Critical care decisions in fetal and neonatal medicine: ethical issues
Appendix 7: NHS organisations concerned with healthcare decision making
The macroeconomic level (see Figure3.4)
The Government, through the UK Departments of Health, is responsible for leading the direction of the NHS. At the macroeconomic level, decisions are made about how much to allocate to the NHS as against competing demands on public resources such as education, social security, defence and the other ministries of central government.
Two agencies that operate at the macroeconomic level and have had increasing importance in the last few years are the National Institute for Health and Clinical Excellence (NICE) and the Healthcare Commission. In England and Wales, NICE has the role of assessing medicines and medical devices based on evidence about their clinical effectiveness and cost-effectiveness.18 One of the reasons for establishing NICE was to curb ‘postcode prescribing’ (patients in different geographical areas receiving different treatments or services based on their location). Since April 2005, NICE has also taken on the role of evaluating public health interventions. The Healthcare Commission is essentially an inspectorate, since it is responsible for evaluating the performance of NHS institutions in England and monitoring adherence to government policy, such as the National Service Frameworks (NSFs), which specify good practice in different specialised areas. In addition, the Healthcare Commission is responsible for the ‘annual health check’, which involves assessing and rating the performance of all NHS healthcare organisations in England each year. The assessment takes into account performance in relation to new and existing national targets, the attainment of certain core standards and improvement in the previous year.
18 National Institute for Clinical Excellence (2004) Guide to the Methods of Technology Appraisal (London: NICE).