Table 1.
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.