NICE and the NHS

NICE's role was set out in the 2004 White Paper ´Choosing health: making healthier choices easier´. In it the government set out key principles for helping people make healthier and more informed choices about their health. The government wants NICE to bring together knowledge and guidance on ways of promoting good health and treating ill health.

Where NICE guidance applies

Where NICE guidance applies differs for each type of guidance:

Country	Which NICE guidance applies
England	clinical guidelines technology appraisals (both single and multiple technology appraisals) interventional procedures public health guidance medical technologies guidance
Wales	clinical guidelines technology appraisals (both single and multiple technology appraisals) interventional procedures public health guidance has no formal status but is regarded as a useful source of reviewed evidence
Northern Ireland	clinical guidelines are usually disseminated after general review technology appraisals, both multiple and single, are usually disseminated after local review interventional procedures public health guidance is usually disseminated after local review
Scotland	multiple technology appraisals (with advice on implementing in the context of the health service in Scotland from NHS Quality Improvement Scotland) interventional procedures public health guidance is also disseminated after local review by NHS Health Scotland

Note: diagnostics guidance is currently in development.

Applying NICE guidance

Once NICE guidance is published, health professionals (and the organisations who employ them) are expected to take it fully into account when deciding what treatments to give people.

However, NICE guidance does not replace the knowledge and skills of individual health professionals who treat patients; it is still up to them to make decisions about a particular patient in consultation with the patient and/or their guardian or carer when appropriate.

What health professionals are expected to do depends on the type of NICE guidance:

Type of NICE guidance	What status does it have?
public health guidance	Not subject to a mandatory requirement regarding funding The NHS, local authority and the wider public, private and voluntary community sectors in England should take it into account
clinical guidelines	Not subject to a mandatory requirement regarding funding The health departments in England and Wales may choose to issue advice to the NHS on their implementation
technology appraisals	The Secretary of State has directed that the NHS is required to provide funding and resources for medicines and treatments recommended by NICE through its single and multiple technologies appraisals It is normally enforceable three months from the date of publication of each technology appraisal Where it is not possible to acquire the technology or where, for other reasons, the intervention cannot be applied within the three month period, the period may be extended. For example, because insufficient trained staff are available Extensions are granted by the Secretary of State on advice from NICE
interventional procedures	Not subject to a mandatory requirement regarding funding Health care organisations should protect patients by following NICE interventional procedures guidance as outlined in the Department of Health's 'Standards for better health' (2004) Enforceable by the Care Quality Commission, and the NHS Litigation Authority takes adherence into account in risk assessing NHS Trusts
medical technologies	Not subject to a mandatory requirement regarding funding

NICE quality standards and quality and outcomes framework

Where NICE guidance applies for quality standards and quality and outcomes framework schemes:

Country	Which NICE guidance applies
England	quality standards quality and outcomes framework
Wales	quality and outcomes framework
Northern Ireland	quality and outcomes framework
Scotland	quality and outcomes framework

Applying quality standards and the quality and outcomes framework

Type	Is it legally enforceable?
quality standards	The NHS is expected to use them to plan and deliver services as part of a general duty to secure continuous improvement in quality
quality and outcomes framework	Voluntary GP practices can choose not to participate or they can choose not to work towards certain areas or individual indicators NICE does not issue indicators to the NHS. It makes recommendations to negotiators acting on behalf of the British Medical Association and NHS Employers who decide which indicators to use

NICE supports effective public health practice

NICE public health guidance is not only used by people in the NHS. The audience for this guidance includes people working in:

• local government
• education
• public utilities (such as gas and water companies)
• the private sector
• the voluntary sector
• central government developing public and social policy

Our guidance helps all these people make decisions that are based on evidence.

NICE supports effective clinical practice

NICE and the National Service Frameworks (produced by the Department of Health) set clear national standards for NHS services and treatments. In 2004 the Department of Health published ´Standards for better health´, which sets out how NHS organisations should respond to NICE guidance.

Medicines and devices

NICE does not license drugs or devices. The Medicines and Healthcare products Regulatory Agency (MHRA) advises the Secretary of State for Health on which drugs and devices should be available for use in the UK. It makes sure that medicines, health care products and medical equipment are safe and do what they are supposed to do.

Most licensed drugs and devices are assessed at a local level within the NHS, to decide whether local hospitals, GPs and health organisations should make them available. NICE is asked to appraise significant new drugs and devices to help make sure that effective and cost effective products are made available to patients quickly and to minimise variations in the available of treatments. While a drug or device is being appraised by NICE, NHS organisations should make decisions on its use locally, using their usual arrangements. Once national guidance has been issued by NICE, it replaces local recommendations and promotes equal access for patients across the country.

NICE and the Health Development Agency

NICE was preceded by the National Institute for Clinical Excellence, which was set up in 1999 and also known as NICE. The functions of another NHS organisation, the Health Development Agency (HDA), were transferred to NICE on 1 April 2005. Read more about the HDA.

Further information

• NICE annual report
• Secretary of State´s speech launching NICE
• Directions from the Secretary of State
• Faster access to modern treatment
• A first class service: quality in the new NHS
• Framework document
• Speech to St Paul Healthcare by Professor Sir Michael Rawlins
• Background information on legal status of the Institute and its guidance