NICE 10 years on: past, present and future
The National Institute for Health and Care Excellence (NICE) is 10 years old. Since its inception, NICE has frequently hit the headlines, and is now a familiar name to most people across the UK. NICE has even gained recognition abroad, with many countries considering NICE as a template for similar organisations in their healthcare systems.
But why was NICE established, and how has it grown and changed in the last decade?
In 1999, NHS healthcare, as in many developed countries, was seen to be a ‘postcode lottery' where there was inappropriate variation in the quality of care and unequal access to new treatments, depending on where you lived. In response to this inequality, the government decided to form an organisation to improve the quality of care that patients receive from the NHS in England and Wales, and allow everyone equal access to treatments and care.
NICE was launched on 1 April, 1999 by Frank Dobson, then Secretary of State for Health, with Professor Sir Mike Rawlins, an eminent doctor, appointed as chair.
NICE was intended to be, and indeed remains to this day, independent from political influence. Once a topic is referred to NICE by the Department of Health, the guidance is developed by independent advisory bodies, whose members come from the NHS, universities, patient organisations and industry.
The task set was not easy, and raised some difficult issues. When NICE was first established, many perceived its only role as rationing healthcare. But this was not the case. NICE was, in simple terms, responsible for improving the quality of care that patients receive from the NHS within the limited resources available to it. In other words, ensuring ‘value for money'.
But NICE sits at the heart of a contradiction. Many people rightly believe that the money available for the publicly-funded health system should be spread to the greatest benefit. At the same time, many are uneasy about costs being taken into account when individual treatment decisions are being taken.
To make these difficult decisions, NICE was to assess clinical effectiveness (how well a treatment or health intervention worked) and cost-effectiveness (how well a treatment works relative to cost). It would then distribute this guidance to healthcare professionals working in the NHS.
NICE's technology appraisal guidance, such as those involving pharmaceutical treatments, are mandatory for the NHS. Every local healthcare body is legally required to provide funding for the new treatment within 3 months of its approval by NICE. Other NICE guidance, such as its clinical guidelines, is exactly that - guidance. However, all NHS professionals must take the advice into account when deciding upon treatments for their patients and NHS trusts are measured on whether they are delivering high quality standards across a range of areas, including NICE clinical guidelines.
Growing and developing
The role of NICE has expanded over the years. Beginning with just one guidance programme (technology appraisals), it now has four main guidance programmes:
- technology appraisal guidance, which covers new pharmaceuticals, procedures, devices, and diagnostics methods
- clinical guidelines, which provide advice about the totality of care for a patient rather than just one part (as is the case with technology appraisals guidance)
- interventional procedures guidance, which covers invasive therapeutic and diagnostic procedures
and since 2005
- public health guidance, which covers activities, strategies or policies for improving health and preventing disease (for example, the most recent public health guidance involved long term sickness absence, and advised employers on how to support employees returning to work).
In the last decade NICE has issued nearly 600 pieces of guidance in all of its programmes and is the most prolific developer of clinical guidelines in the world. The first clinical guideline NICE produced, on the management of schizophrenia, is considered the international gold standard and has been adopted in Spain, Italy, Australia and California.
NICE recognised from the outset that its success or failure would ultimately depend on the rigour of its guidance development processes and also that it would need to harness the knowledge and skills of a broad range of individuals and organisations and engage in partnerships with universities, patient organisations, pharmaceutical manufacturers and healthcare professionals. Many thousands of people have contributed to the development of guidance and have helped shape NICE's national and international reputation.
Over the last decade NICE has continually looked at ways to improve its decision-making process. For example, in 2002 it announced the formation of the Citizens Council - a standing committee made up of 30 members of the general public. The role of this body is to reflect public opinion in the guidance that NICE publishes and to ensure that social values are incorporated into the decision making process.
What lies ahead for NICE?
NICE is undertaking a range of new activities, as well as expanding its existing programmes. The first, and probably most ambitious, is NHS Evidence. Launched at the end of April, NHS Evidence will be a world first in delivering evidence to the NHS and the wider community. This web-based service will allow healthcare professionals and the public to search for the latest quality assessed healthcare information. As well as including NICE guidance, the service will incorporate content from other validated national and international sources.
Another new initiative, NICE Quality Standards, will define more precisely than ever before the care that patients can expect to receive. Information will come from NICE clinical guidelines and will be developed in close conjunction with healthcare professionals. The service will also allow NHS staff to assess the level of service they are providing.
And NICE will take on the role of advising on new indicators for the NHS Quality and Outcomes Framework (QOF), which provides performance indicators and incentives for primary care organisations in the NHS.
NICE has weathered the storms of the last decade and has emerged to become an indespensible part of the healthcare landscape in the UK. It has surpassed all expectations. Asked privately, in 1999, whether NICE would work, Frank Dobson famously replied:
“Probably not - but its worth a bloody good try.”
Ten years on, he said: “NICE has established a worldwide reputation for authoritative advice and guidelines. By the nature of its work NICE cannot always be popular, but the expertise and dedication of the staff are widely respected in Britain and around the world. Well done.”
The current Secretary of State for Health, Alan Johnson, highlighted the benefits that NICE has provided, saying: “Since it was established in 1999, NICE has ensured not only that many thousands of patients benefit from access to the latest treatment but also that the taxpayer gets value for money.”
This page was last updated: 12 July 2010