Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Health Technology Board for Scotland (NC 40)


  1.1  The Health Technology Board for Scotland (HTBS) welcomes the House of Commons Health Select Committee's inquiry into NICE to consider the progress NICE has made in achieving the key goals envisaged in A first class service.

  1.2  HTBS was created in April 2000 as a special Health Board to provide advice to NHSScotland on the clinical and cost effectiveness of new and existing health technologies. HTBS may be regarded as NICE's counterpart in Scotland with regards to its work on Health Technology Appraisals and so these comments relate solely to this aspect of NICE work. HTBS recognises that NICE does much valuable work in other fields, but has little detailed experience of this.

  1.3  HTBS undertakes its appraisals in a slightly different manner from NICE: undertaking broadly scoped appraisals, performing technical work in-house, using topic specific experts for interpretation of evidence in a Scottish context, using open consultation and clarification rather than appeal meetings to resolve issues. Despite these differences in process, HTBS has established a strong working relationship with NICE and has valued the opportunity to share expertise, experience and appraisals work. NICE has acted as a mentor to HTBS in many situations and it is interesting to see alternation in some of the NICE processes to be more in line with the Scottish model (eg open consultation).

  1.4  Scotland has particularly valued the close collaboration established between HTBS and NICE to contextualise the NICE appraisal guidance for Scotland, thus extending its impact across the border. This unique liaison has been recognised as a role model for other Agencies within the UK and EU and HTBS looks forward to even greater collaboration and joint working on full appraisals in the future.

  1.5  Overall, it is clear that NICE is recognised as a world leader in production and delivery of appraisal guidance. Its impact on policy and ability to change healthcare practice is envied by many well-established EU Health Technology Assessment agencies.


  2.1  NICE has established itself internationally as a scientifically credible organisation and this is demonstrated by their membership of the International Network of Agencies of Health Technology Assessment (HTA).

  2.2  NICE was the first appraisal organisation to take evidence from all stakeholders (few organisations involve manufacturers or patient groups). Such broad consultation creates credible guidance, but provides challenges about collation and interpretation of qualitative and quantitative evidence. The members of the NICE appraisal committee, its HTA report contributors and NICE appraisal staff are driving forward new developments in appraisal methodology to ensure that their advice is scientifically robust and can withstand the substantial challenges that arise from broad stakeholder involvement.

  2.3  Value judgements are a fundamental part of a Health Technology Appraisal, but to produce clear guidance it is essential to make the basis for value judgements transparent. This is difficult to achieve and an area with which all appraisal Agencies struggle. NICE has tried to make their rationale clear in the appraisal guidance documents, whilst recognising that healthcare decision makers are overloaded with information.

  2.4  Recommendation: The Committee may wish to take account of the international standing of NICE and benchmark its activities against other European HTA Agencies.


  3.1  The close working relationship established between NICE and HTBS avoids the confusion of duplication and conflicting advice. The outputs of this collaboration are explained elsewhere in this document, but examples of the cooperation that lead to a shared but contextually appropriate advice in Scotland include:

  Continual communication between senior, technical and scientific staff from NICE and HTBS including:

    —  Sharing of information re publication timetables and controversial issues arising from assessments.

    —  Discussion of potential topics to be assessed by each organisation to avoid duplication and allow collaboration where appropriate.

    —  HTBS involvement as consultee in all appraisals, with input of Scottish experts.

    —  NICE sign-off on all HTBS Comments (see below).

    —  Ground-breaking discussions about appraisal methodology.

    —  Sharing of methods for interactions with stakeholders: manufacturers, patient groups and NHS professionals.

  Reciprocal attendance of Chief Executives at Board meetings.

  Invited presentations by NICE/HTBS at international meetings organised by HTBS/NICE.


  4.1  Whilst NICE's remit for Technology Appraisal Guidance extends only to England and Wales, its impact extends to Scotland. During 2001, clinicians and managers in NHSScotland discussed NICE Guidance with colleagues in England and Wales and began to ask what the status of NICE Guidance was in Scotland. Consequently, HTBS agreed to "Comment" on all NICE guidance published after 1 May 2001. NICE Appraisal Guidance is now issued in Scotland with either a covering letter or a printed booklet.

  4.2  HTBS accepts the scientific rigour of NICE Guidance and does not "unpick" it, but develops it for the Scottish context. The HTBS Comment highlights Scottish contextual differences such as the epidemiology of illness/disease, service structure in Scotland, principles of NHSScotland and other issues such as remoteness. The process requires close and intensive collaboration of HTBS and NICE staff, so that the HTBS Comment is delivered to Scotland within six to 10 weeks of the NICE publication. The HTBS Board has been extremely grateful to all NICE staff for their cooperation in this process.

  4.3  HTBS values the NICE "Information for Patients" and uses it as the basis for its Guide for patients and carers in Scotland relating to HTBS Comments. HTBS is currently reconfiguring this Guide for patients and carers to make it accessible as a general overview of the rationale for the advice. This reflects HTBS understanding that issues relevant to individual patients are quite different from those affecting efficient uses of healthcare resources for the public as a whole. The work of the Citizen's Council will be important in this respect and HTBS looks forward to seeing the outcome of the discussions of this group.


  5.1  Recent goals set for NICE require an increase in appraisals above the current level of 30 per year. Given the limited expertise that exists in the UK (and indeed the world) for undertaking the technical appraisal work and for implementing the appraisal guidance in the NHS, one could question whether this is an appropriate goal.

  5.2  There has been concern that the scope of some of the NICE appraisals is too limited and that a broader scope may lead to faster implementation. Consequently, instead of increasing the number of appraisals an alternative would be to consider fewer, broader appraisals. HTBS undertakes such broader assessments that address detailed issues of implementation and early signs suggest that these are gaining professional buy-in in NHSScotland (and the NHS).

  5.3  Recommendation: The Committee may wish to consider whether it is appropriate to ask NICE to increase their capacity beyond 30 appraisals a year, or whether Health Authorities may not benefit from fewer broader appraisals.

  5.4  Recommendation: As it is now mandatory for Health Authorities to fund interventions recommended by NICE, the process for selection topics for NICE appraisal should take cognisance of the theory around priority setting so that implications for topics not considered by NICE can be considered (both those of high value and those that may be disinvested locally).

January 2002

previous page contents next page

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

© Parliamentary copyright 2002
Prepared 8 July 2002