NICE responds to Health Select Committee report
NICE has a vital role to play in prioritising the use of scarce resources within the NHS, according to the Health Select Committee's second report into the work of the Institute, published in January. The Committee also made a number of recommendations on how it believes NICE could improve its way of working.
What did the report say?
The committee recommended that:
- NICE should evaluate all new medicines at the time of licensing using a quicker, less thorough, process which is based on a lower than normal cost-effectiveness threshold and limited consultation. This should be followed by a fully consultative, indepth assessment at a later date, when more evidence of the treatment's effectiveness is available. The second assessment would override the original decision.
- NICE should have access to all the information that the drug regulators (the European Medicines Agency and Medical and Healthcare products Regulatory Agency [MHRA]) have on new health technologies, including clinical trials.
- NICE should examine older health technologies which may no longer be clinically or cost effective.
- Its new health technology assessment decisions should take into account the wider costs to society.
How has NICE responded?
The Institute welcomed the committee's acknowledgement that it plays a vital role in the NHS and is committed to encouraging informed debate about how to get value for money in healthcare. However, it pointed out that:
- The proposals for drug assessments would not allow for sufficient scrutiny of the available evidence, nor sufficient consultation with stakeholders. More patients may be denied clinically effective treatments due to the lower QALY threshold - and the process might lead to more judicial reviews.
- The MHRA already shares information on potential drug safety issues.
- NICE does undertake activities to increase and encourage disinvestment in ineffective practice. This has included a review of UK medical technologies and practices, using the Cochrane library to identify those which should no longer be used. It also publishes monthly ‘recommendation reminders' for clinicians to reinforce the message about not using outdated treatments. In addition, NICE clinical guidelines are supported by guides to help commissioners select the most effective services.
- The current assessment process is determined by statutory guidelines which govern the way the Institute operates. These would need to be altered by parliament before NICE could take into account any wider societal costs.
The report's recommendations are not mandatory. However, the government responded within the 60-day time limit and NICE is now working closely with the Department of Health to review areas where action has been agreed.
Select committees are parliamentary organisations consisting of a group (usually 11) of MPs from all parties who check and report on the work of government departments and their associated public bodies. The committee focused on NICE because of the changing environment within which the Institute now operates (in particular, the rising cost of new drugs and the increased attention it is getting from both the media and the general public). The committee also wanted to find out what is behind the forceful criticisms frequently levelled at NICE.
It received evidence from 31 oral witnesses and written statements from a further 124. It also visited similar organisations in Scotland, France and Canada.
For the Health Select Committee report go to:
For the Institute's full response go to:
This page was last updated: 24 June 2010