Deconstructing Deliberation in the Appraisal of Medical Technologies: NICEly Does it?
Appraisals of medical technologies undertaken by the National Institute for Health and Clinical Excellence (NICE) have significant implications for the setting of priorities for health care expenditure in the NHS in England and Wales. NICE has been characterised as a deliberative body, an evaluation which reflects the recent attention paid by those working within the health policy community to the establishment of mechanisms which deliver procedural justice, in the absence of societal consensus upon the substantive values which should underpin distributive choices in health care. This article critically interrogates the assessment of NICE as deliberative in character. It also considers the relationship between legitimacy and deliberation in this policy context, in light of the claim that ‘thickening proceduralisation’ by establishing and enhancing deliberative structures and processes is a useful strategy for addressing regulatory problems.