PRESS RELEASE

NICE present evidence to Health Select Committee

The National Institute for Clinical Excellence is currently the subject of a short inquiry by the Health Select Committee. NICE welcomed the opportunity to share with the Committee its work to date. Select Committee protocol requires that the Institute does not discuss the ongoing inquiry in public until after it has given its evidence to the Committee.

Professor Sir Michael Rawlins (Chair), Andrew Dillon (Chief Executive) and Professor David Barnett (Chair Independent Appraisals Committee) gave evidence on behalf of NICE on Wednesday 30 January 2002. The Institute's written submission was published on its web site on 18 January 2001.

After the hearing Professor Rawlins said: "The primary role of NICE is to improve patient care. We are doing it in two key ways, firstly by the appraisal of individual technologies to encourage the NHS to uptake those that are clinically and cost effective and secondly by the development of clinical guidelines on the management of individual conditions. We welcome the Select Committee's interest in our work as we recognise the value an inquiry can provide to a developing organisation such NICE. It provides the opportunity for parliament to consider the organisation, and its impact on the NHS and the people it serves and we look forward to seeing their report in due course."

NICE informed the Committee that the Institute's arrangements for developing guidance are recognised internationally as being public, thorough and inclusive, unusually both health professionals and patients are intimately involved in the development of guidance. They submit evidence, provide experts and are consulted on provisional and final decisions. NICE makes public the details of who is involved in each piece of work, it publishes declarations of interests and the minutes of meetings in full. It also makes public full details of its work programme; it consults on and makes public drafts of its work at all stages of the process.

After the hearing Andrew Dillon said, " Through our evidence we aimed to show the inclusive nature of our work and just how far NICE has developed over the past two and a half years. NICE guidance is developed by involving health professionals who work in the NHS, and people rely on the NHS. For NICE this means more than simply asking for their views on draft documents, it involves actively seeking evidence from them and providing them with the opportunity to talk directly to our independent Advisory Committees, as the evidence is being interpreted. NICE works with this network of individuals, Royal Colleges, and national organisations to ensure that the guidance we produce adds value to patients.

Professor Barnet said, "I am pleased that previous witnesses have recognised the independence of the Appraisal Committee and the advice we give. We are aware of the impact of our deliberations and take great care to ensure that they reflect the full evidence".

Topic selection had been discussed throughout the inquiry. The Department of Health and the National Assembly for Wales select topics for the NICE work programme. NICE informed the committee that it had been calling for changes to the way the topic selection process works, as this could have real benefits for the NHS and patients. NICE felt that in their discussions they had been pushing at an open door. NICE wants the topic selection process to be more open and transparent, it wants the NHS and patients to be able to suggest topics and it wants technologies referred to it earlier in their development in order that NICE guidance can be made available at the same time a technology is launched.

Professor Rawlins said, "we know these changes would allow us to focus on topics that really are important to patients and the NHS".

Previous witnesses had reported to the committee that NICE had a threshold or a cut off point of £30,000 cost per QALY (quality adjusted life year) above which no technology would be approved. The institute was clear that this was not the case.

Professor Rawlins stated " This was also a great opportunity to again put on public record that the Institute does not have a cost threshold beyond which a technology would be automatically rejected. Despite our clear statements on this subject, the issue of a threshold seems to have become an urban myth, and that is what it is a myth. This myth has resulted from data taken out of context; and inaccurate comments and reporting by individuals who weren't present when I presented a review of the completed appraisals at the Institute's Annual Public Meeting last year".

The Institute commented that it had reviewed the previous evidence sessions and indicated to the committee that a number of the submissions made by witnesses contained misunderstandings and factual inaccuracies. The Institute is sending a summary of these to the committee for its reference. The Institute was also clear that it disagreed with the Drug and Therapeutic Bulletin's (D&TBs) criticisms of its work and would be sending a paper to the committee providing a detailed response to the issues raised. (note in line with its usual practices once the papers have been submitted to the Committee NICE will publish them on its web site).

Andrew Dillon was clear that, "During this process we have noted that there has been both support for and criticism of the Institute and our work. We believe that informed criticism can improve the way we work; however I have been disappointed by the some of the ill-informed comment made to the committee, so we will be submitting a paper that corrects a number of misunderstandings and factual inaccuracies".

"We will also be submitting a paper that makes clear why the institute disagrees with the criticisms made by the Drugs and Therapeutic Bulletin. We will also be correcting the deputy-editor of the D&TB who suggested that NICE had not responded to correspondence on for example the zanamivir guidance; NICE did respond and copies of our correspondence are available."

Ends.

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