Lord Hunt stands firm on NICE's remit

The extra resources being ploughed into the NHS should leave enough cash to fund guidance from the National Institute for Clinical Excellence - without distorting clinical priorities - junior health minister Lord Hunt insisted last week.

He was addressing the Commons health select committee, during a tough session that also examined the impact of NICE on the finances and workload of the service, the quality of its appraisals and its willingness to engage with stakeholders.

Lord Hunt had an uncompromising message for health authorities that had told the committee in previous sessions that NICE was distorting clinical priorities because cash was being shifted from other parts of the service to fund its guidance. 'The NHS is receiving increases, ' he said. 'That does not mean we do not understand the pressure. Yes, we are going through the annual agony of the service and financial frameworks round, where everyone is shouting to the hilltops. But with the additional resources the NHS is receiving, there is enough money to fund the impact of the NICE guidance as well as the priorities that we have established.' It was the 'normal business' of managers having to 'juggle competing pressures', he said.

Answering concerns that NICE would be overwhelmed by the amount of guidance coming from the institute, Lord Hunt said one consideration was 'how many guidelines individual hospitals can implement over a specific period of time, but if the NHS can cope, then we may up the number of guidelines in the future'.

The committee heard that with NICE's current capacity, there would be 40 appraisals a year and 15-20 guidelines over a two-year period.

The session then turned to the operational style of the institute, which has been criticised for acting like 'an old-style consultant' and 'unresponsive' to criticism.

The British National Formulary and the Drug and Therapeutics Bulletin has questioned the quality of NICE guidance and found the institute unwilling to engage with its concerns.

Lord Hunt stressed that NICE is an open organisation, but he would encourage it to enter 'a closer dialogue' both with the BNF and DTB as well as other stakeholders. He addressed complaints that NICE had only assessed the effectiveness of specific drugs without taking into account alternatives.

Lord Hunt said: 'We can move now from a very narrow remit to make comparisons with a class of drugs. If you have to do a class of drugs, that takes more time, and that limits the number of appraisals we can undertake.'

The government has begun three months' consultation on the way in which topics are selected for NICE appraisal. The document proposes broader membership of NICE's technologies advisory committee.

www. doh. gov. uk See letters, pages 22-23.