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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 22; 335(7620): 585.
PMCID: PMC1988971

NICE should have bigger role in guiding NHS, says report

The National Institute for Health and Clinical Excellence (NICE) should be expanded to enable it to assess all new drugs and treatments more quickly to set priorities about what care should be provided by the NHS in England and Wales, an independent think tank has recommended.

In its latest report the Institute for Public Policy Research looks at what policies are needed to sustain a high quality health service that is affordable but that also meets the public's increasingly higher expectations of what care should be provided.

It says that there needs to be a clear framework for how health resources are rationed and that the public needs to understand that resources are limited. Otherwise conflicts will be resolved by the courts rather than by NICE, and the public will feel let down.

Primary care foundation trusts should be established to strengthen local accountability and engage the public in making decisions about their local health services, the report recommends.

“It is a nonsense that the secretary of state is accountable for everything that happens in the health service, and there is now a great political will and momentum for devolved public services,” said Jessica Allen, head of health and social care at the institute and one of the report's authors.

“To gain foundation status PCTs [primary care trusts] would have to show they are capable of effective public engagement and ensuring widespread local membership that is not just made up of specialist health lobby groups.”

High expectations for what a public service can deliver is not a bad a thing in itself, says the report, as they “play a vital role in holding politicians and providers to account” and also help drive improvements. But when expectations become unrealistic they can steer the health system in inappropriate directions.

The report cites the examples of people who campaign to keep their local hospital open even when it is not the best or safest use of resources and the government being forced into funding expensive drugs that it cannot afford.

The institute rejects the idea of a core list of treatments: “such lists are relatively blunt instruments and have not proved successful in other countries,” says the report. Instead it recommends increasing resources for NICE to enable it to review all new drugs and treatments promptly to ensure there is “a fair and democratic means of taking decisions about priorities.”

The authors of the report call for Ara Darzi, chairman of surgery at Imperial College, in London, to consider their recommendations in his current review of the NHS.


Great Expectations: Achieving a Sustainable Health System is available at

Articles from The BMJ are provided here courtesy of BMJ Publishing Group