NICE rules – literally…

Baroness Young, chair of the newly-formed Care Quality Commission, has revealed that guidance from NICE would become legally enforceable from 2009/10, with doctors to face tough annual checks on their compliance, and failure to comply will be punishable by suspension, fine or prosecution – even the closure of the practice if they dare to put the patient first.

Baroness Young told the recent NICE annual conference in Manchester that policing clinical guidance was set to be a key part of the CQC’s work, and admitted the commission had been handed ‘draconian’ powers by ministers.

Er, how is that a good thing? And when did “guidelines” attain the status of law? It’s appropriate, though – Draco, a sixth-century BC Athenian legislator, was in favour of savage penalties for the poor, while handing out slapped wrists to the wealthy, a policy clearly embraced by this government in its current proposals for the treatment of the chronically sick and disabled, and single parents. James Purnell, Work and Pensions secretary has clearly embraced the beliefs of Draco wholeheartedly.

‘We want to raise the profile and highlight the importance of NICE guidance and build this into the new registration scheme,’ said the out-of-touch-with-reality old bat, adding, ‘I have an image of a patient sat in front of their GP or consultant with a card with the NICE guidance so they can interrogate their healthcare provider.’

What an amazingly stupid idea. In my experience most patients have little or no understanding of the requirements of their particular illness, and would take up a ludicrous amount of GP’s time with these idiotic checklists. On the other hand, I’ve made it my business to know as much as possible about my conditions – I know what the optimum maintenance treatment is, and what I need to treat exacerbations. This means I can discuss my treatment sensibly – and quickly – with my GP. I really don’t need Baroness Young and her prodnose Commission making things difficult for all concerned. Sadly, for I believe every chronically sick person has an obligation to know as much as possible about their illness, for their own benefit as much as anything else, I know I’m in a minority.

However, a CQC spokesperson said: ‘We expect providers always to comply with NICE guidelines and other national guidance unless they can show a good reason to vary from them.’ That is an insanely dangerous idea, because the bean-counters at NICE have only one aim – to reduce costs. Patient welfare is nowhere on their agenda. Also, some of NICE’s recent decisions have been hugely controversial, and not a few guidelines run contrary to accepted clinical opinion, as is the case with the treatment of osteoporosis.

Until the time comes when NICE gets it right every single time – and that’s probably impossible – and stops focussing on penny-pinching, there is no justification for making their guidelines law. None at all.