NICE likely “to take blame” as healthcare budgets tighten, chairman says

BMJ 2013; 346 doi: (Published 04 February 2013) Cite this as: BMJ 2013;346:f749
  1. Matthew Limb
  1. 1London

The UK National Institute for Health and Clinical Excellence (NICE), the body that appraises treatments for the NHS, can expect to come under fire as a “perfect storm” of financial and organisational pressures on the health and social care systems approaches, a conference has heard.

NICE’s remit for producing guidance and quality standards on social care will expand on 1 April 2013.

Its chairman designate, David Haslam, told a Westminster Health Forum seminar on the body’s future role that the job he was about to take up was “almost certainly impossible,” given the challenges that lay ahead.

He said that the effect of an ageing population and increasing cost pressures in health and social care meant that difficult funding decisions would have to be made.

NICE may well be part of the solution to the problem of “postcode lotteries” in health services, he said, but any organisation that was part of making health related decisions linked to the issue of cost, when faced with a finite budget, would face real criticism, he said.

He described NICE as ideally placed “to take the blame.”

Haslam, a GP for many years and national clinical adviser to the Care Quality Commission, said that the boundary between the NHS and social care was “extraordinarily blurred.”

“No one in their right mind would have devised a system from scratch in which [the organisation of] health and social care are different,” he told the seminar in London on 31 January.

He said that the government’s restructuring of the NHS and public health systems had led to lack of overall clarity and that it was vital that NICE worked well together with the Care Quality Commission and NHS Commissioning Board to deliver coherence.

“We do face this perfect storm of confusion and duplication in the brave new world that faces the NHS after 1 April,” he said.

“I challenge anyone to draw me a simple, one page algorithm of how the NHS works. It’s pretty close to impossible.”

Haslam said that NICE guidance had in the past focused on single conditions, which was probably why, among clinicians, GPs were the least likely to use them in their clinical work.

But many people had several long term illnesses, and it was “essential” that NICE became more focused on comorbidity and tackling the “breathtaking complexity” of what quality meant to patients.

He said that he was committed to ensuring that NICE established “real credibility” in social care circles and worked with patients to determine exactly what quality “looks and feels like.”

Laura Weir, head of policy and campaigns for the Multiple Sclerosis Society and who also chairs the group Patients Involved in NICE, said that NICE should “work harder” on behalf of patients.

She called for health and social care guidance to be properly integrated, implemented, and simplified, saying, “People don’t understand the tribalism between health and social care.”

Judith Smith, head of policy at the health policy think tank the Nuffield Trust, said that commissioners needed evidence to help them assess service priorities, including where to invest and where to disinvest.

NICE is developing plans for value based drug pricing, due to be introduced in January 2014. The issue was likely to be highly controversial, Haslam said.

The new system was meant to link the price of a drug to its assessed value, so that what the NHS paid for a new drug would reflect the benefits perceived by doctors and patients.

But NICE’s deputy chief executive, Gillian Leng, said that developing the method was complex, adding, “We still don’t know exactly how it’s going to work in practice.”


Cite this as: BMJ 2013;346:f749

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