Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Chief Executive North West Lancashire Health Authority (NC 70)

  I am writing on behalf of North West Lancashire Health Authority to submit comments to the enquiry which you are undertaking into the subject of NICE.

  This Health Authority supports the role and work of NICE in providing clear and authoritative guidance about the effectiveness of particular forms of treatment. We would most certainly wish to see that role continue, and indeed to see the number of evaluations carried out by NICE increased. However, we do have some concerns.

  Firstly we are concerned that the public now expect NICE guidance to be implemented immediately, and funded accordingly. This, together with the pressures to implement National Service Frameworks, mean that local health organisations have little discretion over the use of resources yet are responsible for meeting local needs. The media headline writers lead us to believe that "postcode prescribing" is a bad thing. Their emotive headlines fail to recognise that sensitive local discretion is actually a very good thing.

  Secondly we are concerned that NICE looks at the effectiveness without giving a great deal of consideration to the purpose of the treatment itself. Many positive NICE appraisals have looked at cancer drugs, which are not curative, and which in many cases offer only very short-term benefits. We are aware of many different types of intervention, which can have a great and sustained affect on the quality of patients lives, that are forced into a lower priority position as a result of not having been considered (yet) by NICE. Photodynamic therapy for age related macular degeneration, surgical techniques for the treatment of intractable angina, and neuro-surgical interventions for Parkinson's disease are examples that fall into this category.

  Thirdly we are concerned about the timeliness of NICE guidance. We recognise the fullness of the agenda, but believe that many pieces of guidance are issued only when the treatment (often a drug) has been superseded. In practice this therefore means that many drugs cannot be funded for use in clinical practice until successor drugs have already been licensed.

  In conclusion, while we recognise the value of individual pieces of NICE guidance, we are concerned that little account is taken of the overall impact of NICE guidance on a Health Authority.

January 2002

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