Researchers call for reform of NICE

Friday, 23 July 2004 12:00 AM

A new paper published in the British Medical Journal (BMJ) has called for significant reforms of the National Institute of Clinical Excellence (NICE), which they accuse of creating inflationary pressures within the NHS.

NICE is responsible for issuing clinical guidelines on the appropriate treatments for specific conditions and appraising new treatments and technologies before they are adopted within the NHS.

This can, however, lead to budgetary tension, as the NHS is expected to implement all of NICE's recommendations, which can prove very expensive.

The authors, from the universities of York and Birmingham, warn that: "Even with recent large increases in NHS expenditure, acute funding difficulties continue to emerge."

They argue that though NICE was set up to inform decision making and prioritise new and existing technologies it "has yet to mature into the efficient prioritisation mechanism that is required to ensure the best use of NHS resources."

"The success of commercial, provider, and regulatory interests in focusing NICE's work on new, expensive technologies has been self serving and inflationary."

"The NHS cannot afford NICE generosity, even with increased NHS funding, because of the resource demands of other access and national service framework targets, many of which have yet to be evaluated by NICE", they warn.

One key recommendation is that NICE should be given a budget so that it would be encouraged to examine the effects of its decisions on the whole of the NHS.

Professor Alan Maynard and his colleagues call for widespread acceptance that "rationing health care is inevitable" and argue that "adoption of new technologies by NHS clinicians should be informed by costs as well as effectiveness".

Further recommendations include suggestions that NICE should not only focus on new treatments, but on the withdrawal of existing ineffective or inefficient therapies.

Responding to the report, Andrew Dillon, NICE's chief executive, said: "Alan Maynard makes some interesting points about NICE's role, most of which are matters for Ministers and the wider NHS to consider.

"Although our recommendations make a big impact on patient care, the cost of the technologies we recommend is marginal (around 0.1 per cent) on an NHS budget which exceeds £60 billion. We think it important that there is a lively debate about our role and impact and Professor Maynard and colleagues' article is a welcome contribution."

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