Political accountability of explicit rationing: legitimacy problems faced by NICE

Editorial, concluding that 'the legitimacy of NICE amongst the general public is essential to engender the trust of those financing and using the NHS and to avoid it being undermined or pre-empted by government, in response to public and media concerns. The caricature of NICE as a 'death panel' may appear farcical, yet the political leverage of hope in new drugs is highly potent and capable of undermining any agency which is perceived as threatening it. The power of this message and the multiple layers through which it is infused makes plain the need for it to be countered. NICE requires not only more consistent government backing but also a means by which it can highlight established services which are preserved by its decisions to reject some innovations. Given the increasing financial pressures faced by the NHS, the significance and utility of NICE in regulating cost-effectiveness is greater than ever. Hence, its ability to preserve its authority in the face of strong challenges is a salient issue. The ostensibly scientific basis of NICE's threshold-oriented recommendations has perhaps led NICE to downplay the significance of sociopolitical influences on its activities. NICE must recognise that robust decision-making is only part of the regulatory 'game'. Media and public profile are also vital to its effectiveness.