Working with NICE ADPH annual conference, Friday 11 th September 2009 Catherine Swann PhD CPsychol AFBPS Associate 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 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

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 concept by 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