Select Committee on Health Appendices to the Minutes of Evidence


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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