NICE is the abbreviated name for the National Institute for Health and Clinical Excellence. One of the aims of NICE is to minimise the variation in the type and quality of treatment available on the NHS in England and Wales. They achieve this by providing clinical guidance to all healthcare professionals to enable them to deliver the best possible care to patients.

What are the NICE guidelines?

The guidelines produced by NICE recommend appropriate treatment and care of people with specific conditions or diseases. There is guidance covering a huge variety of conditions ranging from cardiovascular disease to Mental Health. Healthcare professionals in the NHS are expected to follow NICE’s clinical guidelines when deciding an appropriate course of treatment unless there is some overwhelming reason why this is not possible, although this would be in exceptional circumstances.

The remainder of this article will focus on the ‘Referral guidelines for suspected cancer’ as an illustration of how the guidelines work in practice and the devastating consequences which have been seen when a healthcare professional has failed to properly follow the guidance.

Referral guidelines for suspected cancer

This set of guidelines are designed to help GPs decide when to refer a patient to a cancer specialist and whether the referral should be immediate, urgent or non-urgent. If the guidance is followed, there should be no delay in a referral being made in all appropriate cases.

The guidelines provide information to GPs in respect of many specific cancers such as lung, upper and lower gastrointestinal, breast, skin, bone, brain, gynaecological and urological cancers, amongst others.

Thompsons Solicitors have acted for patients who have suffered a delay in being referred for specialist assessment by their GP.

One example is a case involving a delay in a patient who went to his GP complaining of chest pain. The section in the NICE referral guidelines specific to lung cancer say that patients who smoke or have smoked in the past, have chronic obstructive pulmonary disease, have been exposed to asbestos or have a previous history of cancer have a high risk of developing lung cancer. A chest x-ray was arranged which showed some consolidation. This can be a sign of lung cancer and the NICE guidelines require an urgent referral to a team specialising in the management of lung cancer where consolidation is seen on x-ray. This was not done. The GP should have considered the patient’s history, which included smoking and exposure to asbestos, in light of the chest x-ray and made an urgent referral to an appropriate specialist. As this was not done, there was a serious delay in the patient receiving specialised care.

Thompsons have also acted on behalf of a client whose GP failed to make a referral for further investigation of skin cancer. The GP decided that our client had a squamous cell carcinoma. The NICE guidelines say that in a case where it is suspected that the patient has a squamous cell carcinoma, an urgent referral should be made. The GP in this case only made a routine referral which meant that the treatment was not fast tracked. As a result, the patient experienced a significant delay in receiving surgical treatment to remove the lesion. During this time, the cancerous lesion was allowed to grow and spread.

The NICE guidelines explain what is expected of healthcare professionals from the time of referral to the provision of treatment so if a patient is ever unsure about whether their doctor, nurse or other healthcare professional should be doing more, a quick look at the relevant clinical guidance will soon confirm whether the appropriate treatment is being provided.