Despite the protestations of its boss, the National Institute for Clinical Excellence (NICE) is an instrument for rationing health care. 1 2 Unfortunately, it's not a very good one. A government with spine would learn from the failings of NICE and move on to version 2. Perhaps this is a job for after the next election, whoever wins.

NICE, which covers only England and Wales, began in 1999 with three main functions. 1 3^–5 Firstly, it appraises new technologies, including drugs, and decides which should be encouraged in the NHS and which should be held back. Its other functions are to produce or approve guidelines and to encourage quality improvement. The biggest push for NICE came from political disapproval of “postcode prescribing:” patients on opposite sides of the same street may receive or be denied treatment because they fall under different health authorities, each with different policies on which treatments they will fund.

NICE began with a blaze of publicity by deciding that zanamivir, a new drug for treating flu, would not be made available in the NHS. 6 7 Its decision was based on the lack of evidence that the drug was effective in older people and others most at risk of …