Working with NICE

ADPH annual conference, Friday 11th September 2009

Catherine Swann PhD CPsychol AFBPSAssociate Director, Centre for Public Health Excellence

NICE

The National Institute for Health and

Clinical Excellence (NICE) is the

independent organisation in the UK

responsible for providing national

guidance to the NHS and the wider

public health community on the

promotion of good health and the

prevention and treatment of ill health.

• At NICE the Centre for Public Health Excellence develops public health guidance

• Established 2005

• 31 staff based in London and Manchester, plus collaborating centres based in Sheffield, Exeter, London, Oxford, Liverpool and York

Two types of public health guidance

Programme guidance

• 21months

• Programme Development Group (PDGs)

Intervention guidance

• 14 months

• Public Health Interventions Advisory Committee (PHIAC)

Audiences for public health guidance

• The NHS

• Local government

• The workplace

• Education

• The utilities

• Private and voluntary

sectors

• Other arms of government

• The public

The context of NICE guidance

• Flat-lining NHS budgets, and the impact of recession

• Renewed interest in the prevention agenda, and the cost effectiveness of guidance itself

• A service that needs to deliver AND produce efficiency savings

• Changing political climate

Public health guidance

• 19 piece of guidance published (interventions and programmes)

• Wide ranging topics:

– Changing behaviour: e.g. physical activity, smoking cessation, obesity

– Preventing disease: e.g. smoking prevention; STI

– Promoting health and wellbeing: e.g. mental wellbeing in secondary school-children; mental wellbeing in older people

– Health services and systems: e.g. contraceptive services; finding and supporting those at risk of early death

– Theories and principles: e.g. behaviour change; community engagement

Evolutionary Trends

.Source: The Economist, 12 November 2003.

What we know #1

• Our guidance identifies cost effective – and sometimes cost-saving – interventions and programmes for delivery by different services and professionals, to a wide range of groups and settings

• To ensure that guidance is taken up and used, and benefits and savings are realised, we have to engage with stakeholders

• Directors of Public Health are key stakeholders

• There are multiple opportunities for stakeholders to become involved in producing the guidance but...

What we know #2

• Involvement in guidance development is possible through:– Consultation responses (PCT or ADPH)– Membership of programme development groups

(PDGs)– Membership of standing committees (PHIAC)

• DPH input into guidance helps to ensure it is targeted, implementable, sustainable, useful

• DPH input into implementation is vital

What we don’t know

• How can we encourage more DPH to come forward and get involved?

• How and when have you implemented our guidance? And when / why have you not implemented it?

• What additional tools can we produce to help you to implement public health guidance?

• What other guidance / topics are most needed?

• How can we formalise / develop our relationship?

Vacancy!

• We are about to start developing guidance on the prevention of type 2 diabetes

• We would very much like a DPH on our PDG

• catherine.swann@nice.org.uk

NICE needs

YOU

Interventions completed

• Promoting physical activity in primary

care (March 06)

• Smoking cessation in primary care

(March 06)

• Preventing teen conceptions and STIs

(Feb 07)

• Substance misuse and vulnerable young

people (March 07)

• Needle and syringe exchange schemes

(Feb 08)

• Supporting the smoking ban (April 07)

• Alcohol and Schools (Nov 2007)

• Primary Schools and children’s mental well being (universal and targeted approaches) (March 08)

• Workplace physical activity (May 08)

• Smoking and children (July 08)

• Proactive case finding in disadvantaged communities (Sept 08)

• Mental well being and older people (Oct 08)

Interventions under development

• Mental health and the workplace

• Prevention of skin cancer• Schools and smoking • Improving the uptake of

immunisation • Secondary schools and

mental well being• Child accident prevention on

the road• Child accident prevention in

the home

• Smoking and pregnancy• Weight management

following pregnancy • Weight maintenance during

pregnancy• Child accident prevention in

the environment• HIV prevention in MSWM• HIV prevention in high risk

groups• Other skin cancer• Various obesity topics• Children's emotional and

social well being

Programmes

• Obesity (Dec 06)

• Behaviour change (Oct 07)

• Physical activity and the environment (Jan 08)

• Smoking cessation services (Feb 08)

• Community engagement (Feb 08)

• Maternal and child nutrition (March 08)

• Physical activity, play and sport in pre school and school aged children (Jan 09)

• Long term sickness incapacity (March 09)

• Health literacy in schools with reference to sex education – PSHE (Sept10)

• Alcohol (March 2010)

• Accident prevention (July 2010)

• CVD at population level (March 2010)

• Looked after children (Sept 2010)

• Contraception and disadvantaged young people (tba)

• Obesity

• Type 2 diabetes

A Health Map, Barton and Grant ,2006

based on a public health conceptby Whitehead and Dahlgren, The Lancet ,1991

Methodological principles

• Base recommendations on the best available evidence.• To determine cost effectiveness using the QALY. • To be open and transparent and to involve

stakeholders.• To be clear about scientific and other values• To allow contestability.• To be seen to be independent of government, the

pharmaceutical industry and other vested interests.

Guidance development:

1. Scoping

2. Reviewing the evidence:– Review of effectiveness

• assess quality and strength of evidence, assess applicability

• try to take as broad approach to the evidence as possible (qualitative evidence, expert witness, committee views)

• economic appraisal (cost effectiveness review and modelling: public sector perspective, QALYs)

3. Stakeholder consultation and fieldwork