NICE at 25

Peter Littlejohns is Emeritus Professor of Public Health at King’s College London, and the founding Clinical and Public Health Director of NICE. He has led on a number of international research programmes addressing ways of improving the effectiveness and efficiency of health services through fair prioritisation policies.Keith Syrett is Professor of Health Law and Policy and Director of the Centre for Health, Law, and Society in the School of Law, University of Bristol, UK. He has written extensively on the legal regulation of resource allocation in healthcare, health technology assessment, and public health law.

• Foreword Preface Acknowledgements1 Introduction: Why NICE and why the book? 2 NICE and resource allocation in the NHS: paradise lost?3 Understanding the survival of NICE through a political science lens 4 NICE’s paradigm of public practical reasoning5 Innovation, values and NICE’s changing societal role6 Do NICE’s HTA processes still lead to net improvements in NHS services?7 Public Health at NICE: Methods, politics and policy8 Public involvement at NICE: Evolution, not revolution9 NICE and the law: Judicial oversight, juridification and legitimacy?10 Enhancing the value of public spending on health technology around the world11 Conclusion: NICE from the past into the future

"NICE is the institutional embodiment of a task all health systems must grapple with; how to ration. As this excellent collection of economic, sociological, philosophical, legal, international and political perspectives on its evolving work over the last 25 years makes clear, that task has not been easy or without controversy. Like Zeno’s arrow, NICE may never reach its target, but as this book attests, it has to keep on its journey".Professor John Appleby, Senior Associate, Nuffield Trust, UK."The future of healthcare faces many profound challenges, not least the need to balance ever-expanding demand with restricted resource. NICE was designed to bring rationality to this dilemma and has always relied on using high quality evidence in its work. It is highly appropriate that a challenging and questioning approach to reviewing the evidence for NICE’s impact is central to this important, thoughtful, and informative book".Sir David Haslam, CBE, FRCP, FRCGP, Chair of NICE, 2013-2019."NICE has an important place in the architecture of the UK’s healthcare. Against a background of regular upheavals in the NHS - in leadership, funding, and, critically, political ideology - NICE has survived to enjoy its 25th birthday. But the celebrations, to this writer, are muted. NICE has changed. In a serious, rigorous and careful manner, this book explores not just the ever-present philosophical challenges its approach entails, but, in its need to command legitimacy, the more concerning move towards the accommodation of government and industry in its decisions".Professor Sir Ian Kennedy, Emeritus Professor of Health Law, Ethics and Policy, University College London, UK."No other set of authors could have deployed such a rich combination of insiders’ experience and academic rigor to give the reader a unique insight into what has made NICE tick; the great successes, the errant efforts; the hopes realized and dreams yet unfulfilled. This book will be a landmark in our understanding of the past, and a roadmap to more effective and equitable health care systems of the future".Steven Pearson, MD, MSc, FRCP, President of the Institute for Clinical and Economic Review, USA."The work of NICE has had a life span of 25 years – one of the longest running arm’s length bodies. What is the secret of its longevity and place in our healthcare system is uniquely explored by the authors of this book. There is recognition the future path maybe even more bumpy than the journey to date. A must read for all those that want to see Value-Based Healthcare."Professor Maggie Rae CBE, FFPH, FRCP (Hon), FRCP Edin, FRCPath (Hon), FFSRH (Hon), FFOM (Hon), FRSPH. Visiting Professor at Exeter University and University of the West of England