NICE: a panacea for the NHS?BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7187.823 (Published 27 March 1999) Cite this as: BMJ 1999;318:823
No, but it should be useful for managing the introduction of new technologies
- Richard Smith, Editor
Harold Wallace Ross, the great editor of the New Yorker, had a continuing fantasy that the next person he hired would bring “grace and measure” out of chaos.1 They never did. But his is a common fantasy, entertained at some time by most employers, secretaries of state, and prime ministers. The National Institute of Clinical Excellence (NICE),* which begins its assault on Olympus next week, makes me think of Ross. I have heard NICE mentioned as the solution of most of the NHS's problems: rationing, poor practice, the failure of good practice to spread, postcode prescribing, the mindless adoption of technology, the absence of a sensible mechanism to introduce new drugs, and variations in outcome. How much can we realistically expect?
Like any other institution NICE will evolve, but it begins with three main functions: appraising new technologies, including drugs, before they are introduced into the NHS; issuing and kitemarking guidelines; and encouraging national audit. Most of its initial energy will be put into the first function, and this is the beginning of explicit, national rationing. It is also the appearance of the “fourth hurdle” in that to become widely used in the NHS new drugs will have to prove themselves not only to be pure, efficacious, and safe but also better …