The National Institute for Health and Clinical Excellence (NICE) is the body responsible for deciding what medication and treatments should be available on the NHS.
What it does
NICE has looked at a range of areas including public health, new and existing medicines and procedures and the care of people with particular conditions since it was set up by the Labour government in 1999.
It has looked at a range of illnesses including flu, multiple sclerosis, hip replacements, coronary heart disease and breast and ovarian cancer.
NICE also advises on whether existing medications are ineffective or inefficient and if they should be withdrawn.
The government has also asked it to issue guidance on how to best manage medical conditions.
How it works
The Department of Health decides what treatments and drugs NICE should examine, (though does not govern other aspects of NICE's work).
The institute then consults the pharmaceutical industry, the medical profession, charities and patients and assesses whether the intervention would benefit patients, enable the NHS to meet key targets, like reducing deaths from heart disease and cancer, and be cost-effective.
NICE then makes recommendations to the NHS on which drugs and treatments should be available.
NICE's decisions only apply in England and Wales. However, they are usually adopted in Northern Ireland and Scotland.
What its limitations are
NICE was supposed to eliminate the "postcode lottery" in medical care - where some drugs and treatments are available in some areas but not in others.
And all NHS trusts and primary care organisations are expected to make money available to fund drugs and treatments recommended by the institute within three months of the guidance being issued.
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But in some cases this has proved to be expensive.
And the pharmaceutical industry and many patient groups believe NICE could be doing much more to ensure its recommendations are implemented.
Some say the institute should be given its own budget to fund new treatments so the NHS is not saddled with the bill.
How it relates to government
NICE has been criticised by charities and patient groups that have accused it of banning or limiting the use of some drugs because they would cost the NHS too much money.
But the Department of Health says: "NICE's remit is to produce robust, workable and evidence based guidance, free from political interference."
In July 2002, the influential Commons Health Committee called for the institute's decision making process to be made more transparent and fairer.
In addition, it urged NICE to take greater account of the impact its decisions have on patients' quality of life
However, MPs also suggested the institute had been criticised unfairly in some instances and called on the government to be more open about rationing or restricting treatment in the NHS.
But they did criticise NICE for failing to make rulings on new drugs quickly enough, leaving many patients and doctors in limbo when hyped drugs come on the market.
The institute has since brought in a rapid appraisal process.
How it relates to the pharmaceutical industry
The World Health Organization (WHO) has praised NICE for developing innovative ways of assessing new treatments and procedures.
But it has questioned how open and transparent NICE is when it accepts confidential information from pharmaceutical companies.
The WHO also criticised the way pharmaceutical industry representatives were involved in the decision-making process.
It suggested this could lead to potential conflicts of interest, particularly if members of one company were given information about a rival product.
How it relates to doctors
NICE is charged with drawing up guidelines for doctors, who are expected to follow its guidance or to be able to give very good reasons for not doing so.
But some doctors say the guidelines could be more reader-friendly and the institute could do more to explain why they should change the way they work.
How it relates to patients
In August 2002, NICE established a citizens council representing the general public to give its views on its work.
Some charities say the institute could further empower patients by publishing more information on its website.