The contribution of NICE to effective cancer care
Andrew Dillon
National Institute for Health and Clinical Excellence, UK
Health care systems across the western world share the problem of inappropriate variation in the quality of care. The problem stems from the combination of an explosion in medical knowledge and a mismatch between demands and resources for health care. The goal, however, is much the same wherever evidence is used to inform clinical practice decisions: finding the optimal use of health interventions and approaches to care with the aim of delivering good quality care equitably. To help achieve this aim, NICE provides independent and objective advice to patients and health professionals. NICE has three clinical programmes: appraisal of individual health technologies; development of disease and condition based clinical guidelines and the assessment of the safety and efficacy of interventional procedures. In 2005, two public health programmes were added. All these programmes have made a contribution to guiding improvements in cancer care. Although controversial when they target use in specific patient groups, most of our cancer drug appraisals find value in new treatments and the recent surveys by the National cancer Director make clear that they improve access to these treatments for the patients who need them. Cancer care routinely requires health professionals to work together, often across organisational boundaries. Our cancer service guidance and clinical guidelines offer evidence-based approaches to effective care pathways, designed by multi-disciplinary groups whose members are work in the field in their day to day practice. Of course, the use by the Institute of cost effectiveness in recommending treatments is sometimes controversial in that it addresses explicitly the need to value clinical outcomes in an economic as well as a clinical dimension. Assessments of clinical and cost effectiveness necessarily involve both scientific and social value judgements. The approach taken to social value judgements is being informed by the views of ordinary citizens in the UK through a representative Council. The Institute’s guidance is not an instruction to practice and therefore its success depends heavily on the cooperation of individuals and organisations inside and beyond the NHS. Recent surveys show that NICE has the general support the NHS and that is improving the quality and consistency of care.
Declaration of competing interest: The author is the Chief Executive of the National Institute for Clinical Excellence whose guidance is referred to in this abstract.
