NICE confirms its role in new NHS after government U turn

A month after the government backtracked on its plans to downgrade the role of the UK National Institute for Health and Clinical Excellence (NICE), its chief executive has emphasised the value of the organisation.

Speaking at a Science Media Centre meeting to discuss the future work of NICE, Andrew Dillon sent out a clear message about the role of his organisation. “We want to make it very clear that we feel very strongly about the value of what we do,” he said.

In June the government made a U turn on its decision to give clinical commissioning groups (previously called commissioning consortiums) the power to decide which drugs would be available to patients (BMJ 2011;342:d3862, doi:10.1136/bmj.d3862). During the government’s “listening exercise” on its planned changes to the NHS many GPs said that they were unhappy at being given the power effectively to ration treatments, and the government said that NICE would retain its role in recommending drugs for use in the NHS.

Sir Andrew said he was “delighted” that the government had changed its mind.

“Through the listening exercise there was a really strong message—independent of NICE—about the need to retain the recommendations that we make,” he said.

“NICE guidance [on the effectiveness of treatments] is a very strong and influential signal, but it doesn’t always result in immediate and slavish uptake,” he admitted.

He welcomed the introduction of the new system for pricing drugs, called value based pricing (BMJ 2011;342:d1759, doi:10.1136/bmj.d1759), in January 2014 and said that the government’s aims for the scheme were similar to NICE’s own. However, he said that value based pricing would not “of itself” speed up the uptake of new treatments and that what was needed was a “broader strategy for stimulating the system to do better than it is at the moment.”

He added, “We need to look beyond what the government is doing with value based pricing and look at the system as a whole.”

Sir Andrew said that he believes NICE will have an important role in the new NHS as a steady pair of hands.

“We have been pretty stable over the last 12 years [since NICE was set up], and we have become very familiar in a time when the system is experiencing a lot of turbulence. It’s not a bad thing to have an organisation that’s just ploughing on,” he said.

NICE is sometimes described as one of the big four health regulatory bodies, alongside the Care Quality Commission, Monitor, and the NHS Commissioning Board, but Sir Andrew was keen to emphasise NICE’s role in producing quality standards.

“The [Health and Social Care] bill is very strong on the NHS Commissioning Board taking account of the quality standards NICE is producing . . . When parliament says it expects you to take account of something, that’s significant,” he said.

He was asked whether he expected that NICE’s guidance will be increasingly ignored in the current harsh financial climate in the NHS. He replied that local organisations had always had discretion to follow NICE’s guidance and that “that will continue.” He added that he expected commissioners to make decisions on the basis of evidence and that those decisions would be made “transparently and publicly.”

“We cannot tell the NHS what to do,” he said.