Success was in the air. Delegates at the second annual conference of the National Institute for Clinical Excellence had even heard talk of a cultural shift taking place in the NHS. All that was needed was a rousing speech from the health secretary to rally the troops. And rally them he did.
Rally them round the flag, actually.
Although it had initially sounded as if health secretary Alan Milburn had forgotten to write a speech and brought along the last one he had used, a couple of policy announcements later and he was wrapping himself in patriotism.
Mr Milburn was proud to announce that, 'the NHS is a quintessentially British organisation based on quintessentially British values. Those who attack the principle of the NHS attack the gut instincts of the British people. . . The Bismarckian system of healthcare may be right for Germany. The NHS is right for Britain.'
Mr Milburn announced in his speech that NICE had been asked to review the evidence on fertility treatments, although this news had been trailed by the BBC that morning and seemed to catch NICE on the hop. When HSJ had asked NICE chair Professor Sir Michael Rawlins about the BBC story, earlier in the day, he denied that he knew anything about it, albeit with a grin on his face.
He admitted the institute had been in talks with the department about the guidance, but the timing of the announcement appeared to have taken NICE by surprise.
Mr Milburn also announced the introduction of 'explicit monitoring so that we know that every health authority and NHS trust is taking full and proper account of each NICE appraisal'. The Commission for Health Improvement will incorporate NICE appraisals into its clinical governance monitoring.
The meshing together of NICE, CHI and the clinical governance support team was a clear theme running through the conference, and CHI chief executive Peter Homa was confident that its programme of reviewing every health organisation within four years would be accomplished. Reviews of primary care trusts will be included in this process, but will come in at a later date.
Professor Rawlins told the conference that ministers had never influenced the decision-making process of the institute, although 'guidance from ministers on the resources available' is one of the six criteria NICE used to appraise individual technologies (see above). He also admitted that restricting the availability of provisional and final appraisal determinations had not worked. The decision to release provisional papers 'has, I know, not pleased the healthcare industries, but the present arrangement is unsustainable'.
On the question of cost, he said when it came to saying a treatment was not cost-effective, 'we are not afraid to be honest'.
Professor Rawlins said that 'those who had claimed that NICE's advice would be ignored by clinicians and health authorities have also been proved wrong'.
He said: 'Overall, there has been little substantive criticism about the rigour of the advice we have produced.'
When asked why NICE could not review all the various drugs and treatments on offer for a particular disease or condition, Professor Rawlins said: 'The real problem is that we don't have enough capacity. It is not financial, it is expertise.'
NHS director of clinical governance Professor Aidan Halligan gave the conference a remarkably upbeat assessment of the progress of clinical governance in the NHS: 'For some remarkable reason a cultural shift is happening. We are moving towards a patient-centred health service. What is becoming clear is that we need a lot of data.'
But he pointed out that this could be a problem, and that the NHS has five times as much data as the Pentagon.
Professor Halligan said that almost 200 trusts had already been involved in the clinical governance programmes run by the NHS support team.
The session on the experiences of those who had been involved with NICE had heard calls for more ringfenced funding to ensure that all areas could implement NICE guidance, rather than have to agonise over financial difficulties. Professor Rawlins told HSJ that he did not accept this argument, however.
He said it was the responsibility of HAs to plan for contingencies such as the recommendations of NICE, and blamed poor financial planning if HAs and primary care groups could not cope.
Mr Milburn also argued against separate funding when questioned about this. 'We have been very clear to health authorities that one of the very first calls on money this year is to use it to fund NICE recommendations.'
Despite much postive talk, the work of NICE is not all plain sailing. Initial results from the first four pilots of CHI's clinical governance audit have shown that although work is being done to develop policies, these have had little impact on clinical outcomes.