Select Committee on Health Minutes of Evidence

Examination of witnesses (Questions 80 - 87)



  80. That really is most, most important.
  (Dr Riley) I agree.

Julia Drown

  81. One further thing on the funding and the relationships. How many public health departments do their own work on clinical effectiveness- and there does not seem to be much co-ordination of that across the country. Does your role include trying to direct that research and achieving better co-operation around the country? What will be the relationships between public health departments and NICE?
  (Professor Sir Michael Rawlins) There should not be any need to have 70 health authorities making these appraisals. What we would wish to do is to capitalise on the expertise that is out there. The DECs for example, the Regional Development Evaluation Committees, have underpinning them a lot of the public health departments or Institutes of Public Health and have a lot of expertise which we will need to use in the long term. There are other comparable organisations in other parts of the country. We do need to engage with them and work with them and this is why I earlier described NICE as a virtual Institute because it will always need to have a very close relationship with groups around the country.

  82. So a lot of your work will be done through the different departments?
  (Professor Sir Michael Rawlins) Absolutely, yes.

  Chairman: Do any of my colleagues have any further questions?

Audrey Wise

  83. Yes. The Secretariat and the question which was touched on by my colleague, Ivan Lewis, about independence. Of course it is understandable initially that it comes from the Department of Health but if I might give a sort of example. I find it very helpful that the Committee Secretariat, which ought to be larger I may say, belongs to the Committee, they are not civil servants, they are House of Commons people. I would like to feel that although initially they are Department of Health people that you will be allowed, able and will develop a different arrangement for the Secretariat.
  (Professor Sir Michael Rawlins) Absolutely. As from 1 April, as Dr Riley and Dr Radford keep telling me, I am on my own. It is not quite as bad as that. Next year they will be looking at NICE to see whether we have done the things that the Department ought to have done. NICE will have its own staff, its own payroll as a special health authority and indeed will be independent and no doubt in a year's time we will not be quite so friendly.

  84. Finally, on the point which was raised by Julia Drown about anonymity it strikes me that complete anonymity is pretty difficult to achieve. I think that the result would be that it would be anonymous as far as the public at large is concerned but it would be very well known to the powerful people. That seems to me to be wholly undesirable. I think that the risk of them being lobbied should not weigh too much in the balance. They will have to be tough minded, genuinely independent and able to resist any improper attempts at influence but they should perhaps be open to the idea of accountability. That seems to me to be important. Just as an individual Member, I have no idea what my colleagues would think, I would strongly say that anonymity and transparency really do not go together and credibility is going to depend a very great deal on transparency. If you are not to be portrayed as the big bad wolf stopping people getting X, Y or Z but instead portrayed as the friends of patients ensuring a levelling up of treatment then I think you will need transparency and you should dismiss anonymity.
  (Professor Sir Michael Rawlins) I am not disappointed by your remarks.

Mr Austin

  85. Some concern was expressed earlier about whether your guidelines will be implemented at PCG or trust level. I have been trying to get my head round the new proposals for the establishment of the Commission for Health Improvement which I understand will have an ability according to the guidelines to conduct a review, for example, of guidance issued by NICE but that will be on a national basis. It does not appear to me in the notes that I have been looking at that there is any ability for the Commission for Health Improvement to look at perhaps the failings of a particular PCG or trust to carry out your guidelines. I wonder if you could comment on that.
  (Dr Radford) I will certainly do my best although you do recognise the Commission is not my policy area, but I will try and do my best to comment. Clearly the Commission has a number of roles, one of those roles is to do a systematic review of national service frameworks, for example, and within this programme it will be looking at what is happening in the field and whether the service frameworks are being implemented, and part of the service frameworks will incorporate guidelines on care from NICE. So they will be looking at what is happening at a local level in this programme around some of the guidelines from NICE. They will also have a role to which you are referring, which is to go in on a request, or to be sent in, to look at areas of concern, where perhaps with a PCT or a trust or whoever there may be some concerns about the practice within that or some particular issue, so they will have an ability to go in and look at that. So there are a number of roles, of which I have just described two, which may include looking at what is happening in different circumstances with regard to clinical governance and, as part of clinical governance, what is happening around NICE guidelines, the audit methodologies and some of the products of NICE.

  86. So if as a constituency member I am concerned the PCGs in my area were not carrying out NICE's guidelines, my area of complaint ought to be to the Commission?
  (Dr Radford) I would imagine in the first instance it would be, because the PCGs are still within the health authority's responsibility, to ask the health authority to address that, so go to the health authority in the first instance for a response.


  87. Any further questions? Do any of the witnesses have anything they wish to add on areas we have not touched on which you feel would be relevant to this session?
  (Professor Sir Michael Rawlins) I do not think so. Thank you.

  Chairman: Can I thank you all for your helpful evidence this morning. We are most grateful to you for coming along and we look forward to meeting you again in due course and we wish you well with your work.

previous page contents

House of Commons home page Parliament home page House of Lords home page search page enquiries

© Parliamentary copyright 1999
Prepared 10 March 1999