Select Committee on Health Minutes of Evidence

Memorandum by Newcastle and North Tyneside Health Authority (NC 112)


  1.  This evidence was prepared by Dr David Walker, Acting Director of Public Health, on behalf of Newcastle and North Tyneside Health Authority. The evidence was prepared after consultation with clinicians and managers working in areas directly affected by the work of the National Institute for Clinical Excellence.


  2.  The work of the National Institute for Clinical Excellence has been of general benefit to Health Authorities in their planning and commissioning roles. The principal benefits have been provision of clear guidelines, resolution of post-code prescribing issues and provision of comprehensive analysis of evidence, which is often impossible at local level. The appointment of distinguished and well-qualified senior officers did much to establish the credibility and authority of the organisation. Despite the problems identified below, the organisation is regarded as a valuable resource for Health Authorities.


Providing clear and credible guidance

  3.  Guidance provided by NICE has generally been clear and credible. The website and hardcopy publications are well produced and distributed.

  4.  In some cases there has been a lack of clarity in indicating how recommendations are supported by evidence. This is particularly the case when evidence has included unpublished data. An example of this was the appraisal of Zanamavir (Relenza). The evidence published with the appraisal did not appear to support the recommendations of the Institute. Rather than resolving the issue, this led to an intense debate in the medical press and the questioning of the credibility of the organisation.

Ending Confusion by providing a single national focus

  5.  In the areas addressed by NICE, the recommendations of the Institute are generally accepted as definitive and provide a national point of reference for decision making. This has reduced confusion.

  6.  NICE inherited a challenging backlog of work in addition to emerging problems. There are many outstanding issues that NICE has yet to address and may not have the capacity to address in the future. Priority setting is a key issue for the future.

Providing guidance that is locally owned and acted on in the right way

  7.  There is an inevitable tension between national guidance and local priorities. NICE guidance is based on broad consultation with stakeholders but local Health Authorities, who are required to ensure the implementation of the guidance, are unlikely to be consulted and have no right of appeal against draft appraisals. There is a perception that NICE guidance is imposed rather than locally owned.

  8.  The allocation of funding for the implementation of NICE guidance has not been universally equitable. The uplift to allocations in some parts of England last year, which included a proportion for implementation of NICE guidance, did not take account of the differential use of drugs approved by NICE in different NHS Trusts.

Actively promoting interventions with good evidence of clinical and cost-effectiveness so that patients have faster access to treatments known to work

  9.  NICE guidance is powerful in promoting interventions with good evidence of clinical and cost-effectiveness but may not provide faster access to those treatments. In a few cases the duration of the process has been unacceptably long, for example the use of beta interferon for the treatment of multiple sclerosis. This may result in a polarisation of views which may not be resolved by the publication of the guidance.

  10.  The long duration of NICE appraisals often results in an interim decision being taken by Health Authorities and PCTs. Indeed this is often encouraged by the Department of Health, for example in the appraisal of Glivec. This presents difficulties when the interim decision conflicts with the final NICE recommendation.


  11.  The capacity of NICE for technology appraisals should be increased to reduce the delay between the development of new technologies and the production of guidance concerning their use.

  12.  A fast tracking route for key appraisals should be established.

  13.  Health Authorities and PCTs should be consulted as part of the appraisal process.

  14.  A feedback loop should be established to inform NICE about progress in the implementation of guidance.

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Prepared 8 July 2002