An organisation called NICE (National Institute for Clinical Excellence) is often involved in deciding if cancer drugs and treatments become available on the NHS. So, it’s helpful to understand more about what NICE does.

NICE stands for the National Institute for Health and Clinical Excellence. It’s an organisation that gives advice on which new drugs and treatments should be available on the NHS and how particular illnesses, like cancer, should be treated.

NICE looks at how a new drug or treatment compares to the treatment we already have and whether it’s good value for money. When NICE has made a decision about a drug or treatment, it issues NICE guidance. NICE was set up to help to make sure that people have equal access to treatments and drugs wherever they live. Sometimes, because of different prescribing or funding policies in different areas, access to treatments can vary across the country, (so called ‘postcode prescribing’).

When NICE guidance for a drug has been issued this should no longer happen and PCTs must put arrangements for funding in place within three months. NICE guidance for a non-drug treatment is not enforced in the same way so differences in regions can still happen.

NICE doesn’t decide about all drugs or treatments used in the NHS. If NICE hasn’t issued guidance, PCTs can use other information to decide whether to provide a drug or treatment. A lack of NICE guidance is not a reason for not providing a treatment. Your doctor can prescribe a drug for you before NICE guidance is available, as long as your PCT agrees to this. But, once NICE has issued guidance, this replaces local decisions.

NICE advises the NHS in England and Wales. But in Scotland and Northern Ireland there are different bodies involved. The Scottish Medicines Consortium (SMC) advises Scottish NHS Boards on the use of new drugs. And, sometimes, the NHS in Scotland will choose to adopt NICE guidance on certain treatments.

In Northern Ireland, The Department of Health, Social Services and Public Safety makes its decision after looking at NICE guidance.

All medicines in the UK are subject to a system of licensing laid down by European and UK law. Before a drug is licensed it will have been through years of research and development. After this the developer will apply for a licence for the drug. This is when the safety of the drug is looked at, as well as how it compares to drugs currently in use.

Most new cancer drugs must be licensed by the European Medicines Evaluation Agency. The organisation that regulates medicines in the UK is the Medicines and Healthcare products Regulatory Agency. A large part of its work is to support the European Medicines Evaluation Agency. Until a new drug is licensed it cannot be widely prescribed within the NHS.

When a drug is licensed it is usually for specific use. So, a drug which is licensed to treat breast cancer should not be prescribed to treat any other type of cancer. If new trials show that the drug is also helpful in treating another type of cancer the makers will have to apply for an additional licence.

Despite these procedures and any guidance, it is still up to the doctor to decide whether to use a treatment or prescribe a drug. Doctors may wish to treat a patient with an unlicensed drug. In this situation the PCT will assess how useful it is. They may then allow it to be prescribed on a ‘named patient’ basis.

NICE is often asked for its guidance when a new cancer drug is licensed. If NICE says it should be available, PCTs have three months to follow this advice.

Non-drug treatments, for example new ways of giving radiotherapy, become available when there’s good evidence from studies that they work well. NICE may be asked to produce guidance on treatments to standardise their use across the NHS. This advice applies to Scotland, Wales and Northern Ireland as well. Unlike drugs, NICE advice on treatments doesn’t have to be followed by PCTs. So, this means that there can be differences in the availability of some treatments in areas.