The National Institute for Health and Clinical Excellence has been in the political spotlight recently, with the Coalition Government looking to radically change its role. This month we welcome a guest contribution to our Medical Update from Roger Evans, Assistant Editor, Nursing Standard on the future of NICE.

The Government’s stance on the National Institute for Health and Clinical Excellence (NICE) is puzzling. The July white paper, “Equity and Excellence: Liberating the NHS”, looked to broaden the role of NICE through developing quality standards for health and social care. But the announcement of a £200m cancer drugs fund undermined NICE, as well as favouring one particular patient group.

To the relief of big pharmaceutical companies and patient groups lobbying on specific conditions, NICE will no longer be able to reject new medicines for use in the NHS. But far from simplifying the regulatory process, dismantling this part of NICE’s role will complicate matters.

NICE provided a balance to the power of pharmaceutical companies and created an objective method for assessing value for money. Its processes have been independent of Government and lobbyists, and its decisions have been based on cost-effectiveness and clinical need.

The restructuring of NICE raises the spectre of a ‘postcode lottery’ for expensive drugs. Giving individual GPs and GP consortiums the power to decide what drugs should or should not be available locally will lead to geographical disputes over access to treatment.

With the removal of patient boundaries, patients could end up moving from one GP practice to another trying to get the best treatment for their condition.

GPs will not wish to restrict access to new treatments for their patients, but they will bear the brunt of the Health Service’s need to save £20bn by 2014. Despite the rationing of care being at odds with the GP role of patient advocate, GPs will no longer be in a position to blame a third party when they say no.

RPC Comment

Although NICE has been seen by many as a way of rationing treatment, recent figures have suggested that it may have had the opposite effect, with NHS spending on drugs increasing substantially. Previously, challenges to decisions made by NICE were brought via the courts by way of judicial review and there was the advantage of one national decision being made by NICE and either upheld, quashed or remitted to NICE for further consideration. The prospect now is of individual decisions on drug availability being made by GPs who will be unlikely to have the depth of resources to review and approve medicines for NHS use. There is likely to be a much wider range of decisions made which will, in turn, lead to a greater number of similar cases being rushed before the courts. These will raise complex arguments, some no doubt under the umbrella of the Human Rights Act. There may be reduced clarity for general practitioners and patients alike.