICUs develop local protocols.

Noted (AI summary) NHS England is funding research expected to conclude by September 2027, to collect evidence on the safety and reliability of cervical screening tests within 3 months of birth, after which national guidance will be considered and updated accordingly. NICE clarifies that the recommendation to delay cervical screening post-partum comes from Public Health England (PHE) guidelines, not NICE guidance, and that NICE guidance recommends a suspected cancer pathway referral for a cervix with an appearance consistent with cervical cancer.

Noted (AI summary) NICE clarifies that the Clinical Knowledge Summaries (CKS) are not NICE guidance, and that NICE guidance and prescribing information for risperidone does not include a requirement for continued ECG monitoring. However, the publishers of the CKS will make some changes to ensure it is clear where ECG monitoring is required. The ICB will review the investigation from the practice, await the NICE response, update the JAPC guideline and medicines management webpage, and share lessons learned and guidance updates with primary care clinicians and across relevant networks, and support service links with colleagues.

Noted (AI summary) Somerset NHS Foundation Trust has developed supportive guidance for families regarding Section 17 leave from inpatient units, which is currently out for feedback and will be shared at an operational meeting for approval. They also describe planned training for mental health staff on menopause. NHS England acknowledges concerns about menopausal care and highlights increased awareness and demand. They describe training programmes, awareness sessions and e-learning packages that have been launched, some since Anne's death, to improve resources for healthcare practitioners. NICE expresses condolences and states that the concerns raised are not directly attributable to NICE but are addressed to other organizations. They reference existing NICE guidance and quality standards related to suicide prevention and menopause, and indicate that the menopause guideline was recently updated and will remain under surveillance. The RCOG extends condolences and recognises the concerns raised, highlighting that management of the menopause is covered in the core training curriculum for Obstetricians and Gynaecologists, including a Special Interest Training Module and the Diploma of the Royal College of Obstetricians and Gynaecologists. Kenny & Murphy Ltd sold the incident site in March 2024 and has no influence over tenants there. However, they have discussed electrical safety with tenants at their other sites and provided them with relevant leaflets and documents.

Noted (AI summary) The RCOG acknowledges the coroner's concerns regarding the lack of guidance on managing abnormal antenatal CTGs, emphasizes the need for individualised care plans and refers to NHS England guidance on computerised CTG use. NICE acknowledges the coroner's concerns and will consider reviewing the evidence on antenatal CTG interpretation and actions, and will work with others to see if they can produce a practice guide to inform practitioners.

Noted (AI summary) NICE acknowledges the coroner's concerns regarding drug interactions in the death of Chloe Elizabeth Burgess, but states that the British National Formulary (BNF) is best placed to address these concerns, as NICE only makes the BNF available on their website but does not control its content. The Royal College of Physicians notes the concerns and will discuss this case at their next Patient Safety Committee and Joint Medicines Safety Working Group to explore whether further action should be taken.

Noted (AI summary) NICE is working collaboratively with the MHRA on the issues raised and will provide a further response once that work has concluded; the outcome will inform any action NICE may need to take in respect of its recommendations. The MHRA outlined existing warnings and guidelines related to SSRIs and suicidal behavior, referencing NICE guidance, and added the adverse reaction report to the Yellow Card database. The Royal College of GPs provides general comments on GP curriculum, shared decision making, NICE guidance and its Mental Health toolkit, but notes no specific changes it will make.

Noted (AI summary) NHS England acknowledges concerns about smoke-free policy application in mental health settings but refers to existing NICE guidance and states that individual NHS Trusts are responsible for local implementation. They also note that regional colleagues are seeking assurances from the relevant system regarding local arrangements. NICE acknowledges the concerns but states that the issues raised regarding national policy contradictions are outside their remit and best addressed by NHS England and the CQC. They highlight their guideline NG209 on tobacco dependence. The Department of Health and Social Care acknowledges the concerns regarding the smoke-free policy's impact on mental health inpatients and refers to the legal requirement for smokefree hospital premises. They expect NHS organisations to support patients who smoke through cessation measures or safe leave arrangements, and note that NHS England will address concerns around national guidance.

