Views of Directors of Public Health about NICE Appraisal Guidance: results of a postal survey. National Institute for Clinical Excellence.

Background: We aimed to determine the views of Directors of Public Health about the Health Technology Appraisal Programme of the National Institute for Clinical Excellence (NICE) before the move to strategic health authorities and primary care trusts in April 2002.
Method: In December 2001 we sent a questionnaire asking about the work programme, products, decision-making, general approach, resource allocation and success of NICE to all Directors of Public Health in England and Wales. Ninety-two of 100 responded.
Results: Three-quarters or more agreed that NICE has covered a number of priority and controversial areas, produced good-quality health technology appraisals, well-presented reports and readable guidance in a consistent format, that it has raised the profile of clinical effectiveness, provided a focus for debate about health technology, and succeeded in making the National Health Service (NHS) set aside resources for approved technologies. A similar proportion, however, also agreed that guidance was not timely, did not address 'whole systems' and made some disappointing recommendations, and that decision-making was not influenced enough by the needs of the NHS. They considered that NICE did not address implementation, decide between competing technologies or help the service prioritization debate, and that guidance sent unrealistic signals about affordability to patients and politicians and caused difficulty for the implementation of other technologies locally.
Conclusions: A majority of Directors are positive about NICE's role of providing high-quality appraisal and central guidance but negative about its influence on local priority setting. Major concerns remain about the affordability of competing demands, whether this is NICE's responsibility or not.