Wednesday, May 11, 2011

NICE's Future is Assured, Says Departing Chairman Rawlins

"The future of the National Institute for Health and Clinical Excellence is assured," said its long-serving chairman, Professor Sir Michael Rawlins, speaking at the start of the institute's annual meeting on Tuesday 10 May in Birmingham, U.K.

Addressing a packed auditorium in the U.K.'s second-largest city, Rawlins pointed to the way the proposed Health and Social Care Bill will give NICE a new name – the National Institute for Health and Care Excellence – and will remove it from political interference by establishing it as a new non-departmental body.

The existing roles and responsibilities of NICE are however expected to remain unchanged, but the new NICE will take on additional responsibilities for generating advice about social care.

This year, NICE still expects to publish 39 technology appraisals (including drug appraisals), 21 clinical guidelines, 5 public health guidelines and 30 quality standards.

Rawlins accepted that treatment guidelines for specific disease conditions are now addressed by several appraisals, which is why the institute has just launched "NICE Pathways", its online resource that brings together all the relevant appraisals for each specific condition, producing a path of care.

Rawlins was not so forthcoming on one issue of particular interest to the pharmaceutical industry, however: value-based pricing. He claimed that NICE would play a critical role in developing such pricing for medicines in the U.K., but said the details of how this would work in practice have yet to be decided.

No surprise there, perhaps: after all, the British pharmaceutical industry appeared to be similarly in the dark about VBP at a March press conference. And although industry hasn't voiced strong opposition to VBP in principle (it would rather play a role in designing it), it does worry that VBP is incompatible with the wider set of proposed reforms in the U.K, which may lead to health care being commissioned by consortia of general practitioners. The worry: the likely volume of prescribing of a particular medicine, a vital component of deciding a price, cannot be estimated if each of the 400 or so consortia have different prescribing formularies.

But with the success of this wider set of health care reforms (known as the Health and Social Care Bill) looking increasingly uncertain, this particular worry may go away. The Bill's progress has been halted while politicians take stock of its implications, following concerns that it was being rushed into law without proper debate.

With the future shape of health care management in the U.K. in the balance, there's everything to play for for those (including NICE) involved in managing health care in the U.K. But Rawlins himself, while expressing his confidence in the agency's future role, is calling time: he will not put himself forward as a candidate for chairman of the new NICE next year, he told the audience in Birmingham. That makes this his last year, after leading the agency since its inception 12 years ago.

--by John Davis

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