“We will, by about two years’ time, have completed about 120 guidelines.  And from then on we won’t be able to do any new ones……. …. So what we’re proposing to the government is the government invests much more heavily in our guidelines programme, so that we can not just keep the existing ones up to date, but do a whole lot of further guidelines.” Professor Sir Michael Rawlings Chairman of NICE, BBC Today 27^th June 2008

Last week NICE, the National Institute of Clinical Excellence and Quango extraodinaire, celebrated its ninth birthday. In a sixth of the time that the NHS has been around NICE has so successfully entrenched itself that we’d be forgiven for believing we were born with it.  For achieving such unquestioned status so quickly it must top the chart of the 111 new quangos set up by Labour since 1997.

It’s Chairman, (founding and still in situ) Professor Sir Michael Rawlings’s ambition for NICE is expansionist. Sir Michael, who has managed to chair the Advisory Council for the Misuse of Drugs over the same time period and has been proud to announce that in a career’s lifetime in the NHS he had never had to send a bill to patient and wouldn’t know how much to charge if he had to, was breezily confident about drawing on evermore government funding.  He seemed blithely unaware that the money is running out, that the country is in the worst economic downturn since the 70’s, that Gordon Brown is facing a further billion pound bill to pay for his 10p tax fiasco, on top of the 2.7 billion rescue package to date.  

But then all this clearly passes you by if you happen to run one of the country’s 1,162 quangos.   A recent report by the Taxpayers Alliance revealed Quangos’ lack of inhibition about spending our money.  Quango creep has left the Exchequer and us poorer by £64 billion per annum, the equivalent to £2,550 per household.  Quangos now employ almost 700,000 bureaucrats.  Even under the Cabinet Office’s restrictive definition, the cost of these bodies has risen by 50% in the last ten years.

But cost and waste aside should we worry about the role of quangos in our lives?  Undoubtedly we should. 

The conclusions of the recent Price Waterhouse Report – Review of Prison Based Drug Treatment Funding,  illustrate why: 

“The strategy will need to clarify and prioritise the required outcomes, and introduce revised commissioning arrangements to facilitate the coordination of drug treatment services and ensure that best practice is followed.”

 You might just write this off as contemporary newspeak or gobbledygook. That would be a mistake.  Underneath the verbiage what Price Waterhouse is recommending is the imposition of a treatment system already an expensive failure in the community, this time across the entire prison estate.  Yet the depressing ‘outcome’ of this ‘more focussed national strategy’, is unlikely to be the rehabilitation of drug using offenders or indeed the reduction of crime and re offending.  It is likely to be an inescapable imposition of methadone maintenance across the prison community. Should the individual prisoner want to use his time locked up to get clean, tough.  In this new Price Waterhouse world of prison treatment the extraordinary idea of retoxifying prisoners to cope with their presumed illicit drug use on getting out even gets credence.  Forget the urgent need for down to earth solutions  – the dearth of and need for ‘dry’, secure and safe, post release  half way house accommodation and care -  when complex bureaucracies can be established and computer system installed to track the hoped for  seamless movement of offenders from methadone in prison to  methadone in the community.

How did the Price Waterhouse Review, arrive at these conclusions so confidently and so uncritically?  How could they be so utterly unaware that the approach of the National Treatment Agency (another Quango) that their plans mirror, has been laid bare like the emporer’s new clothes? 

The answer can be tracked back to NICE - where else? The ‘Evidence of Drug Treatment Effectiveness’ on which the PW conclusions are premised comes straight from NICE. And guess what?  It is the same evidence that has so influenced the National Treatment Agency which they so repeatedly invoke in justification.  And when we see that several members of the Expert Panel and Steering Group of Price Waterhouse Review are closely professionally connected with each other and with the NICE drug treatment guidance panel………

And it goes on.  Now a senior member of the NTA Board, Professor Lord Kamlesh Patel, has just been put in charge of another Prison Drug Treatment Review Group, funded by the Ministry of Justice and Department of Health. On what will he be basing his thinking over this process? To the assembled delegates at the recent National Treatment Agency conference he made this quite clear – the recommendations of the Price Waterhouse Report.  Of course.