05 July 2002
The Commons' health committee said Nice recommendations should be accompanied by a departmental decision on whether they should be implemented and guidance on how much they would cost.
Nice investigates the clinical and cost effectiveness of drugs, treatments and equipment for the NHS in England and Wales, and issues recommendations that are usually adopted by the health service.
It does not take account of affordability and NHS managers complain that the extra costs are not funded by the DoH.
Nice's clinical guidelines – such as its backing for sibutramine to combat obesity, which will cost around £19m a year – have added to an already rapidly growing NHS drugs bill. In England, medicines prescribed by GPs cost around £2bn in 1990/91, a figure that rose to £4.85bn in 1999/2000.
The institute's 44 appraisals of technical equipment are estimated to have increased costs by £550m.
Nice has refused to recommend drugs on the grounds that they are not cost-effective, most notably beta interferon for multiple sclerosis. However, in this case the government stepped in and agreed to fund its use as part of a research project into its efficacy.
In its report on Nice, the health committee said decisions on the affordability of the institute's recommendations should be made by the government. This would provide clarification on whether the guidance would be funded and ensure that the recommendation was implemented.
Nice was set up to end the 'postcode lottery' of care rationing, but the committee said the institute's recommendations could have the converse effect.
'There is the potential to give Nice-approved treatments priority over other perhaps equally important treatments and services not considered by Nice,' it added.
Committee chair David Hinchliffe called for a more explicit debate on rationing. 'We have recommended that the government should work to achieve a comprehensive framework for health care prioritisation, underpinned by an explicit set of ethical and rational values,' he added.
Nice chair Professor Sir Michael Rawlins welcomed the report. 'This is an important and positive report,' he said. 'There is much to consider.'
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