The Scots and the English and Welsh are producing national guidance on NHS practice in different ways. Two apparently competing national agencies have already been established in Scotland---the Health Technology Board for Scotland and the Scottish Intercollegiate Guidelines Network (SIGN). Yet another one is in the pipeline---the Scottish Medicines Consortium. In England and Wales there is one agency---the National Institute for Clinical Excellence (NICE). Are these national agencies contributing effectively to the enhancement of performance in the NHS or are they merely fuelling demand and distorting the processes by which resources are prioritised
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