Nice Annual Conference: Money must be made available for NICE guidance, minister says
Authors: Colleen Shannon
Journal: BMJ (2003)

Health minister Norman Warner announced last week that he is taking steps to ensure that health organisations make the necessary financial arrangements for the implementation of the recommendations of the National Institute for Clinical Excellence (NICE).

Since its inception in 1999 NICE has issued guidance on the use of over 200 drugs and treatments. With some exceptions the NHS in England and Wales is required to provide any treatments endorsed by NICE within three months of the institute's decision, but in reality the NHS has struggled to keep up with the pace of the institute's outputs.

Patients' organisations, the drugs industry, and many clinicians have been growing impatient with the slow rate of change. Lord Warner, who has responsibility for NICE, has now promised measures to ensure that patients have faster access to recommended treatments. In particular he wants NHS organisations to improve their financial planning, making adequate allowance for the cost of putting NICE's guidance into practice.

Speaking at NICE's annual conference in Birmingham last week, Lord Warner said: “Although money for implementing NICE technology appraisals has clearly been made available from the centre over the last few years, it may not always have been incorporated appropriately in local budgets. We need to seek better ways of ensuring that in the planning and budgeting processes health bodies are fully aware of the likely impact of NICE guidance over each coming financial period.”

He also envisaged an important enforcement role for the strategic health authorities and for the Commission for Health-care Audit and Inspection, which will formally take on an expanded remit in April 2004.

The minister hinted that the government would countenance a nudge from patients' groups, which could provide information to the public and encourage swift change on a local level.

Lord Warner did acknowledge that the challenge for the NHS has been great. “Have we been realistic about the speed at which NICE guidance can be implemented, given the fact that past development within the NHS has not always been at the same pace?” he asked. “As a newcomer in this area, it has struck me that—for example, in the case of clinical guidelines—the number of things to be done may be seen by some as rather overwhelming.”

He suggested that NICE could target different guidance at different segments of the health service.

Commenting on Lord Warner's comments, John Appleby, chief economist at the health think tank the King's Fund, told the BMJ that primary care trusts had “no financial excuse” for failing to comply. “There are some PCTs [primary care trusts] who are just overcommitted with other things. They haven't fully estimated the impact of the guidance for them in their area, but the only comeback to that is that they should,” he said.

But Nick Bosanquet, professor of public policy at Imperial College, London, defended trusts' tardiness on implementation: “Often NICE guidance is conditional in that it requires diagnostic tests, screening of patients, special clinics. It's often difficult to organise those quickly, because there is already a queue for these facilities. It's wrong to heap all the blame on PCTs.”




Figure 1





Lord Warner: “Have we been realistic about the speed at which NICE guidance can be implemented?”

Credit: RUI VIEIRA/PA




He also said that the government should wean itself off prioritising extra funds for acute services and should strengthen primary care budgets instead.