Introduction of value based pricing may miss its 2014 target, NICE says

BMJ 2013; 346 doi: (Published 02 April 2013) Cite this as: BMJ 2013;346:f2115
  1. Nigel Hawkes
  1. 1London

With a new chairman, a new name, and a new role the National Institute for Health and Care Excellence enters the world of the changed NHS in England with only its acronym unchanged (NICE).

Although its writ now extends to social care as well as healthcare, it has ingeniously recast its name so that the well established NICE brand can be retained. Yesterday (2 April) it published its first two pieces of social care guidance, which cover supporting people with dementia and quality standards for the health and wellbeing of children and teenagers in care.1 2

Under the Health and Social Care Act NICE has become a statutory body rather than a strategic health authority that was at the whim of ministers. “As an SHA we could be written in or out by a health secretary on a daily basis,” said Andrew Dillon, who remains chief executive. “Now in an NHS where so much is changing around us, NICE represents stability. I believe we made a significant contribution to the NHS and I hope we will in social care, too.”

NICE’s new chairman, David Haslam, admitted at a London press conference to introduce the changes that he had a tough challenge in succeeding Michael Rawlins, who along with Dillon created NICE. Calling Rawlings “a real star,” Haslam said that he was honoured and delighted to be succeeding him.

He said that the NHS was still based on an outdated model of care in which well people became ill, were treated, got better, and resumed their lives. “It’s not like that now,” he said, “with so many people living with cancer or HIV/AIDS or having multiple conditions. If we were designing the health and social care system today, we wouldn’t design it as it is—it would look very, very different.” He hoped that his background as a generalist (he was a GP in Huntingdon for 36 years) would help him understand these needs, but he did not underestimate the challenge, he said.

NICE made its name by making difficult and often unpopular decisions about reimbursement of new drugs by the NHS, but the policy of value based pricing of drugs, promised by the coalition government, will blunt this effect.

NICE is promised a continuing role as an assessor of value, but the simple yes-no answers that triggered so many headlines will be no more. Asked whether he could see any visible progress on value based pricing, which is due to start at the beginning of 2014, Dillon was diplomatic. “The Department of Health has commissioned quite a lot of work, and NICE will play a significant role, but beyond that we don’t know very much more than you,” he responded.

“We still don’t know the details, and until we do it’s hard to comment.” The target of 2014, he said, would be achieved only if people moved very quickly, though progress depended on how radical a change was envisaged. “If it’s just an evolution of the present system, 2014 is a more likely prospect,” he said.

The first two social care quality standards had been developed in close partnership with service users, carers, and the organisations that represent them, said Gillian Leng, deputy chief executive of NICE. “Having evidence based guidance on what works well and quality standards set on high priority improvement areas will be important for a number of different audiences, perhaps particularly people who will be paying for their own care,” she said. Nine other topics are in the pipeline.

Most of the £3m (€3.5m; $4.5m) a year that NICE will spend on social care guidelines will be channelled through a centre at the Social Care Institute for Excellence in London, which won a three year contract after competitive tendering. Its chief executive, Andrea Sutcliffe, said, “We look forward to continuing our work together. So, good luck to the new NICE, and here’s to us both providing practical, evidence based guidance and support for health, social care, and other agencies and most importantly for the people who use these services.”

Bridget Robb, interim chief executive of the British Association of Social Workers, said that she expected NICE to build on the guidance that already existed in social care and to clarify the interface between health and social care. She warned that the task of bringing health and social care services together would be “enormously challenging to all involved” but that clarity on guidance and standard setting would help.


Cite this as: BMJ 2013;346:f2115


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