Keith Syrett

A Technocratic Fix to the "Legitimacy Problem"? The Blair Government and Health Care Rationing in the United Kingdom

The work of the National Institute for Clinical Excellence, an agency which has recently been created by Tony Blairs Labour government to provide guidance on best clinical practice to the National Health Service, has generated considerable controversy in the United Kingdom. It has been argued that the role which the institute plays in appraising cost effectiveness, especially of expensive new health technologies, constitutes explicit, national rationing. Although the employment of scientific and evidence-based criteria as the basis of decisions might have been expected to secure legitimacy for the institute—even when its recommendations have the effect of denying access to a particular treatment—the reaction to much of its work so far indicates that this goal has not been fully achieved. While alterations to structure and procedure may be considered as possible means of addressing the agencys difficulties, such proposals are not without problems. Consequently, in the final analysis, the British example may serve as a demonstration that the inherently political nature of priority-setting in health care precludes any easy technocratic solution.

Deconstructing Deliberation in the Appraisal of Medical Technologies: NICEly Does it?

Appraisals of medical technologies undertaken by the National Institute for Health and Clinical Excellence (NICE) have significant implications for the setting of priorities for health care expenditure in the NHS in England and Wales. NICE has been characterised as a deliberative body, an evaluation which reflects the recent attention paid by those working within the health policy community to the establishment of mechanisms which deliver procedural justice, in the absence of societal consensus upon the substantive values which should underpin distributive choices in health care. This article critically interrogates the assessment of NICE as deliberative in character. It also considers the relationship between legitimacy and deliberation in this policy context, in light of the claim that thickening proceduralisation by establishing and enhancing deliberative structures and processes is a useful strategy for addressing regulatory problems.

Mixing Private and Public Treatment in the UK's National Health Service: a Challenge to Core Constitutional Principles?

The question of whether those patients who privately purchase treatments which are not available on the National Health Service should, as a consequence, lose entitlement to free care for their condition has proved highly controversial in the United Kingdom. This article considers the debate upon this issue. It focuses in particular upon the degree to which the solution adopted conflicts with the foundational principles of the National Health Service which have recently been enshrined in the NHS Constitution.