The National Institute for Health and Clinical Excellence (Nice) is an organisation that does a generally laudable and necessary job. It has none the less acquired a bad name. This is a case where both aspects of its reputation are valid.
When Nice was established almost 10 years ago, a central part of its brief was to end the so-called postcode lottery, according to which patients in some parts of the country received treatment or drugs free that had to be paid for or were simply unavailable to patients elsewhere. New drugs were held up against rigorous cost-benefit standards before being approved for prescription on the NHS.
Quite soon, however, Nice came to be widely seen less as a guarantor of fairness than as a miserly gatekeeper charged with curbing the state's ballooning drugs bill.
Public opinion began to turn when some patients, terminally ill with cancer, were denied expensive new medicines that might have extended their lives. That some of these drugs were available to patients in Scotland, and were standard issue to patients elsewhere in Europe, prompted resentful questions about the speed of Nice's procedures and the criteria determining its decisions.
The Chairman of Nice, Sir Michael Rawlins, has now heralded some welcome changes in the way the organisation works. The approval process, he says, will be speeded up and a new, more flexible approach to prescriptions will be considered for those who are terminally ill. "We appreciate," he said, "that these extra weeks and months can be very special." He said that in these cases what he called the "threshold range of cost-effectiveness" could be extended.
And a very good thing, too. The chief problem with Nice is not – as many critics maintain – its very existence, but the rigid formulae to which it works, its preoccupation with procedure, and what might be termed its managerialism. Cost-benefit calculations are valid and desirable, but they are not immutable. Nice's decisions affect real human beings and their families. Common sense and humanity belong in there, too. Nice is needed, but 10 years after its foundation, it must be Nice with a human face.Reuse content