The National Institute for Health and Clinical Excellence has had its integrity upheld after fending off its first High Court legal challenge.

The National Institute for Health and Clinical Excellence has had its integrity upheld after fending off its first High Court legal challenge.

The organisation's victory over its decision not to recommend the use of certain drugs to treat Alzheimer's disease was seized on as a sign that its processes were fair.

But primary care trusts have called on the watchdog to improve the way it communicates with the public over the need to provide drugs that are cost effective.

Their warning was followed by an admission to HSJ by NICE chief executive Andrew Dillon that some of its board members were not supportive of a previous pledge by the institute to hold its committee meetings in public.

Last week's case was brought by drugs firm Eisai and saw five complaints against NICE thrown out. One count, that it breached race and disability anti-discrimination duties when drawing up its guidance, was upheld.

Chris Ham, professor of health policy at Birmingham University's Health Services Management Centre, said the result showed NICE was 'rigorous in its methods'.

'It all comes down to the decision-making process and how fair and transparent that is. All the evidence so far suggests they did very well in that respect.'

And Professor Stirling Bryan, who sits on NICE's appraisal committee, proclaimed the outcome as a 'strong endorsement for the processes that NICE have put in place'. The decision should give the institute fresh confidence, he said.

If Eisai's appeal against the ruling failed and the ongoing Commons health select committee investigation into NICE was broadly positive, NICE's reputation would be further enhanced, he added.

Bolton PCT acting chief executive Tim Evans said the decision had staved off a return to a 'free-for-all' where those who shout the loudest get the most and those who are least able to shout get the least'.

Birmingham East and North PCT chief executive Sophia Christie said NICE's involvement in the row over breast cancer drug Herceptin had made its job more difficult. 'It puts the onus on all of us as public servants to be having the debate with the public about the importance of cost effectiveness,' she said.

Liberal Democrat health select committee member Sandra Gidley sounded a warning over signals from NICE that it might not honour a pledge made by NICE chair Sir Michael Rawlins to the health select committee in May that it would hold meetings in public.

NICE chief executive Mr Dillon told HSJ this week that the proposal needed approval from its board. While he supported it, others had concerns it would not 'allow the debate to be unfettered, for all the issues to be explored and for people to express their real views'.

Nick Bosanquet, professor of health policy at Imperial College London, said although the decision might strengthen NICE in the short-term, it was not equipped to be an efficient rationing body.

'It raises the question about how far NICE can take on a rationing role, irrespective of what is happening in the health service as a whole. If the NHS is riddled with inefficiency and waste it's ludicrous for NICE to be rationing a few drugs on the fringe.'

The Alzheimer's Society and Shire Pharmaceuticals were registered as interested third parties in the legal challenge. The drugs under consideration were acetylcholinesterase inhibitors. These include donepezil, marketed as Aricept.

Eisai's allegations included that NICE did not appropriately take into account the benefits the drugs bring to carers, nor accurately reflect the costs of long-term care in its calculations.

The court found that NICE did breach its duties under the Disability Discrimination Act and the Race Relations Act by not offering specific advice regarding people with learning disabilities and people for whom English is not their first language.

Mr Dillon said: 'The point about compliance with the anti-discrimination legislation is very important and I wouldn't diminish that.'