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Updating the NICE NSP Guidance


Updating the NICE NSP Guidance Chris Carmona, Public Health Analyst Centre for Public Health Plan Rationale for the update The draft NSP recommendations Changes from ... – PowerPoint PPT presentation

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Title: Updating the NICE NSP Guidance

  • Updating the NICE NSP Guidance
  • Chris Carmona, Public Health Analyst
  • Centre for Public Health

  • Rationale for the update
  • The draft NSP recommendations
  • Changes from the original guidance
  • Implementation issues
  • Questions.

Updating the guidance
  • Guidance was published in Feb 2009 and was
    reviewed in Apr 2012
  • An expert group considered whether any new
    evidence or significant changes in policy and
    practice would be likely to lead to substantively
    different recommendations.
  • The proposal of the expert group was consulted on
  • On the basis of consultation and expert opinion,
    NICE decide whether or not to update the guidance.

  • The review process concluded that
  • There was no new evidence to contradict the
    current recommendations
  • There was new evidence that could add to existing
  • There was new evidence that could expand the
    previous work to more fully meet the scope

  • NICE decided to undertake an update of the
    existing NSP guidance.
  • Following the expert group and consultation, the
    update focussed on
  • New evidence related to existing recommendations
  • Vending machines, outreach, drop boxes.
  • NSP provision to PIED users
  • NSP provision to under 18s

Drafting the giuidance
  • CPH commissioned reviews of the evidence.
  • A public health advisory committee (PHAC)
    considered the evidence.
  • On the basis of the evidence and public
    consultation they drafted new recommendations and
    updated old recommendations.

Original recommendations
Recommendation 1 Planning, needs assessment and
community engagement
  • Look at local need and local data on use and
    geographic spread (including estimating coverage)
  • Make sure NSPs are configured to meet this need
    both temporally and spatially
  • Do all of this in consultation with PWID and
    local communities

Recommendation 2 Meeting need
  • Commission a range of generic and targeted
    services that aim to increase coverage (ideally
    to over 100)
  • Develop strategies for disposing of dirty needles
  • Encourage syringe identification schemes
  • Audit services
  • Integrated care pathways.

Recommendation 3 Types of service
  • Set up a 3-tier model of service provision
  • Make sure services are co-ordinated to provide
    good temporal coverage in each 24 hour period.
  • Make sure people who are on OST can also get
    clean needles and syringes.

3 tier model of NSP provision
  • level one distribution of injecting equipment
    either loose or in packs, with written
    information on harm reduction (for example, on
    safer injecting or overdose prevention)
  • level two distribution of pick and mix
    (bespoke) injecting equipment plus health
    promotion advice (including advice and
    information on how to reduce the harms caused by
    injecting drugs)
  • level three level two plus provision of, or
    referral to, specialist services (for example,
    vaccinations, drug treatment and secondary care).

Recommendation 4 Equipment and advice
  • Provide people with as many needles and syringes
    as they need, without arbitrary limitation.
  • Provide them with sharps bins
  • Provide them with other equipment they need to
    safely take drugs
  • Provide them with information and a gateway to

Recommendation 5 Community pharmacy-based NSPs
  • Make sure staff are appropriately trained for the
    level of NSP work theyre doing
  • Collect used sharps bins
  • Offer staff Hep B vaccination

Recommendation 6 Specialist NSPs level three
  • In addition to the above,
  • Offer a range of needles, syringes and equipment.
  • Provide harm-reduction services
  • advice on safer injecting practices, assessment
    of injection-site infections,
  • advice on preventing overdoses and
  • help to stop injecting drugs.
  • Where appropriate, offer a referral to opioid
    substitution therapy services.
  • Offer (or help people to access) a range of
    health and welfare services.

Whats new?
  • The updated guidance is still not fully signed
    off so I am unable to share with you the exact
    wording and content, and anything that I say
    today may change during the final sign off
    processes within NICE.
  • The final decisions will be made in mid Feb and
    the guidance will be published on March 26th 2014.

Whats new?
  • There are two completely new recommendations.
  • There are some notable additions to
  • The early recommendations have been reorganised
    to make them more logical.

Developing a policy for young people aged under
  • Requires local areas to develop and implement a
    policy on providing NSP and related services to
    young people aged under 18 (including young
    people under 16).
  • Asks how local services will achieve the right
    balance between the imperative to provide young
    people with injecting equipment and the duty to
    safeguard them and provide advice on harm
    reduction and other services. It includes
  • the young persons capacity to consent
  • the risks they face
  • the benefits of them using services
  • the likelihood that they would inject anyway,
    even if equipment was not provided.
  • Provide NSP as part of a package of care (esp to
    under 16s) where possible.
  • Offers some ideas about the things local areas
    will need to consider, for example consent,
    parental involvement, specialist substance
    misuse services for YP, training needs

Provide equipment and advice to people who inject
  • Ensure needle and syringe programmes
  • Are provided at times and in places that meet the
    needs of people who inject IPED. (For example,
    outside normal working hours or outreach in
  • Provide the equipment, information and advice
    needed to support these users.
  • Are provided by appropriately trained staff
  • Specialist NSPs with high numbers of IPED users
    should provide specialist services for them. It
  • specialist advice about IPED and side effects
    (stacking/cycling etc)
  • advice on alternatives (for example, nutrition
    and physical training as an alternative to AAS)
  • information about, and referral to, sexual and
    mental health services and to specialist IPED
    clinics, if these exist locally.

Notable additions
  • Not discourage secondary distribution
  • Where possible, provide low dead space syringes
  • More points about data collection and monitoring.
  • Consider drop boxes (in consultation with police
    and communities)
  • Consider whether NSVM might be appropriate

NICE Guidance support
  • Costing and Commissioning tools
  • Press and dissemination
  • Linking with national policies and systems -
    potential collaboration with PHE
  • Good practice case studies

Communications support
  • Filming in house filming of a needle exchange
    program for the NICE website.
  • Interviews with experts for the NICE website
  • Opportunities for the press to film on location
  • Press work with national media channels
  • Press release
  • Contact lyndsey.unwin_at_nice.org.uk
  • Lyndsey Unwin Media Relations lead

Into practice case studies
  • Please contact mandy.harling_at_nice.org.uk Senior
    Implementation Adviser Please let us know about
    any local work underway where
  • It has generated consultation with BME
    communities or men who have sex with men or
    emerging populations e.g. people injecting legal
  • Local policies/protocols addressing NX provision
    for young people
  • Services are delivering needle exchange (NX) for
    IPEDs users
  • NX in settings custody suites GUM clinics or
    AE depts.
  • Community pharmacies are integrated into local
    planning and pathways for NSPs

Thank you.
  • Chris Carmona Lead analyst
  • Chris.carmona_at_nice.org.uk
  • Mandy Harling Senior Implementation Adviser
  • Lyndsey Unwin Media Relations lead
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