One in six trusts of the English health service is not adhering to guidance on the use of treatments from the National Institute for Health and Clinical Excellence (NICE), or does not know whether it is or not, according to the preliminary results from the new annual health check scheme, which are designed to publicly show whether trusts are meeting standards (BMJ 2006;333: 114, 15 Jul).

Michael Rawlins, chairman of NICE, whose recommendations are being flouted, particularly in the area of cancer, multiple sclerosis, and rheumatology

Credit: NICE

The finding echoes reports from doctors' and patients' organisations that the approval of a treatment by NICE does not necessarily mean that trusts will provide it, particularly for some of the newer, more costly drugs. The Audit Commission warned, in a report last year, Managing the Financial Implications of NICE Guidance, “Currently, the implementation of NICE guidance by NHS bodies is less comprehensive and timely than desired.”

The commission considered that cost was a key factor and recommended that financial aspects of implementing NICE guidance should be integrated into mainstream financial management arrangements.

Cancer drugs have proved particularly problematic. A report published by the national cancer director …