Examination of witnesses
(Questions 80 - 87)
THURSDAY 4 FEBRUARY 1999
RADFORD and DR
80. That really is most, most important.
(Dr Riley) I agree.
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?
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.
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.
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.