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We found Raftery's discussion of the workings of NICE most helpful,
but think that the issue of affordability needs further discussion.
Raftery states that the 22 judgements he reviewed would cost the NHS an
additional £200 million i.e. 0.5% of annual NHS spend in England and Wales
and that this should be readily met within the 9% annual cash increase the
NHS received this year.
But once increased pay and prices and a host of other cost pressures
are taken into consideration, the real (ie volume) growth in NHS spending
this year is only about 2% (and not, as stated by Government, around 6%).
Paying for NICE guidance would therefore account for 25% of available
growth monies, and given other "must dos" (such as National Service
Frameworks and waiting times targets), NICE costs are a major cost
pressure for Health Authorities and Primary Care Trusts.
The Department of Health say that the cost of NICE guidance has
already been built in to the NHS budget this year. But what about next
year? With statutory obligations on health authorities and Primary Care
Trusts to fund NICE recommendations imminent, how much is to be earmarked
next year? And if the sums are not enough, what is the NHS expected to
stop doing in order to meet its growing list of 'must dos'?
Shahed Ahmad, Senior Registrar in Public Health Medicine
John Appleby, Director, Health Systems Programme
King's Fund, London W1M 0AN
No competing interests
11 December 2001
Senior Registrar in Public Health Medicine
King's Fund, 11-13 Cavendish Square, London W1M oAN