National institute for health and care excellence

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While its technical appraisal decisions were effectively compulsory in England and Wales as of 2015, its guidelines and advice may have wider ramifications on international healthcare resource allocation as it has a rigorous process more independent of interest groups than some groups preparing clinical guidelines.

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NICE recommendations do not apply except effectively in the case of interventional procedure guidance. Recommendations from the Scottish Medicines Consortium are the equivalent of NICE technical appraisals for medicines

QuotationMarkLeft.png NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health in England and Wales. On 1 April 2005 NICE joined with the Health Development Agency to become the new National Institute for Health and Clinical Excellence (also to be known as NICE). QuotationMarkRight.pngNICE home page, Feb 2006

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.

See NICE National Institute for Health and Clinical Excellence (NICE).

The Scottish equivalent is the Scottish Medicines Consortium [1] 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?


NICE guidelines

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[2] 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[3]. 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

  • 1999 Primary regulation to become a special health authority called the National Institute for Clinical Excellence. Budget £10m
  • 2000 Established. First technology appraisal published
  • 2001 First clinical guideline published
  • 2003 First interventional procedure recommendation. This responsibility is extended to Scotland.
  • 2005 First public health recommendation. Joined with the Health Development Agency to become the National Institute for Health and Clinical Excellence . Budget £27m
  • 2009 Responsible for quality and outcomes framework (QOF) and NHS Evidence accreditation
  • 2010 First quality standard and medical devices recommendation Budget £74m
  • 2011 First diagnostics recommendation. Budget £70m
  • 2012 New regulation to become an executive non-departmental public body
  • 2013 Recreated as National Institute for Health and Care Excellence now responsible for both health and social care guidance

External links