An Audit Commission report suggests that three quarters of hospitals and other NHS trusts are not following guidelines from the National Institute of Health and Clinical Excellence (NICE) for tackling ill health.

The commission found that recommendations issued by NICE, which was set up to ensure high NHS standards, were a low priority in the financial management of trusts. It found that fewer than one in six budgeted routinely for new, more effective treatments.

There have been numerous complaints in recent years that NICE advice is not being followed in all areas.

There has been particular concern about access to new drugs such as herceptin, a leading breast cancer medication, and IVF treatment for infertile couples.

While NICE has recommended that childless couples should be eligible for three cycles of treatment on the NHS, and the Government has pledged at least one, some trusts are refusing to comply because of cash problems.

The financial watchdog confirmed yesterday that patients across England were still facing a postcode lottery of care because NICE guidance was not being systematically introduced. The auditors said trusts that did not comply should have this reflected in their annual performance ratings.

Health charities and politicians condemned the treatment disparities as an appalling injustice to patients.

NICE, which was set up with much fanfare by Labour six years ago, makes recommendations to the health service about whether specific drugs or treatments should be used, as well as producing guidelines.

Many trusts involved in the commission’s research said that cost was a significant barrier to following the guidance. Costly new treatments for rheumatoid arthritis were cited by many health managers as a current problem.

Though adhering to NICE can be expensive — new IVF and depression guidelines are estimated to cost £83.9 million and £57.7 million a year respectively — the report concluded that much greater implementation could be achieved if financial management improved.

For its research the Audit Commission received questionnaires from 71 NHS bodies and also visited 16 sites for more in-depth interviews.

From the site visits, the commission found that only 25 per cent could verify that they were implementing NICE appraisals of drugs and treatments within three months of publication.

One trust said that in one particular case it had taken them closer to three years to achieve full implementation due to the costs involved. The authors of the report said that though the sample of trusts visited was small, it did appear to be indicative of the broader picture across the NHS.

When it came to clinical guidelines, such as for the treatment of heart failure or diabetes, the commission found that implementation “ranged from nil to full compliance”.

The research found that 85 per cent of those questioned said that the funds available to implement technology appraisals were insufficient — particularly for the most expensive drugs. A third of trusts said that NICE had issued guidance in 2002-03 that they were unable to fund.

When questioned about budgetary priorities, two thirds said that they had set money aside for one or more clinical guidelines in the last three years. The commission said that this meant that the other third had not budgeted for a single guideline.

James Strachan, the commission’s chairman, said: “NICE plays a major role in ensuring high-quality patient care across the NHS . . . But guidance is not being systematically implemented across the country. There will always be competing priorities for funding, but surprisingly our report shows that it is not actually cost that is the root of the problem.

“What would make all the difference, and is achievable, is improved financial planning and better communication.”

Joanne Rule, the chief executive of CancerBACUP, said that it was appalling that almost two years after the charity highlighted postcode prescribing of cancer treatments, poor financial management was still found to be to blame.

Gill Morgan, chief executive of the NHS Confederation, which represents more than 90 per cent of NHS organisations, said that the annual cost of complying with NICE guidance was £800 million.

“Extra investment in the NHS is growing by an average of 7.4 per cent a year in real terms but drug costs are rising even faster.”

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