This chapter provides the background and context to help us to understand the emergence of medical practice guidelines. Section 3.1 describes the emergence of medical practice guidelines in the Netherlands and England. It explores the different trajectories that the guideline development process has followed in the two countries – particularly the shift from consensus-based to evidence-based guidelines – while drawing out the implications that this might have for this book. Section 3.2 introduces the relevant professional associations and other actors involved in drafting and negotiating guidelines in these two countries and explores differences in the composition of guideline working groups and practices in negotiating guidelines. Section 3.3 discusses guidelines in the broader institutional context of healthcare delivery, the role of the institutional and regulatory context on guidelines and the financing of guidelines. Section 3.4 discusses the role of guidelines in the wider governance of healthcare in the Netherlands and England. Concluding remarks are presented in section 3.5 in the form of a cross-country comparison.

HISTORICAL PERSPECTIVES: FROM CONSENSUS TO EVIDENCE-BASED

It is important to trace the history of the development from consensus- based to evidence-based guidelines in both countries and assess when and to what extent, the shift from consensus-based to evidence-based guideline development occurred, as this will enable us to understand the current developments in both countries.

THE NETHERLANDS

In the Netherlands, the production of so-called ‘consensus statements’ began in 1982, when the National Association for Quality Assurance in Hospitals (CBO) produced a set of clinical practice guidelines describing a ‘state of the art’ procedure a health professional should follow when confronted with a situation the guideline describes. These consensus statements were produced in response to increasing government pressure to cut budgets, which led to fears that cost considerations might endanger the quality of care. The scientific council of the CBO, who produced these initial guidelines, consisted of representatives of the various scientific organisations of medical specialists. The CBO aimed to improve the quality of care in hospitals and the guidelines were meant to reduce practice variation and provide a way to audit care.