Happy Birthday NICE24th June 2006
It is seven years since the government set up the National Institute for Clinical Excellence to provide guidance on the clinical and cost-effectiveness of treatments and protocols.
NICE has always been controversial. Even as the government set it up in 1999, it was handed what some considered the poisoned chalice of ruling on the use of zanamavir, the antiviral drug for flu. NICE said no, and fury ensued.
Since then the organisation has barely been out of the headlines. There are those who say NICE takes too long, is too prescriptive in how it takes evidence and that its guidance is too narrow, which in turn leads to a plethora of sometimes contradictory guidelines.
Chief executive Andrew Dillon defends the methodology. The WHO has judged it to be the ‘global leader’. A recent independent review of its recommendations published in the BMJ found it to be fair and consistent and with an appeals process that so far has prevented appellants seeking remedy in the courts.
Nevertheless some doctors feel they have no option but to ignore not just guidelines - which describe best practice and therefore are not mandatory - but also guidance, the mandatory part of NICE’s work that PCTs must fund.
Doctors have clinical freedom, but PCTs will be monitoring GPs’ quality and outcomes framework scores against the use of NICE guidance. Hospitals also audit against NICE guidance.
But NICE has been forced to answer to its decisions to politicians and responded to health secretary Patricia Hewitt’s questions on Herceptin with a fast-track appraisal process that would cut the time it takes to produce guidance on a new drug or technology from 24 to six months. Herceptin was at the top of the list, ruling in June 2006 in favour of its use in limited circumstances.
The bigger issue for PCTs is funding. The arguments around Herceptin have been well aired and the common theme is that if NICE is going to recommend expensive treatments PCTs should get funding to support it. The more sophisticated view is that NICE should start considering not just cost-effectiveness but affordability.
‘You can always find critics of any individual piece of advice. It would be amazing if you couldn’t,’ says NICE chief executive Andrew Dillon. ‘But I don’t think anyone is saying we can do without NICE.’
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