Small groups should not undertake responsibilities on their own

EDITOR—Doyle's refreshing article describes the daily realities of priority setting faced by commissioning bodies.1 The article also provides a welcome counterbalance to the unrealistic hype over the National Institute for Clinical Excellence (NICE) being hailed as rational decision making in the NHS and the answer to postcode prescribing.

Commissioners are given the task of making difficult funding decisions in a politically and socially ambigious milieu. In undertaking this task I give caution over the practice of agreeing exceptions on compassionate grounds. I support Doyle's suggestion that this is often a means to bypass the evidence. It is often seen as a useful tool to avoid getting caught over the “never say never” directive. This is because agreeing some exceptions shows that the organisation does not “fetter its discretion” (the term for this type of transgression by public bodies).

There is much to recommend expressing compassion in …