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National Institute for Health and Clinical Excellence

I am grateful for that helpful comment. I do not want to be misconstrued. I am talking about when it is absolutely cut and dried that one thing is right and others are not. That is when the word ““directive”” should be used, or another word, if we can think of one. I echo the Chairman of the Committee's comment that there could be one mandatory element in some clinical guidelines. He mentioned NICE's current work on venous thromboembolism. Of the recommendations that have been made on that, the risk assessment should be mandatory for everybody going into hospital. Disinvestment is an incredibly important part of NICE's work. We are not going to get any more money coming into the health service, so we want to make absolutely sure that what we have is being used as best it can be. I was pleased to read about NICE's recommendation reminders in its optimal practice review, and the fact that it recommends savings in its technology appraisals. That is a hugely important part of its work. If we cut out inappropriate prescribing, we will make huge savings. The Department of Health made a start on that with its ““Better Care, Better Value”” indicators, which showed some time ago that just by prescribing generic statins at the right time, the NHS could save £80 million a year, which is amazing. If we can make such savings through appropriate, correct prescribing, we will do the health service a power of good. On implementation, I was pleased to read about implementation consultants, but slightly disappointed that there are only six of them for the whole of England. The Chairman of the Committee mentioned our trip to Canada, on which we found that NICE's equivalent there had such people in every part of the country. They were making a huge difference.