Is NICE losing its standing as a trusted source of guidance?

Dear Editor

Professor Michaels summarises the issues facing organisations developing guidelines well. The NICE guideline development committee on AAA (referenced in his article and of which I was a member) was heavily influenced by NICE's 'Social Value Judgements' policy document when developing its recommendations following literature review and HE analysis produced by NICE's technical team. A different set of social value judgments would have likely resulted in different recommendations.

It is essential that decisions made by NICE reflect the societal values and that there are mechanisms to ensure that social value judgement policies remain relevant and contemporary. A balance between a strict utilitarian approach (embodied in HE analysis) and wider libertarian considerations of fairness, equity, dignity and autonomy is essential. Population level cost effectiveness decisions will always conflict with patients' personal priorities at times of healthcare need unless there is a wider public discourse about what it is reasonable for the NHS to provide and how it might provide this.