The announcement of the first list of treatments to be examined by the National Institute for Clinical Excellence has been met by calls for more 'muscle' to enforce its recommendations.
Managers' leaders described the list of 10 treatments to be assessed this year and 11 to be examined in 2000 as 'sensible but ambitious'.
NHS Confederation policy director Nigel Edwards welcomed the list's focus on 'procedures and areas that will affect a large number of people rather than concentrating on the outre and unusual'.
But he said it was 'unclear whether there was adequate funding' to support the 'pace that NICE has set itself'.
'Is NICE going to be able to afford to do all this? It is a very long list,' he said.
Alan Maynard, professor of health economics at York University, said the agenda included some 'enormously ambitious and broad' topics. But it also included a number of treatments that have been subject to NHS reviews, on which further study would be 'a bit repetitive'. He questioned the timetable, which will see NICE producing its guidance 'months before the Commission for Health Improvement gets off the ground' next April.
Mr Edwards also expressed concern at 'what seems to be a mismatch' between the progress of NICE and CHI, which has yet to make any key appointments.
A shortlist of four candidates to chair CHI is believed to have been in existence for some weeks, with an announcement expected soon.
Mr Edwards said trusts 'should be able to react' to guidance from NICE 'without necessarily needing enforcement machinery' from CHI. But he said it would be hard to forecast how well CHI would perform in its role as a disseminator of good practice until it had an 'identifiable person in charge'.
This week the Department of Health announced the creation of an extra 'clinical advisory group' to precede CHI and 'support the NHS in the implementation of clinical governance'.
A spokesperson said the team headed by Aiden Halligan, professor of foetal medicine at Leicester University and head of obstetrics at Leicester Royal Infirmary, would 'set up what CHI is going to do and what form it will take'.
See comment, page 15;
politics, page 17.
Flu drug, Relenza.
Starting autumn 1999
Wisdom teeth extraction.
Liquid-based cytology for cervical screening.
Coronary artery stent developments.
Taxanes for ovarian and breast cancer.
Asthma inhalers for children.
Proton pump inhibitors to treat dyspepsia.
Beta interferon and glatarimer to prevent relapse of multiple sclerosis.
Zanamivir and Oseltamivir for flu.
NICE will also issue guidelines on back pain, pressure sores and schizophrenia.