A Short History of NICE
The Centre’s annual lecture, in November 2016, was on the history of NICE (National Institute for Clinical Excellence, now the National Institute for Health and Care Excellence (NIHCE). Nicholas Timmins, a health journalist and Senior Fellow at the Kings Fund, together with Sir Michael Rawlins, former Chair of NICE, and John Appleby, have recently published A Terrible Beauty A Short History of NICE. The National Institute for Health and Care Excellence (2016)
Nick Timmins gave the lecture, Sir Michael commented and then both answered questions from a large and lively audience. NICE was set up by Frank Dobson, Labour Health Minister in 1999 and he chose the name. Its origins were earlier-in the explosion of the power of medicine after the war and the parallel explosion in the research literature. Archie Cochrane’s famous 1971 Rock Carling lecture, published as Effectiveness and Efficiency (1972) was one of the drivers of cost effectiveness in health services. The health economist Alan Williams, developed the QALY at York. The purchaser provider split arrived and in the late 1980s and early 1990s came the assessment of new pharmaceuticals for cost effectiveness along with the Health Technology Assessment (HTA) Programme.
It also took a political spark to get NICE going. Gerry Malone as Conservative minister of state for health in the mid 1990s had to take a decision on access to beta interferon. Politicians wanted a scheme where ministers did not have to take decisions about the availability of medicines-in the context of the debate about the rationing of health care at the end of the 1990s. NICE was a non political body which took the heat off ministers.
Timmins and Rawlins recounted the later history of NICE and some of the challenges it had faced. In 2005, a delay over a decision on herceptin because of potential political interference produced what they called ‘NICE blight’. In 2008, patients were losing the right to NHS treatment if they paid privately for cancer drugs. David Cameron and Andrew Lansley as health minister created the separate Cancer Drugs Fund, which undermined NICE and persistently exceeded its budget.
NICE, created at a time of expansion under a Labour government, now faced affordability as an issue. The speakers argued that this was a political issue for ministers. There was a danger of ‘mission creep’ for NICE, that it became a rationing body.
It had had its failures, which they recounted. Among them were the assessment of homeopathy. Immunisation had remained with the Joint Committee on Vaccination and Immunisation and had not been given to NICE; our speakers thought that NICE could look at vaccines effectively as much as it could look at pharmaceuticals. Meanwhile, its budget had been cut by 30%. But clinical guidelines had become an ordinary way of life, its director Andrew Dillon had been there since the start, and NICE would live, albeit perhaps reduced in remit, to fight another day.