Through rigorous assessments, a focus on cost effectiveness and ability to mandate certain treatments, NICE has had an impact on shaping some elements of NHS care, but its influence has limitations.
It is unclear what effect the commissioning reforms introduced under the Health and Social Care Act 2012 will have on NICE’s ability to support the delivery of cost effective NHS care.
Clinical commissioning groups (CCGs) will operate within a new national Commissioning Outcomes Framework which seeks to promote a degree of national consistency in relation to local spending decisions. Balanced against these are aims to devolve more decision making to local bodies and to focus on clinical outcomes as the prime yardstick for performance assessment.
Determining the degree of local clinical flexibility within an overall commissioning framework will be complex and challenging
The new CCGs are likely to be relatively inexperienced at setting commissioning priorities, financial management and budgetary control.
Determining the degree of local clinical flexibility within an overall commissioning framework will be complex and challenging, and there are likely to be ‘test cases’ along the way, where the balance of national consistency and local flexibility will be defined and refined.
We suggest that the NHS Commissioning Board will have a crucial role to play in coordinating the work of NICE, NHS Evidence, the Care Quality Commission, Monitor and other regulators in bringing together the necessary evidence and standards into a framework for commissioning that can assure delivery of the Commissioning Outcomes Framework.