Noted (AI summary) NICE acknowledges the coroner's concerns regarding arterial thrombus but clarifies that existing guidance focuses on venous thromboembolism and does not cover arterial prophylaxis. NICE will continue to monitor new evidence in this area.

Noted (AI summary) NHS England is awaiting DHSC's final ME/CFS Delivery Plan and is developing e-learning modules for healthcare professionals. They have engaged with NICE regarding guidance on ME/CFS and nutrition support, and regional colleagues are working with Royal Devon University Healthcare NHS Foundation Trust to develop formal pathways for acute admission and emergency admission for patients with ME/CFS. NICE will review evidence on dietary management for severe ME/CFS published since the 2021 guidelines and consider amendments to emphasize the need for appropriate nutritional support. It will also work with the Royal Devon University Healthcare NHS Foundation Trust to identify examples of good practice and determine if any updates to the section on fatigue are possible in NICE Clinical Knowledge Summaries. The MSC highlights that it is not a regulator but shares information about how ME/CFS is taught and assessed in medical schools, noting the GMC's new national licensing exam and examples of curriculum content. It has also shared the NHS England e-learning package on ME with medical schools. DHSC will reconvene the ME/CFS Task and Finish Group to develop a final delivery plan by the end of March 2025, focusing on research, attitudes, and education. NHS England is establishing a working group to determine additional support for commissioners, and NICE will review evidence on dietary management and strategies for severe ME/CFS and amend guidance. The MRC has invested £3.6m since 2019 in ME/CFS research in partnership with the NIHR, including co-funding the DecodeME study, and continues to engage with researchers and patient representatives to catalyse biomedical research in this area.

Noted (AI summary) NICE acknowledges the concerns raised but does not consider any actions from NICE would address the issues. NHS England states that the concerns are local issues for the Trust to address, but that regional colleagues are engaging with the ICB and NHS England will review the Trust's response; also describes national work on PFD reports. East Kent Hospitals is reinforcing the Acute Abdominal Pain Pathway (AAPP) through monthly teaching sessions and case discussions. The AAPP document includes updated patient risk assessment, and the Hospital Discharge and Criteria to Reside Policy was updated to include a checklist for self-discharge.

Noted (AI summary) NHS England states that they do not endorse a particular STREAMing model nationally and that the STREAMing pathway in use by Medway Maritime Hospital does not have an undue prioritisation of chest pain and that the pathway would likely not have altered the outcome of the initial assessment in this case. They also note that all reports are reviewed by the Regulation 28 Working Group. The Royal College of Emergency Medicine states that they are unable to comment on the specific concerns raised as they are unfamiliar with the STREAMing model and notes existing guidance and work with NHS England on initial assessments. NICE acknowledges the concerns but states that the issues raised are outside of their remit, as they relate to a system produced by NHS England.

Noted (AI summary) NHS England acknowledges the coroner's concerns but states that NICE is the appropriate body to provide clinical guidance. NHS England will review NICE's response and consider any resultant actions, while noting the need for individualised care in such cases. They are also gathering information on a delay in reporting a CT scan result. NICE acknowledges the lack of specific guidance on restarting anticoagulants after traumatic intracranial haemorrhage. NICE will consider the issues raised through their guidelines surveillance process and discuss a consensus statement with relevant specialist societies.

Noted (AI summary) NICE acknowledges the concerns regarding clozapine and blood cancers but states that the MHRA is the responsible body for medicine regulation and safety. NICE welcomes any findings that may impact its current recommendations and advice. Viatris states its clozapine product is safe when used as prescribed and that ongoing monitoring shows no change in the benefit risk profile, so no action is proposed. Response contains no text. Response text consists only of A6 and A7.

Noted (AI summary) NICE acknowledges the lack of evidence for specific DOAC reversal protocols and states that clinical judgement is required. They reference existing guidance on head injury and andexanet alfa, and commit to monitoring new evidence.