Health technology assessment and mental health

Abstract

In company with all other branches of the NHS, those concerned with mental health are currently the target of a plethora of standards, guidelines and derivatives thereof. In England and Wales, the responsibility for the production of national clinical guidelines rests with the National Institute for Clinical Excellence (NICE), and the Commission for Health Improvement (CHI) is charged with the monitoring of performance. In Scotland, the Scottish Intercollegiate Guideline Network (SIGN) and the Clinical Standards Board for Scotland (CSBS) undertake these respective responsibilities. However, NICE is also responsible for a rather different form of activity, and one that has forced it recurringly into the media limelight in the 2 years since its creation. This is the formulation of national advice on the clinical and cost-effectiveness of new and existing health technology. Health technology is a rather pedantic, if precisely defined, term that means essentially any health intervention and it includes medicines, devices, clinical procedures and even health care settings. Post-devolution and in the wake of the establishment of the Scottish Parliament, the Health Technology Board for Scotland (HTBS) was created by statute in April 2000. This organisation shares with NICE the responsibility for issuing advice on the clinical and cost-effectiveness of health technologies, in HTBS's case primarily to NHS Scotland. Therefore, two nationally-oriented organisations exist on either side of Hadrian's Wall, responsible to their respective Parliaments for providing authoritative opinions on whether or not a particular health intervention should be provided within the NHS. A crude approximation to the subject of this advice would be ‘value for money’. While, for reasons that will be explained, such a term is potentially misleading, it does serve to identify the basic elements of the need to which this activity is a response.