Challenges for the National Institute for Clinical Excellence

doi:10.1136/bmj.329.7459.227

BMJ 2004;329:227-229 (24 July), doi:10.1136/bmj.329.7459.227

Education and debate

Challenges for the National Institute for Clinical Excellence

Alan Maynard, professor¹, Karen Bloor, senior research fellow¹, Nick Freemantle, professor²

¹ Department of Health Sciences, University of York, York YO10 5DD, ² Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT

Correspondence to: A Maynard akm3@york.ac.uk

So far NICE has focused on evaluating new technologies ratherthan existing ones. But this approach is creating inflationarypressure that the NHS cannot afford

The first 150 words of the full text of this article appear below.

Introduction

Even with recent large increases in NHS expenditure, acute fundingdifficulties continue to emerge. It is essential that a nationalmechanism to prioritise new and existing technologies is availableto inform decision making. The National Institute for ClinicalExcellence (NICE) was created to meet this need.¹ However, despiteRawlins and Culyer's essay on consultation and equity,² NICEhas yet to mature into the efficient prioritisation mechanismthat is required to ensure the best use of NHS resources.

Rationing

Rawlins has stated that there is "no role for NICE in the rationingof treatments to NHS patients."³ These weasel words belie theinevitability of healthcare rationing, which is ubiquitous inall healthcare systems. Rationing involves depriving patientsof care from which they may benefit and which they wish to have⁴;this is inescapably the business of NICE. Indeed, rationingis the inevitable corollary of prioritisation, and NICE mustfully inform rationing . . . [Full text of this article]

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Restricting access to NHS funding

Equity and efficiency trade-offs

Selecting technologies for approval

Mechanisms to constrain NICE induced inflation

Conclusions

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