Using Evidence to Deliver Cost-Efficient and Effective Practice


Sir Andrew Dillon, Chief Executive NICE

15th October 2015


The ambition for NICE

  • An independent, authoritative source of advice on effective and cost effective ways of getting the best outcomes for people using the NHS and social care
  • A way of making difficult and important decisions openly and consistently
  • A means of ensuring equality of access to treatment and services
  • A service for those who use as well as those who work in the NHS and social care health


The organisation

  • Public agency, set up by Act of Parliament
  • Funded by the UK Departments of Health
  • Managed by an independent Board, with a chairman appointed by the Secretary of State
  • Income in 2015-16: £73 million
  • Staff: 630

Guidance produced by independent advisory committees, working to methods and processes developed and quality controlled by NICE





Reconciling multiple aspirations

  • Deciding what represents good value in health and social care is a complex challenge, with multiple perspectives: users, funders, suppliers, government 
  • Individual perspectives are multi-faceted: patients and clients are both users and payers; life sciences companies have individual and collective ambitions; Government has political, fiscal and operational responsibilities
  • NICE uses independent advisory committees to provide a 'safe space' in which these potentially competing priorities can be reconciled



Approach to developing guidance

  • Comprehensive evidence base
  • Expert input
  • Independent advisory committees
  • Consistent processes and methods
  • Genuine consultation and contestability
  • Regular review



Value for money

  • We have a duty to use taxpayers’ money responsibly
  • Resources are limited and so we need to maximise what we can do with the money that we have available
  • It can help achieve an equitable distribution of resources
  • A reasonable approach to economic evaluation will encourage responsible pricing
  • But…
  • Everyone wants the NHS to use its resources fairly and efficiently, but few are comfortable for their treatments to be restricted



NICE advisory committee meetings

  • Meetings structured to enable participation by members and people invited to give evidence
  • Use methods for interpreting evidence which helps ensure but don’t force a conclusion
  • Encourage those involved to keep the debate inside the meeting
  • Enable those involved to be conscious of but not to feel they should necessarily take account of media and political debate
  • Resources to help engagement (briefings, guides, public involvement team)
  • Policy for managing conflicts of interest





Concluding thoughts

  • These decisions are some of the hardest in British public life
  • They touch on the some of the most sensitive and personal ways in which Government can affect our lives
  • Bringing science, politics and service delivery together is messy, difficult to explain and frequently leaves someone unhappy
  • But it is, as Frank Dobson said when he launched NICE in 1999, “worth a bloody good try”



"TheTriumph of NICE"

“NICE may prove to be one of Britain’s greatest cultural assets along with Shakespeare, Newtonian physics, The Beatles, Harry Potter and the Teletubbies”

Richard Smith, Editor, British Medical Journal 2004