Commissioning guides could be produced for every decision made by the National Institute for Health and Clinical Excellence, its chair has said.

Professor Sir Michael Rawlins said NICE would be willing to produce the guidelines if managers found them useful, which would expand the organisation's role.

When it was founded in 1999, NICE was specifically barred from having any role in implementation.

But Sir Michael said in December 2006 that NICE 'should spend more on implementation than guidance'. The institute has already published five pilot guides.

Talking at the King's Fund last week, he said a small amount of extra funding would allow NICE to issue implementation guidance for all decisions.

He said every time a guideline is produced 'a commissioning guide would follow in days, advising commissioners of what they should be purchasing for the community'.

Embracing implementation

Sir Michael said it had 'become apparent that we couldn't just divorce ourselves' from implementation. Work was now being carried out through NICE's implementation directorate, which receives 14 per cent of the institute's budget, he said. Ten more implementation guides are due to be published this financial year.

Sir Michael also addressed the controversy around NICE's work at last Thursday's discussion.

He said while technology appraisals 'get all the media hype', it is clinical guidelines that 'will really make the big difference'.

Speaking about the institute's appraisals, he said the public had to understand that the NHS did not have a 'bottomless pit' to fund new treatments.

Sir Michael added: 'Twenty years ago, politicians were not honest with people about it. They pretended it was possible for everything to be done. It wasn't then and it certainly isn't now.

'Politicians are being much more straight about this now and I hope this will gradually get through to some sections of the media and the public that we have to make difficult choices.'