NICE needs sweeping changes to maintain credibility, say MPs

The National Institute for Clinical Excellence (NICE) should think more broadly and adopt more rigorous processes to avoid “serious damage” to its credibility, according to the first independent evaluation of the institute's work.

A cross party committee of MPs has unanimously commended NICE's efforts in a “highly contentious” area, but it has called for sweeping changes in the way it works and has urged government commitment to develop a robust rationale for prioritising healthcare spending.

The House of Commons health select committee's report, launched on Wednesday, urged NICE to establish robust mechanisms to ensure closer collaboration with respected publications such as the British National Formulary and the Drug and Therapeutics Bulletin.

“To neglect the input of respected bodies such as the Drug and Therapeutics Bulletin and the British National Formulary is to miss a key opportunity for quality assuring NICE's work and risks serious damage to the credibility of its guidance,” the report says.

NICE must have the funds and remit to think bigger, the committee concluded. Instead of appraising an individual drug or intervention in isolation, it should “fundamentally shift” its emphasis towards treating specific conditions or advising on a whole class of drugs. The committee backed the Kennedy report's recommendation that NICE should develop guidelines for all major causes of mortality and morbidity under a more inclusive and transparent “topic selection” process. There should be clearer cross referencing between technology appraisals and guidelines, clearer links with national service frameworks, and clearer communication to the NHS of the legal obligations to follow such advice, it said.

The report's 32 recommendations reflect many of the criticisms made by clinician witnesses during the inquiry. The editor of the Drug and Therapeutics Bulletin, Professor Joe Collier, who advised the committee on the inquiry, described the report as “excellent” and “thoughtful.”

The committee took note of the Cochrane Centre's concern that NICE withholds much of the supporting evidence for its appraisals because drug companies supply the information in confidence. In future, all evidence submitted to NICE should be available for public scrutiny, the committee advised. The Association of the British Pharmaceutical Industry should develop guidelines with NICE on what clinical information its members must routinely share with NICE and what they must supply on request, it said. In addition, the association should make this sharing of data a condition of membership.

Dr Trevor Jones, director general of the Association of the British Pharmaceutical Industry, said the trade body would consider making its members comply with the guidelines as a condition of membership, but only if the idea was feasible. “I don't think it's going to be possible to prescribe in detail what companies would have to submit, but there could be some core information that we might be able to identify,” he told the BMJ.

Alluding to concerns that NICE has become the scapegoat for controversial rationing decisions, the report described prioritisation of healthcare spending as an issue of “overwhelming importance” that demands more open debate.

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Michael Rawlins, chairman of NICE