Omen writes

Thinking about the reaction to the NICE glaucoma guidelines over the last few weeks I recalled the antics of Laurel and Hardy and the catchphrase 'that's another fine mess you've got me into Ollie'. Replace Ollie by NICE and you can see that conversation going on between the mandarins in Whitehall and their counterparts in NICE.

It is yet another example of the inability of government and its agencies to work in a joined up way, something that NICE seems unable to manage even within its own organisation. On the one hand it issues advice on the gold standard of diagnosis with no reference to the cost of implementation and on the other refuses access to treatment on the basis of cost. This was clearly demonstrated when in response to a question about the cost of implementation the chairman of the NICE glaucoma group said that the funding issue had nothing to do with him. This rather surprising statement was in fact correct; the reason can be found in the workings of NICE. A clinical guideline is produced and this is followed at a later date by guidelines on implementation.