National Institute for Clinical Excellence: NICE works.

The National Institute for Clinical Excellence was established in 1999. Its original remit was to undertake technology appraisals of (mainly) new interventions and to develop clinical guidelines. In providing both forms of guidance, it was required to take into account both clinical and cost effectiveness. After a difficult first few months, it gained the confidence and trust of the professions. It subsequently gained additional responsibilities with a commensurate increase in its staffing and budget. It is, moreover, the only one of the National Health Service organisations established in the late 1990s and early 2000s to have not only survived but grown. This paper describes not only the National Institute for Clinical Excellence's early years but also, in the author's view, the features of its guidance programmes that led to its success and (in retrospect) some things it could have done differently. © The Royal Society of Medicine.