National institute for health and care excellence
The National Institute for Health and Care Excellence(NICE, formally National Institute for Health and Clinical Excellence, NIHCE ) has a central role in health cost-effectiveness analysis in England and Wales. In 2010 its role further evolved and according to the Secretary of state for health it will be able to give advice about what is the best treatment but it won't be saying 'You must have this' or even less saying no to things. In 2013 it also became responsible for social care guidance.
The Scottish equivalent is the Scottish Medicines Consortium  It is specifically tasked with providing advice promptly on release of a new medicine. It is independent of NICE with regard to medication decisions. Shock and horror may sometimes be expressed if its findings differ from those of NICE. What does independence mean if not the ability to differ if there is some doubt on a matter?
These are not compulsory but local NHS policy implementation should not second guess the guideline and be explicate when resource or other reasons dictate a variance. Doctors working in the NHS are expected to be familiar with relevant guidelines and might be advised in cases open to legal challenge to document their reasons for clinical variation.
NICE interventional procedure recommendations
These have the same status as guidelines except they also apply in Scotland. In England the relevant Heath Service Circular directed that "Any (fully trained) doctor considering use in the NHS of a new interventional procedure which he/she has not used before, or only used outside the NHS, should seek the prior approval of their NHS Trust’s Clinical Governance Committee. If the procedure is the subject of NICE guidance, the committee should consider whether the proposed use of the procedure complies with the guidance before approving it."
NICE technology appraisal recommendations
NICE defines two types of appraisals and both are compulsory to fund and implement in England and Wales with in a defined period. Actually the regulations themselves only refer now to one type of technology appraisal. Less than 10% have such a period extended beyond 3 months :
- Single Technology Appraisal (STA)
- Multiple Technology Appraisal (MTA)
Both require a formal referral by the Secretary of State for Health (Department of Health) to NICE so not every technology will be examined.
NICE highly specialised technology recommendations
Highly specialised technology recommendations can be created since 1 April 2013. These are also compulsory to fund and implement in England and Wales with in a defined period, by default being 3 months.
It was set up as the National Institute for Clinical Excellence (NICE) in 1999 aiming to address one of the historic challenges of the NHS, a marked variation by region in access to more controversial and expensive health care. This was to be approached by the commissioning of national evidenced based guidelines, and a legal requirement for a subset to these guidelines called technical appraisals to be both funded and implemented within 3 months of publication. In Wales a Direction on this legal requirement was issued originally by the Welsh Assembly on 22nd February 2002 and re-issued on the 23rd October 2003. In England the initial direction came into force on 1 July 2003, and has had further annual updates since where mainly an appraisals implementation has to be delayed. On 1 April 2005 it joined with the Health Development Agency to become the new National Institute for Health and Clinical Excellence (still abbreviated as NICE) as a special health authority. Following the Health and Social Care Act 2012, NICE was renamed the National Institute for Health and Care Excellence which came into being on 1 April 2013. It is now an Executive non-departmental public body (ENDPB). reflecting its new responsibilities for social care. It is currently regulated by its own legislation Implementation of its guidelines and other policies is monitored in the public domain. It has been subject to several court challenges itself and to date one court action on how its guidance should be interpreted in formulating local policy. There are by 2015 indications that the funding situation for public health and social care may be delaying implementation of technology appraisals where the responsible commissioner is a county council.
NICE's expanding remit
- ↑ http://www.scottishmedicines.org.uk/smc/CCC_FirstPage.jsp accessed 18th February 2009
- ↑ he National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013
- ↑ [https://www.nice.org.uk/news/feature/court-judgement-what-it-means-for-commissioners-and-providers-and-using-nice-guidance-and-standards NICE view of Thanet CCG judgement 2 June 2014