Education And Debate

From guidance to practice: Why NICE is not enough

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7341.842 (Published 06 April 2002) Cite this as: BMJ 2002;324:842
  1. Thomas H S Dent, consultant in public health medicine ([email protected])a,
  2. Mike Sadler, medical directorb
  1. a North and Mid Hampshire Health Authority, Harness House, Basingstoke RG24 9NB
  2. b NHS Direct Hampshire and Isle of Wight, Winchester SO22 5DH
  1. Correspondence to: T H S Dent
  • Accepted 1 November 2001

The National Institute for Clinical Excellence (NICE) has an important role in providing the NHS with consistent and timely guidance on what is best for patients. However, it can fulfil its promise only if its products are implemented within a system which supports the changes that NICE promotes. At present, this is not the case. We consider what NICE needs to succeed and how its chances could be improved.

Summary points

The National Institute for Clinical Excellence (NICE) can fulfil its promise only if its guidance is implemented by a health service that supports the changes that NICE promotes

At present, this is not the case: there is ambiguity about how NICE reaches its conclusions and uncertainty about the impact of guidance on the NHS and about who monitors compliance

As a result, NICE's impact is uncertain and geographical inequity in the provision of health services is likely to persist

Debate and clarification of these issues would give NICE a better chance of benefiting patients and strengthening the NHS

How does NICE work?

NICE was generally welcomed on its inauguration. 1 2 Previously, a lack of capacity at national level to appraise healthcare interventions before, or indeed after, their widespread diffusion had several adverse consequences: no guidance was available when important new drugs were first marketed, local policies varied, and unproved interventions entered routine use.3 NICE filled this gap, giving guidance on interventions of uncertain value and providing clinical guidelines and clinical audit packages. NICE should be congratulated for the transparency it has shown in its processes, in the face of some opposition from the pharmaceutical industry.

NICE's decisions are based on an assessment of the technology, usually prepared by independent researchers commissioned by the Health Technology Assessment programme, and submissions from the manufacturer(s) and from patient and professional groups. These are considered by the …

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