National Institute for Health and Care Excellence

Action Planned (AI summary) NHS England developed the TB Action Plan for England, 2021-2026 and commissioned a GIRFT review of TB service provision. They also supported professional awareness resources, a TB eLearning resource, and issued a TB service specification. The UKHSA co-developed and co-owns the National TB Action Plan with NHS England. It has developed and delivered a series of webinars on TB available to healthcare professionals, and contributed to the RCN competency framework for TB nurses. NICE will share the report with their guideline surveillance team to check for new evidence on TB contact tracing. They also plan to discuss the report with the UK Health Security Agency.

Action Planned (AI summary) NICE will review its guideline on venous thromboembolism to address the issue of continuing VTE prophylaxis on discharge and their implementation support team will consider delivering support on VTE risk assessments and discharge planning, and their external communications team will reflect on the issues raised by the report to improve future guidance dissemination.

Action Planned (AI summary) While NHS England does not routinely provide guidance on nasogastric decompression tubes, they have asked regional colleagues to raise awareness of the concerns raised in the report and learnings from the case with their regional Integrated Care Boards, which can then engage with local NHS Trusts. NICE has shared the report with its topic selection and prioritisation team to consider guidance on small bowel obstruction and nasogastric decompression. The report has also been shared with NICE’s guideline surveillance team to see if an update to recommendations on nutrition support for adults is required. The MHRA has reached out to manufacturers of nasogastric tubing to confirm their primary intended use and to review their instructions for use, expecting to complete the initial review by 4 January 2024, after which they will work with manufacturers to update their IFU where applicable.

Action Planned (AI summary) NICE acknowledges the guideline on gastroenteritis in under 5s [CG84] does not align with the UK Resuscitation Council’s 2021 guideline on paediatric advanced life support, and has forwarded the report to their guideline surveillance team who will review the UK Resuscitation Council’s 2021 guideline and consider if CG84 and other related NICE guidance need to be updated.

Action Planned (AI summary) NICE will consider the issues raised in the report when they update their guideline on falls in older people (CG161).

Action Planned (AI summary) The Mayor of London has implemented measures such as the Ultra Low Emission Zone (ULEZ) and is expanding the monitoring network. They are also supporting health and care system support for vital structural changes. DEFRA, DFT, and DHSC will continue to work to improve public awareness of air pollution, including a pilot project with GPs providing air quality advice and information to a range of vulnerable groups. They will also make expertise available to relevant professional organisations. NICE amended its asthma guideline (NG80) in March 2021 to clarify the link between air pollution and asthma and added links to NICE guidelines on air pollution: outdoor air quality and health and indoor air quality at home. The RCGP is in the process of producing a planetary health element of the curriculum that all new GPs will be assessed against and are also planning a high-profile webinar incorporating elements regarding pollution. The RCP will work with specialist societies to raise the profile of air pollution's impacts, review the internal medicine curriculum, increase knowledge among physicians, produce resources for professionals to discuss air pollution with patients, improve incentives for conversations, and urge government to tighten regulations. The NMC will consider the concerns in their evaluation of pre-registration standards, focusing on communication with families, and identify further activity to ensure professionals understand their obligations to communicate clearly with patients about evidence related to managing and preventing ill-health. The BTS intends to build upon work undertaken to date by raising awareness of the effects of poor air quality, producing an updated Position Statement on air quality and lung health, and adding the health care profession voice to the debate on climate change and air pollution through membership of the UK Health Alliance on Climate Change and involvement in the Taskforce for Lung Health. The RCPCH curriculum includes a domain on health promotion, and they are working with NHS England/Improvement and Health Education England to develop asthma competencies for child health professionals and carers. They also declared a climate emergency and published a report on tackling climate change. HEE will write to the relevant medical Royal Colleges, GMC and NMC to highlight that improving awareness of the impact of air pollution on health should be considered when developing curricula. The GMC will review standards for medical education to consider how environmental issues are covered, encourage medical schools to address air pollution in curricula, and promote inclusion of environmental impacts in postgraduate training curricula. HEE will add the theme of environmental impacts to the list of potentially important areas to consider as they progress the credentialing agenda. UKHACC delivered a pilot project with Global Action Plan, funded by Defra and the Clean Air Fund, to educate paediatricians and respiratory health professionals on air pollution advice for patients. The London Borough of Lewisham has expanded monitoring capacity, taken part in the Breathe London project, and refreshed the Joint Strategic Needs Assessment for Air Quality. They also promote air quality monitoring tools via social media and local advertising, and ensure information is positioned on relevant websites and newsletters.