National guidance agencies do not enhance the NHS but distort the allocation of resources, say academics

September 27, 2001

Wrong SIGN, NICE mess, is national guidance distorting allocation of resources? BMJ Volume 323 pp 743-5

In a report in this week's BMJ, the NHS guidance agencies come under fire for distorting the allocation of resources and not contributing to the performance and effectiveness of the Health Service.

The system in Scotland is criticised for having two competing agencies, the Scottish Intercollegiate Guidelines Network (SIGN) and the Health Technology Board for Scotland. And another agency, the Scottish Medicines Consortium is soon to be set up.

In England and Wales one agency exists, the National Institute for Clinical Excellence (NICE). The remit of the above agencies includes ensuring that patients receive the highest levels of care, that postcode rationing is reduced and that the NHS performs as cost-effectively as possible. However, SIGN has not even started to consider cost effectiveness. NICE has done this but is reluctant to advise against funding many costly new drugs. Neither agency is up to the job of informing the public and government about the 'hard choices' about the rationing of scarce health resources.

The authors of the paper make various suggestions to improve the current ' muddle' and find a way forward:

NICE should become a national healthcare rationing agency, with SIGN and the other Scottish agencies complementing this activity. NICE needs to start saying 'no' to costly and relatively cost ineffective new drugs and devices. NICE should prioritise national guidance within a fixed growth budget for new technologies. NICE should be given the option that national guidance is inappropriate for some technologies, if reducing postcode prescribing would compromise other goals relating to equity or efficiency.

All those involved in rationing health care in the UK, be they politicians who promise more than can reasonably be delivered or practitioners who deal with such choices in their everyday work, need to be more focused and explicit if this ambitious rationing agenda is to avoid muddle and damage to patients, they conclude.


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