Six weeks before the National Institute of Clinical Excellence (NICE) goes live as the arbiter of NHS treatment in England and Wales, the chairman, Professor Sir Michael Rawlins, said the most important thing on his agenda is to gain the early confidence of the health professions, as well as the public and parliament.
Sir Michael appeared before the Commons health committee as the government issued a discussion paper on how NICE intends to proceed. In a foreword, the health secretary, Frank Dobson, states that NICE will sort out the “wheat from the chaff” and protect patients from outdated and inefficient treatment.
Sir Michael was asked about doctors' fears that he would be looking over their shoulders and interfering in their discretion. As a practising doctor, he said, he had some sympathy with that. But clinical guidelines would never encompass 100%of patients. People vary, and some would not fit into guidelines. There would still have to be a lot of professional judgment.
He described the functions of NICE as follows: firstly, to appraise all new technologies for their clinical and cost effectiveness and advise whether they should be in routine use in the NHS or not; secondly, to disseminate clinical guidelines based on clear scrutiny of the scientific literature in a form that is practical and useful to health professionals; and thirdly, to develop and promote clinical audit.
Sir Michael said that the global explosion of medical knowledge and literature was now so great that no doctor could begin to assimilate more than a fraction. Confronted with the 167 guidelines for treating asthma, the average clinician found it difficult to know where to begin.
The discussion document gives details of how the NICE appraisal process will work. Initially it will select about 20-30 new interventions each year for appraisal and recommend which are suitable for routine clinical use in the NHS.
The document, Faster Access to Modern Treatment, is being sent to wide range of professional groups for comment by 19 March.