Innovation in European healthcare – what can Sweden learn? - LIF

The implementation of NICE guidelines is mandatory and
expected to be carried out through all NHS trusts within three
months
• However, studies have shown considerable geographical variation in uptake of NICE
guidance, suggesting a persistence of the former ‘post-code lottery system’ of rationing
healthcare.
– Implementing NICE technology guidance within three months is supported by funding for PCTs based on estimated
costs.
– However high capital costs, implementations of expensive drugs or prostheses, and competing local priorities, have
disincentivised PCTs from funding expensive guidance from their allocations.
– The estimated cumulative total cost of implementing NICE guidance between 1999-2004 was £800 million, which at
that time, represented a total of 1% of NHS expenditure.
• A study by the UK National Audit Commission indicated that improving the implementation of
NICE guidance is more likely with the following motivations:
– Established systems of tracking implementation: A system must be inclusive of professionals involved in
implementation to motivate them and hold them accountable.
– Weaknesses in financial management: Costs of implementation are generally unknown when budgets are set at
a local level because of 1) lack of knowledge of current and future guidance, 2) uncertainty of the full costs. Funding
as historically only included the actual costs of the drug/technology appraised, not the associated costs of staffing,
training and equipment.
– Clinical resistance: Perceived as a bigger challenge than funding restrictions. An enthusiastic champion (usually a
clinician) who develops a strong business case as part of their local delivery plan is more likely to secure the funds
needed.
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