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EDITOR-Wailoo et al highlight a fundamental challenge that the National Institute for Clinical Excellence (NICE) faces on a daily basis. 1 The government established NICE not only to advise the NHS on the quality of care that individual patients could expect (in terms of appropriateness and effectiveness) but also to address the other important dimensions of healthcare quality (equity, fairness, and efficiency) that society expects.
We agree that being required to address both in the guideline programme will lead to understandable tensions. But this is also true of the appraisal process. The appraisal committee's decisions have sometimes "favoured" the individual health perspective 2 and on...