Ministers have been told to forget any idea that their new health care appraisal agency will save money. So far, according to the man chairing the agency, it has cost "well in excess of £100m".
When the national institute for clinical excellence (Nice) was set up, it was widely seen as a means of rationing costly new drugs and procedures. But Sir Michael Rawlins, its chairman, last week told the organisation's annual conference that the cost of implementing its advice in its first full year had been more than £150m. Savings from the advice had been £47m.
Sir Michael also dismissed suggestions, fuelled by Nice's change of heart on anti-flu treatment Relenza, that the agency has been pressured by the government. There had, he said, been "no overt - or covert - attempt by ministers or officials to influence our guidance" and no guidance about available resources.
"Although the secretary of state does have reserve powers if we do 'lose the plot', we have never had a steer - formally or informally - about the nature of the guidance we should give," he insisted.
Nice's forthcoming work programme includes production of clinical guidelines for conditions ranging from dyspepsia to schizophrenia, as well as for pre-operative investigations.
Egon Jonsson, director of Nice's equivalent body in Sweden, told the conference in Harrogate that as a consequence of his agency's recommendation, routine pre-operative testing of younger patients in Swedish hospitals had all but ceased. Savings had amounted to five times the agency's budget.
As a result, Mr Jonsson said, health ministers had offered to double the budget. "Watch out, Nice, this could happen over and over again," he warned, "and it's not that easy to spend money wisely."
Mr Jonsson called for greater collaboration among appraisal bodies - of which there were 20 in Europe, assessing 600 drugs and procedures at any one time. He said: "I notice that many of the topics that Nice is going to look at are topics that many other agencies, including my own, have already done."
The British agency was uniquely strong, however. "Nice has the power to say no," Mr Jonsson said. "The potential is enormous."
