APPENDIX 30
Memorandum by Iechyd Morgannwg Health
Authority (NC 41)
This submission has been prepared on behalf
of Iechyd Morgannwg Health Authority by Nicola John, Prescribing
Adviser. Nicola sat on the Steering Group for NICE which produced
the book "Implementing NICE Guidance—A Practical Handbook
for Professionals".
1. It is generally helpful to have the evidence
of clinical and cost effectiveness appraised on an England/Wales
basis by NICE. The forward timetable assists in the planning cycle,
but there are two areas which could be changed.
— early publication of the national
prevalence and incidence data, well in advance of the guidelines
would assist commissions to forecast the likely cost of NICE recommendations;
— the current gap between licensing
of a drug and the receipt of a NICE guideline means that commissioning
bodies have to make funding decisions by relying on local appraisal
of the evidence. This leads to variations in decision making,
and can cause delays in agreeing funding.
2. The current mechanism for allocation
of non pay funds to secondary care trusts should be reviewed.
For drugs, the inflation factor for existing drugs is measured,
and this tends to be negative, as older drugs decrease in cost
with time. Greater weight should be given to the cost of introducing
the new drugs recommended by NICE; this would ensure a more even
uptake of the guidelines across the country.
3. It would be helpful if the guidelines
also assessed the service implications of their introduction.
For some drugs, the effect on service provision is minimal, but
for others, major investment is required in staff recruitment
and training. Furthermore, to maximise effectiveness of therapies,
the manner of service delivery should also be examined. Examples
of best practice could help with changing working patterns.
3 June 2002
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