National Institute for Clinical Excellence

The National Institute for Clinical Excellence (NICE) was established on 1 April 1999, as a special health authority by order of the secretary of state, to promote clinical excellence in the health service. It aimed to support the reduction in variation of the availability and quality of NHS treatments and care nationally.

NICE was responsible for producing guidelines for the management of clinical conditions, providing advice on when to refer specialist cases, and for producing guidance on the use of medicines, medical equipment and clinical procedures. NICE considered the clinical evidence, as well as cost effectiveness, of particular interventions or technologies.

It was responsible for appraising new technologies including drugs (health technology assessments) and, from 2003, to assess whether interventional procedures used for diagnosis were appropriate for routine NHS use.

NICE was controversial from the outset. There was an inevitable conflict between those who felt that any life was worth prolonging, despite the cost, and those who welcomed a prioritisation process for spending NHS resources.

The organisation also produced guidelines for the management of clinical conditions and had a role in encouraging quality improvement. NICE inherited four confidential inquiries covering:

• maternal deaths
• stillbirths and deaths in infancy
• perioperative deaths and suicides
• homicides by people with mental illness.

The responsibility for the inquiries was later transferred to the National Patient Safety Agency.

Later inclusion of public health

On 1 April 2005, NICE joined with the Health Development Agency and extended its work to include public health, leading to a change in name to the National Institute for Health and Clinical Excellence (still abbreviated as NICE). Its objectives expanded to include improving outcomes for people by providing national guidance and advice in England.

The Health and Social Care Act 2012 made NICE a non-departmental public body that was operationally independent from the Department of Health. Since then, NICE has taken on the role of producing quality standards for social care and revised its name to the National Institute for Health and Care Excellence.