The reality of the decisions the National Institute of Health and Clinical Excellence (NICE) must make

In its defence has to be the point that the NHS has an amount of money beyond which it cannot go.

With that in mind any organisation faced with the choice of approving or rejecting drugs is going to have a tough job in public relations terms.

For any drugs rejected by NICE there are always going to be people unhappy with that decision resulting in complaints about the NHS and NICE.

If the drug happens to be a treatment for cancer then the likelihood is that the decision by NICE will find its way into the national press and the name of the organisation will be damaged as a result.

However, it is likely that NICE is here to stay. For all its many faults and the many problems that it has encountered since its beginning, the original idea, to have an independent body responsible for deciding which drugs and treatments should be provided by the NHS is a sound one; it is unfortunate though predictable that it will have negative connotations.

However, it is at least arguable that whilst NICE as an organisation has a duty to better explain the reasons for the decisions it comes to, there is also a duty on politicians and the media to better explain NICE's role and the dilemmas it encounters on a regular basis.

Also, pharmaceutical companies themselves, while often attacking NICE, have to see that some drugs are not cost-effective because of the high prices demanded by some of the companies.

As thoughts turn to public spending cuts by whoever wins the 2010 General Election, the pressure on NICE is likely to intensify and the organisation will have further difficult choices to make in the months and years ahead.