The majority of technologies assessed by NICE are pharmaceutical, but it has also considered surgical procedures, medical devices and screening technologies. The Institute is also responsible for assessing the safety and efficacy of interventional procedures for diagnosis and treatment. It is tasked with conducting assessments and drawing up guidelines by the Department of Health and Senedd Cymru.
The purpose of the proposed body was to drive up clinical standards in the NHS, and make sure that improvements were consistent across the Service. Previously, medical technology appraisals were carried out by a variety of professional and academic bodies, at both the national and local levels. Work was duplicated, standards were variable and the status of findings was frequently unclear.
The Government had previously attempted to address this problem, introducing the Selected List Scheme, which listed obsolete or ineffective treatments, in However, since that time, developments in medical technology had progressed rapidly, with vast numbers of new drugs becoming available.
NHS clinicians found themselves unable to tell which new products were the most effective, leading to local variations in commissioning practices. NICE was established and began work in April The NICE system is fundamentally administrative in operation since the implementation of its decisions have an impact on the choices clinicians make that do not reflect clinical necessity.
It is an assumption that the decision logic that applies below the threshold also holds above the threshold; but these two areas are quite different. This is what is called a boundary problem. What NICE has done is defined moral duty to act out of their model. Where the boundary is set does not just separte two parts, it creates two zones in which different decision logic applies.
That's why the QALY threshold, regardless of where it is set, while arbitrary there is no evidence base that tells you where that boundary should be has consequences. Below the threshold, the rule of rescue does not need to apply.
Above the threshold, it defines the zone itself: it is where the withdrawal of the benefits of a medicine, for instance, are denied someone on grounds other than of duty.
That people feel strongly that something is wrong with decisions above the boundary is evidenced by the need to create the Cancer Drug Fund. NICE is good for what it is good for, but it should be clear, as Wittgenstein wrote: "Whereof one cannot speak, thereof one must be silent.
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About highly specialised technologies. We published a guideline to educate the general public about how they can help fight the battle against antimicrobial resistance. We also started a series of 30 management of common infection guidelines. Find out more on our antimicrobial prescribing guidelines page. In March we updated our quality standard promoting physical and mental health in the workplace.
We published NICEimpact cancer. A report that considers how our evidence-based guidance might contribute to improvements in the diagnosis and treatment of cancer. On 1 April, we marked 20 years of improving health and social care through evidence-based guidance. Creation of NICE. Find out more about us First NICE guidance We published our first piece of guidance: a rapid assessment of flu product zanamivir. First public board meeting Register to attend a public board meeting.
First technology appraisal. TA1 Guidance on the extraction of wisdom teeth March. National Collaborating Centres established. First clinical guideline. CG1 Schizophrenia December.
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