NICE guidance on drugs, alcohol and smoking in

young peopleDr Nichole Taske

Centre for Public Health Excellence

The National Institute for Health and Clinical Excellence (NICE) is

the independent organisation responsible for providing national

guidance on the promotion of good health and the prevention and

treatment of ill health.

When/why was NICE created?

• NICE’s role was set out in the 2004 White Paper ‘Choosing Health’.

• (New) NICE formed on 1 April 2005 following the merger of NICE and HDA following the Department of Health’s review of Arms Length Bodies

• NICE brings together knowledge and guidance on ways of promoting good health and treating ill health.

We produce guidance in three areas of health:• Public health – guidance on the promotion of good health

and the prevention of ill health – for those working in the NHS, local authorities and the wider public, private and voluntary sectors.

• Health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS.

• Clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

What does NICE do?

Public health Guidance: Audiences

• The NHS• Local government• Education• Private and voluntary sectors• Other arms of government• Employers

Two types of public health guidance:

1. Programme guidance

– 18 months

– Programme Development Group (PDGs)

2. Intervention guidance

– one year

– Public Health Interventions Advisory Committee (PHIAC)

Guidance development: key stages

1. Scoping

2. Development

3. Validation

4. Publication

1. Scoping the guidance

Draft scope for consultation

Stakeholder meeting

Consultation

Final scope

2a. Development: reviewing the evidence

• Review of effectiveness– assess quality and strength of evidence– assess applicability

• Economic appraisal– economic evaluations and modelling– public sector perspective, QALYs

• Evidence for consultation

2b. Development: drafting the recommendations

• Guidance development committee (PHIAC or PDG) draft recommendations based on:– strength and applicability of evidence– cost effectiveness– impact, including on inequalities in health– risks, benefits– implementability

3. Validation

• Draft recommendations released for consultation

• Fieldwork

• Guidance development committee revise recommendations based on: – stakeholder comments– fieldwork data

4. Publication

• Sign-off by NICE Guidance Executive

• Guidance published

Guidance products

• Full guidance• Quick reference guide (QRG)• Supporting documents:

– evidence reviews, – economic model/s, – fieldwork report, – PHIAC/PDG minutes

• Implementation support

www.nice.org.uk

NICE guidance on drugs, alcohol and smoking in

young people

Public health guidance on drugs, alcohol and smoking in young people

• Intervention guidance – Substance misuse in vulnerable young people– Alcohol and schools – Smoking and children

• Programme guidance– PSHE focusing on sexual health and alcohol

Clinical guidance on drugs and substance misuse

• Technology Appraisals – Methadone and buprenorphine for the management of opioid

dependence (2007)– Naltrexone for the management of opioid dependence (2007)

• Clinical Guidelines– Drug misuse: psychosocial management of drug misusers in the

community and prison settings (2007)– Drug misuse: opiate detoxification of drug misusers in the

community and prison settings (2007)

Substance misuse in vulnerable young people

• Intervention guidance on community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people (to age 25).

• Published March 2007;• Recommends that anyone who works with young people:

– identify those who are vulnerable to drug problems and intervene at the earliest opportunity;

– gives advice on stepping in and helping young people access the right support and services;

– outlines effective individual, family and group-based support which can improve motivation, family interaction and parenting skills.

Alcohol and schools

• Guidance on interventions delivered in primary and secondary schools to prevent and/or reduce alcohol use by young people under 18 years old;

• Due November 2007;• Currently in validation stage of guidance development

– Consultation on draft recommendations closed August 2007;

– PHIAC are currently revising recommendations in line with stakeholder/fieldwork comments.

Smoking and children

• Intervention guidance on preventing the uptake of smoking by children and young people (to age 18).

• Due July 2008;• Currently in development stage (evidence review)

– Consultation on evidence synopsis and submission of evidence by stakeholders: 23 November - 21 December 2007

PSHE focusing on sexual health and alcohol

• Programme guidance on school, college and community-based personal, social and health education, including health literacy, with particular reference to sexual behaviour and alcohol.

• Due September 2009;• Currently in scoping stage:

– Consultation on draft scope closed in October 2007

– Final scope due November 2007

Opportunities for stakeholder involvement in

public health guidance development and delivery

Stakeholder involvement

Actively sought at 3 key stages:

1. Defining the scope

2. Consulting on the evidence

3. Consulting on draft recommendations

Opportunities for involvement in public health guidance development

How to contribute:

• Stakeholder process (registration of, and consultation with, relevant government and non-governmental organisations for each piece of guidance)

• Committee and group membership, expert advisors (eg encourage individual members of stakeholder organisations to apply for PDG membership)

• Unusually, one-off projects such as focus groups, interviews

The stakeholder process:

Organisations can:

• Register an interest – at any stage of the development process• Comment on the draft scope – raise specific issues of concern to

people likely to be affected by the guidance• Submit evidence, if requested – surveys, grey literature etc• Nominate experts to apply for membership of the programme

development group (PDG)• Nominate experts, if invited, to give evidence to the guideline

development committee (PHIAC)• Comment on draft reports and guidance – raise specific issues of

concern to people likely to be affected by the guidance

Implementation of NICE public health guidance

Organisations can:• Work together with NICE to support the implementation of

guidance. For example, – Through helping in the dissemination of the guidance, particularly to

non-NHS organisations;

– Through strategic positioning of NICE guidance within organisational processes/procedures;

– Others?