NICE guidance could be made mandatory

The shadow health secretary, Andy Burnham, has revealed that under new plans a Labour government could reduce variation in access to drugs and procedures by making it mandatory for commissioners to follow national clinical guidelines.

Under the current system, NICE’s clinical guidelines are advisory, not mandatory. Andy Burnham said he wanted to“strengthen” NICE’s role and when asked if he would consider making its guidelines mandatory rather than advisory, he said: “I wouldn’t rule that out.”

He said: “We can’t just have national entitlements broken up… We need to look at how you strengthen NICE. Where they have said something is effective and affordable, on what basis does a local commissioner withhold that from somebody? I’m not comfortable with that. I don’t support that. Strengthening NICE is important because what I am seeing at the moment is CCGs beginning to take quite drastic decisions with respect to rationing. Some of this is veering into the judgmental.”

Mr Burnham acknowledged making all NICE guidance “nationally binding” would be a major step with significant implications, and said he had not taken a final decision on the policy.

Mike Birtwistle, health policy expert and founding partner of consultancy Incisive Health, warned that: “If guidelines became mandatory they would be subject to far more scrutiny from commissioners who would be worried about cost and might demand more robust evidence. It would be difficult to make some clinical guidelines mandatory and some just advisory because there would be considerable debate about which guidelines were given mandatory status.”

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