Health watchdog Nice denies bowing to pressure on minimum alcohol pricing calls


A health watchdog has denied it bowed to pressure from the Department of Health to remove calls for minimum alcohol pricing from its public health guidance.

Professor Gillian Leng, deputy chief executive of the National Institute for Health and Care Excellence (Nice), said the reference to minimum pricing had been taken out of the guidance because it had already been called for previously by Nice.

But she did not deny that an official from the Department of Health wrote to Nice two weeks after the draft guidance was published, reminding it that its guidance should not address questions "relating to national public policy issues, such as those relating to legislation."

The British Medical Journal (BMJ) has obtained a letter under the Freedom of Information act from the innovation, growth, and technology directorate of the Department of Health.

The sender's name has been redacted.

In the letter to Nice chief executive Sir Andrew Dillon, he is told that "in developing quality standards, and the underpinning are asked to have regard to ministers' views on the most helpful and appropriate focus for Nice public health guidance."

Ministers, the letter continued, "have indicated that...Nice guidance is not an appropriate vehicle for addressing questions relating to national public policy issues, such as those relating to legislation."

The draft guideline published by Nice - Dementia, Disability And Frailty In Later Life - Mid-life Approaches To Delay Or Prevent Onset - said efforts should be made to reduce alcohol consumption, including "enforcing minimum unit pricing, supported by activities to prevent illegal alcohol sales".

However, this reference to minimum pricing is removed from the final guideline, published months later.

John Britton, professor of epidemiology at the University of Nottingham, who chaired the guideline committee, told the BMJ of his disappointment at the changes, which had been "imposed after the committee had signed off a final version of the guidance."

He said: "Speaking personally, I think the guidance was diminished by these changes, since in my view both national and local policies and practices are key components of disease prevention."

But Prof Leng defended Nice's position, telling BBC Radio 4's Today programme: "What happened with the guideline around mid-life strategies was that, quite appropriately, when we came to review it, we realised there were recommendations that we had already published."

She said the focus of guidance should be on "new areas" and there was still a "cross-reference" to guidance which recommended minimum pricing for alcohol made in 2012.

"We didn't think - standard editorial policy - that we needed to state it again," she said, arguing that it was not correct to say the information had been "censored".

She went on: "Our advice is independent, our methods and processes are independent but our work programme has always been set by Government."

She said Nice was given a "formal brief" by the Government.

"Within that brief, we are then entirely independent in what we do and what we say."

Asked if she understood that people may see it as Nice just having to toe the Government's line, she said: ""I can see that some people might feel that was constraining.

"From a Nice perspective, that's the task we're asked to do, and we give an independent response."

But in a separate communication, a spokesperson for Nice said: "The revision of the reference to minimum unit pricing in the guideline occurred as a result of the pre-publication check done in February 2015.

"The recommendation was amended to align with the revised remit given to Nice in 2014 that no recommendations addressing national public policy issues or legislation should be made in Nice guidance, unless specifically indicated within a topic referral."

A Department of Health spokesperson told the BMJ that the letter sent to Nice "reflects the established departmental position about the scope of Nice's role in providing public health guidance."

In a statement to the BMJ, Sir Andrew said: "Our public health advisory committees have been aware for some time that the Department of Health does not expect us to provide advice to them on their legislative programme."

Simon Capewell, professor of clinical epidemiology at the University of Liverpool, who gave testimony for the original guidance, said it was "very frustrating that Nice's analysis of the evidence base for a minimum unit price for alcohol did not lead to the introduction of this important public health measure."

Katherine Brown, director of the Institute of Alcohol Studies, told the BMJ: "The idea that ministers would meddle with supposed independent public health advice to suit their own political agenda is alarming.

"It brings into question whose interests are being prioritised: the public's or big business."