For nearly three decades, decisions about which medicines the NHS pays for have not been made by ministers, but by the National Institute for Health and Care Excellence, known as Nice. Its job has been powerful: to act as a check on the pharmaceutical industry by demanding evidence that new drugs are clinically effective and worth the price, protecting NHS budgets from spiralling costs.
That independence has helped to shape how NHS money is spent in England and Wales, and, just as importantly, what it is not spent on. Nice does not exist to block new medicines, but to make sure limited public funds are used where they deliver the greatest benefit.
