Progress | Centre-left Labour politics

NICE to see you?

The Cameron confusion over the role of the National Institute for Clinical Excellence

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Last year David Cameron made a speech about diminishing the role of quangos in a future Conservative government. Whilst the speech stressed the importance of democratic accountability it laid out a series of ground rules for when decisions should be taken by quangos. To quote:

“The third and final specific example of our approach that I want to explain today is in health: the National Institute for Clinical Excellence. NICE assesses which drugs and treatments are clinically effective and cost- effective for use in the NHS. Based on these assessments, individual doctors and hospitals then determine whether the drug or treatment is appropriate.

“The decisions NICE takes are inherently technical, drawing on specialist knowledge about the range of medicines and treatments that are available. More than that, these judgments have to be made impartially and objectively – balancing the interests of a variety of people who want access to particular medicines and where there are limited resources.

“It would not be right to allow these extremely sensitive assessments to be made on the basis of anything but the objective evidence. So Andrew Lansley sees an important continuing role for an independent NICE.” (David Cameron, 06/07/09)

So far so sensible, as policy goes. But as the election campaign starts the Tories cannot resist developing a different politics. Last Monday the first chapter of their manifesto on health took a totally different stance.

“The current system lets ministers off the hook by blaming decisions on unaccountable bureaucrats in NICE, the agency which approves drugs for the NHS.” (‘Our reform plan for the NHS’, 04/01/10)

This politics gives them an opportunity through a political nod and a wink to say that Tory ministers will agree all drugs without worrying as they did last June about NICE’s ‘objective evidence.’ Now apparently they will not ‘hide behind ‘unaccountable bureaucrats” but pledge to make the decisions about what drugs the NHS uses on political and not objective grounds.

Which would they do?

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Paul Corrigan

was a health adviser to the Labour government


  • Well said Paul. Other suggestions from the Tories have been equally mystifying. For example, Phillip Blond’s (the so-called “Red Tory”), in his pamphlet “The Ownership State”. It describes a “new approach” to empower “frontline” workers to form a “civic association” for providing public services. Blond states that the “current model” of public service provision is “not up to” the challenge of increasing expectations, an ageing population and the “shock” to public finances. Blond recognises that FTs are the closest type of organisation in the UK to civic associations but does not provide a critique of FTs, or acknowledge the long history and experience of co-operatives and mutuals in the UK. This is odd considering Cameron’s shallow claims to be co-operatively minded. Blond also does not provide a detailed institutional design, and in fact specifically rules out doing so. He states that a civic association would typically be a maximum size of 150 employees, contradicting using John Lewis as an example of successful employee democracy. John Lewis employs tens of thousands. Blond’s pamphlet does not deal with how a huge organisation such as a hospital, also normally employing thousands of people, would be handled, either.

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