I think a crucial point is for NICE to appreciate why assessment of objective outcomes is so vital, because I'm not sure they do. The whole thing has been driven all these years on the presumption ME/CFS is psychological, in which case subjective outcomes are the accepted order of the day; we all know the powerful forces still wanting to promote that. I fear NICE do not yet properly appreciate ME/CFS really is a physical condition, hence assessment has to be based on objective outcomes. For us it is obvious, but for NICE, having been marinaded in BSP 'stuff' all these years, it may actually be a mindset change they are still not onboard with, especially as the BSP brigade will still be filling their heads with the old psychobabble beliefs. If we cannot be sure NICE really understands this, then the rest will be even more of an uphill struggle.