“I don’t mind people thinking I’m incompetent, although I don’t want them to,” Care Quality Commission chief executive Cynthia Bower told HSJ this week.

The resulting debate on hsj.co.uk divided between those who felt Ms Bower had an impossible job and those who believed she had a case to answer over failures of the regulator’s performance and her leadership.

The CQC chief was interviewed at HSJ’s Leadership Forum. An hour beforehand, Sir Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence, had subjected himself to the same scrutiny – and his answers were instructive both for Ms Bower and everyone shaping the new regulatory framework for the NHS.

We’ve all got used to NICE, but it is worthwhile reminding ourselves quite how radical its role is and, given the life and death nature of its decisions, how much support it has from the government, NHS, media, the public and even the pharmaceutical industry.

That support is not unequivocal and it has often been hard won. Arguments continue over the exact nature of its role, but NICE continues to grow its remit and its influence.

There are a range of reasons for its success and the regulator’s leadership is definitely one of them. For a start, there has been continuity – both Sir Andrew and chair Sir Michael Rawlins have been in post since NICE’s creation in 1999. However, they were only able to build that unprecedented record because of the absolute clarity with which the two knights carved out NICE’s role. In negotiations with policy makers they have made absolutely sure what responsibilities NICE is and is not adopting, and the limits of any outside influence. Having set those boundaries, they have firmly stuck to them, politely reminding any trespassers of what had been agreed.

Part of those negotiations has been an agreement that the majority of NICE’s guidance should not be mandatory. Sir Andrew believes this underpins NICE’s acceptance by – and influence on – the NHS.

As the country is whipped into a regulatory frenzy by care scandals and the impending Mid Staffordshire Foundation Trust inquiry report, we should remember the lessons NICE’s success can teach us.

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