It is not the case that there is a free lunch here

Nigel Edwards NHS Confederation

But by the new year, NICE appraisals will be binding with patients getting the right to any approved treatment which their doctor says is appropriate.

But it will not be providing extra moneym for every approved drug - even if it costs thousands of pounds for every patient - and the move has been condemned by NHS managers.

They say it will merely force cash-strapped authorities to make cuts elsewhere to fund expensive treatments - leaving other patients worse off.

Deadline set

Health authorities will in future have only three months from the publication of a new guideline by NICE to find the money to pay for it.

The change, announced at NICE's annual conference by health minister Lord Hunt, was pledged in Labour's manifesto during last year's election.

He said: "The Government is fulfilling a commitment to introduce a statutory obligation on the NHS to provide funding for treatments and drugs recommended by Nice on the basis of clinical and cost effectiveness.

"We want to ensure that patients get the appropriate drugs or treatment they need based on these recommendations."

It comes as another survey to be presented at the conference reveals that many health authorities are still refusing to fund new drugs for lung cancer, despite the treatments winning NICE approval.

Fewer than 15% of authorities, according to the CancerBacup survey, have set aside money specifically to do so.

Patients' needs

A spokesman for the charity said: "It's not enough to have the right policy in place if it's not being implemented effectively, and if the patients it's designed to benefit are not benefiting.

"Patients need to know that the treatment they receive in one part of the country is as good as that received by people in other areas."

But Nigel Edwards, acting chief executive of the NHS Confederation, which represents managers, told BBC Radio 4's Today programme that NICE-approved drugs were not necessarily the most cost-effective.

"The money to pay for these new treatments will have to come from somewhere.

Extra tension

"It is really quite possible that it will be taken from things that might benefit more patients and be much more cost-effective but the drug concerned has not been lucky enough to be put through the NICE process," he said.

"It is not the case that there is a free lunch here," Mr Edwards continued.

"This provides an extra tension in the system and really ducks the issue.

"The people on the ground - the people who give care - do know what their patients need.

"But it is very difficult the further you are from the patient - and by the time you get to Whitehall you are a very long way," Mr Edwards concluded.

Future battlegrounds

There are many areas which could prove controversial once the proposal goes forward.

In psychiatry, the prescribing of new types of anti-psychotic drugs is patchy - if prescribed reliably countrywide, many health authorities say they would have to cut community psychiatric nursing to afford it.

Another major appraisal which is likely to be completed next year is into fertility treatments - an area in which there would be an enormous demand, and which few health authorities currently fund.

Approval for even limited funding of IVF would create a major headache for many health authorities.

Even one cycle of IVF for one couple would cost well in excess of �1,000.