5 Questions for the New Chair of NICE Sharmila Nebhrajani

Siobhan Harris

Disclosures

July 31, 2020

Sharmila Nebhrajani took up the role of chair of NICE at the end of May.

Sharmila Nebhrajani

She called the position "a rare thing - a role that is both supremely important and acutely interesting".

Sharmila Nebhrajani has a wealth and depth of experience in many sectors including in medicine, industry, government and charities.

It's fair to say she joined NICE at a critical time for patients, the health and care system, and indeed the country, as we responded to COVID-19.

Medscape UK asked her about her new position, her experience, and the challenges ahead.

Q&A

How do you feel about taking on the role?

NICE is deservedly world-renowned. From assessing the clinical and cost-effectiveness of the latest drugs and devices to writing guidelines to ensure high quality care it has made a real difference to health care in the UK and is a beacon across the world for evidence-based medicine. NICE has also had extraordinary leadership stability since its birth 21 years ago, so it is a huge honour to be appointed as only the third Chairman in its history and as the first woman to hold the role.

So, I am absolutely delighted to be taking on the leadership of such an undeniably successful organisation. But I am also acutely aware that it brings with it significant responsibility. We must work with dedication to set a new strategy that develops NICE’s ability to respond quickly and effectively to rapid advances in our field but do so without putting at risk the rigour, the principles, and the expertise that lie at the heart of the organisation. In a time of huge clinical possibility but also resource constraint, my job is to ensure that those in the health system can look to NICE for clear wisdom and guidance to successfully navigate the next 21 years and beyond.

Do you see COVID-19 as the biggest challenge facing NICE at the moment?

COVID-19 is a huge challenge for the whole health system, NICE included. We responded to the initial urgent need by developing speedy guidance for clinicians and doing so in 3 weeks rather than the usual timeframe of many months. Of course, with that speed came the need to do things differently, significantly shortening the deliberation time and the consultation process for example.

In my view the COVID challenge, and NICE’s response to it, became a small microcosm of the way in which we must work in the future; developing our advice in a more agile way, creating "living guidelines" that can be rapidly prioritised and updated as we learn more about disease, and presenting the information in a way that makes it useful to busy staff at the point of care. These challenges that were shown so clearly for COVID, are just as relevant to the many other diseases doctors and nurses are trying to tackle every day.

What other challenges do you think NICE will have to contend with under your stewardship?

Three main challenges spring immediately to mind. Firstly, the health advances promised by personalised medicine are extraordinary. We face the very real possibility of therapies being available for an "n of 1"; such therapies could not only treat symptoms but be genuinely curative. As a society we will need to think about how we assess the cost-effectiveness of these treatments and how much we are prepared to pay for them.

Secondly is the rise of AI and machine learning impacting all branches of medicine. NICE methods will need to adapt to assess these sorts of dynamic interventions which, rather than fixed, are learning in real time, using messy real-world data and with software that updates rapidly. Just think how often your smartphone updates its operating system – that is about as far away from evaluating trial-based RCT data as you can get!

The final challenge for NICE is how best to help catalyse the adoption of innovation by the NHS. UK universities lead the world in science and medical research, the UK has some of the most innovative life science, medtech, and data companies and we at NICE need to play our part in making sure that the innovations that come from these sectors are made available to UK patients quickly and at a price the country can afford.

Can you tell us about your academic and career background in health, medical research, and management?

I studied Medicine at Oxford University which I loved; but after graduating, rather than continuing with clinical studies, I had a hunger to see the world. I began my international business consulting career and focused particularly on helping companies survive after the fall of communism in the former Soviet Union and Eastern Europe. I had always intended to return to medicine at some point but the sheer interest of working with people in Hungary, Russia, Ukraine and as part of the first ever European delegation to Kazakhstan in the depths of winter kept me thoroughly stimulated and I never quite found the time to return to Oxford. Nevertheless I became a World Fellow at the University of Yale and in my career I have been blessed to work on some of the most exciting developments in our modern society – from a long career at the BBC as part of the team that built the iPlayer to the Human Fertilisation and Embryology Authority chairing the panel considering the proposal to create the first human/animal hybrid embryo. Most recently I was Chief Executive of Wilton Park, part of the UK Foreign Office family of organisations, where I led the Global Health programme looking at issues such as AI and data for health systems in Africa and the challenge of NCDs as well as geopolitical issues such as the pressures on democracy and the implications of the rise of China on the World order.

What are you most looking forward to in your new role?

All of it!  Being the Chairman of NICE is like playing for your country. I could not think of a role I would want more.

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