ABSTRACT
NICE was a product of new ideas from the 1970s and 1980s about using evidence to make health policy – particularly economic rationality but also the use of scientific evidence and of deliberation. NICE was not conceived, and has not operated, only to stop the NHS from spending scarce resources on less effective treatments (the ‘pessimistic’ outlook, of government health economists). It was also meant to be a promoter of patient access to the best new technologies (the ‘optimistic’ outlook, of government medical officers). This second role quickly grew into one of supporting innovation in the UK life science industries. NICE has to reconcile the contradictory pressures which these priorities produce. NICE has thrived as an organisation because its early work to establish its methods and principles was done exceptionally well. By 2004, it had already built a reputation for using evidence rigorously, as well as for independence, transparency and fairness. NICE secured these early achievements through talented and diligent leadership (e.g., careful and transparent system design) and, for example, by attention to recruiting and keeping the best people. NICE has sought to remain true to these roots, even as the challenges have become harsher: its future value depends on continuing to do so.
