Clive Jackson, Director of the National Prescribing Centre

The National Institute for Clinical Excellence (NICE), one of the key creations of the far-reaching White Paper The New NHS, should become the cornerstone of Government policy to raise healthcare standards and iron out unacceptable local variations.

There had been much speculation about NICE's role. With the launch in July, of the DoH's consultation document on quality A First Class Service some welcome flesh was put onto the bones of NICE.

We now know that NICE will be a statutory body i.e. a special health authority – similar to the Prescription Pricing Authority (PPA). It will, therefore, have its own chairman, chief executive and board, who will be supported in their work by a Partners' Council – a body drawn from a wide range of people and groups involved in healthcare.

But what is NICE aiming to achieve? The simple answer is to promote and support clinical and cost-effectiveness in healthcare. This will be delivered through the production and dissemination of evidence-based clinical guidelines linked with associated clinical audit methodologies and information on good practice.

In its work, NICE will draw on, and bring together, the expertise that has been developed in a range of professional bodies and respected national organisations such as the NHS Centre for Reviews and Dissemination (NCRD) and the National Prescribing Centre (NPC). Its programme will be agreed with, and funded by, the DoH.

In future, local professionals and decision-makers in the NHS can expect to have clear national guidance on the most appropriate use of selected healthcare technologies and interventions. It is important to recognise that this does not just mean drugs. For example, surgical and diagnostic devices or techniques are expected to be given an equal prominence when prioritising topics for NICE guideline production.

Once produced and disseminated, the DoH will "expect the guidance produced by NICE to be implemented consistently across the NHS". It would, however, seem reasonable for an element of local interpretation and decision making to be required for their effective implementation.

Assembling national guidelines for new technologies, not to mention assessing older ones, another important aspect of NICE's future role, is recognised to be a detailed and lengthy process. NHS professionals and managers should, therefore, have time to develop local frameworks to incorporate and implement such guidelines into healthcare planning and delivery. Clearly, a significant portfolio of new, nationally generated or endorsed NICE guidance will not become available overnight for major healthcare interventions.

In the medium term therefore, a range of high quality, evidence-based guidelines, currently available from other respected sources, seem likely to continue to have an important role to play in the work of the NHS.

There is a need to acknowledge that the future roles of many existing bodies will be affected by NICE, and that no-one as yet knows exactly how much influence over the delivery of healthcare, in general, the new Institute will exert.

For our part, at the NPC, we welcome the development of NICE and are looking forward to evolving further as an integral part of this new and exciting agenda.

Finally, NICE's work will ensure the NHS gets optimum clinical benefit, out of both new and existing technologies, in a cost-effective manner. Similarly, it will also ensure that interventions of little or no proven value are removed from routine use. Together, these two approaches should deliver high quality, up to date healthcare for all patients, and value for money across the NHS.

Guidelines in Practice, November 1998, Volume 1
© 1998 MGP Ltd
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