Is NICE’s role changing – and should we be worried?

The UK’s National Institute for Health and Care Excellence (NICE) will shortly celebrate its 25^th birthday – an unusual achievement for a non-departmental public body and one that will likely garner both attention and praise. But today’s organisation differs in important ways to the one established in 1999. This seminar will consider how NICE’s approach to technology appraisal has changed over time and the implications of these changes for the role that NICE plays in society and its status as a legitimate healthcare priority-setter.

The content of the seminar will be based on empirical work that has used qualitative methods (documentary analysis, interviews, ethnography) to longitudinally explore normative aspects of NICE’s approach. It will include consideration of the findings of three linked studies (Charlton and Rid, 2019, Charlton, 2020, Charlton, 2021) and other work-in-progress that suggests that the normative principles which provided the foundation for NICE’s approach in the early 2000s are no longer sufficient to justify its decisions.

It will be argued that while these historical principles supported NICE’s traditional role as a gatekeeper to the NHS – tasked with ensuring the efficient use of shared resources by requiring incoming technologies to demonstrate good value – the new principles governing NICE’s approach support a somewhat different role: that of facilitator, tasked with securing patient access to ‘innovative’ technologies (Charlton et al., 2022). The normative justification for this change, and its implications for patients, will be considered and discussed.

CHARLTON, V. & RID, A. 2019. Innovation as a value in healthcare priority-setting: the UK experience. Social Justice Research, 32, 208-238. https://doi.org/10.1007/s11211-019-00333-9

CHARLTON, V. 2020. NICE and Fair? Health Technology Assessment Policy Under the UK’s National Institute for Health and Care Excellence, 1999–2018. Health Care Analysis : HCA, 28, 193-227. https://doi.org/10.1007/s10728-019-00381-x

CHARLTON, V. 2021. Justice, Transparency and the Guiding Principles of the UK’s National Institute for Health and Care Excellence. Health Care Analysis, 1-31. https://doi.org/10.1007/s10728-021-00444-y

CHARLTON, V., LOMAS, J. & MITCHELL, P. 2022. NICE’s new methods: putting innovation first, but at what cost? BMJ, 379, e071974. https://doi.org/10.1136/bmj-2022-071974