Table 1.

Documents defining the English Health Basket, 2005

Catalogue: type of document, actors and contents					Criteria used for defining benefits
Type of document	Legally binding	Positive/negative definition of benefits	Degree of explicitnessa	Updating	N	C	E	CE	B	Other
Acts of Parliament	Yes	P	1	Irregular, amended by further legislation	+	–	–	–	–	Political judgement ‘necessary to meet all reasonable requirements’
Statutory instruments (SI)	Yes	P or N	1–3	Irregular, amended by further legislation	+	–	+	+	+	Safety
Directions	Yes	P	2	No	+	–	+	–	+	–
National Service Frameworks	No	P	2 or 3	Unclear	+	–	+	–	–	–
NICE technology appraisals	Yesb	P or N	3	Every 4 years	–	+	+	+	–	–
NICE clinical guidelines	No	P	2 or 3	Every 4 to 6 years	–	+	+	+	–	–
NICE interventional procedures	No	P or N	3	Unclear	–	–	+	–	–	Safety
Contracts	Yes	P	1–3	Infrequent-although small amendments more frequent	+	–	–	–	+	–
Waiting time guaranteesc	No	P	2	Irregular	+	–	+	–	–	–
HRG tariffs	No	P	2 or 3	Still evolving	–	+	–	–	+	–
Devices tariff	No	P	3	Monthly	–	+	–	+	+	Safety, quality, appropriateness
Fee schedules	No	P	3	Annually (at least)	+	–	–	–	+	–

N need, C costs, E effectiveness, CE cost-effectiveness, B budget (from [1, 2, 3], DH website (http://www.dh.gov.uk/home/fs/en), HMSO website (http://www.hmso.gov.uk/), expert advice (see Acknowledgements))

^a “Explicit is subdivided as 1: all necessary”; 2: areas of care; 3: items.

^b The statutory duty is upon PCTs to ensure funding is available to facilitate implementation, not upon doctors to adopt the approved technology.

^c The dominant instrument for securing these are performance ratings prepared by the Healthcare Commission.