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NICE, Public Health and Local Government

Articles by Mike Kelly former Director of the Centre for Public Health at the National Institute for Clinical Excellence are always worth a read. He has just published one in the Journal of Public Health which looks at the role of evidence-based public health guidelines in local government.

One of the points that Mike makes is that councillors have a much broader view of evidence than the NICE model whose approach has its origins in evidence based medicine, peer reviewed literature etc. He notes that elected members must also take into account a range of other factors – such as their local knowledge and the views of their constituents.

Mike’s paper got me thinking – as he says –  local authorities are democratic political decision making bodies and NHS organisations are not. As I explored this a bit further it seemed to me that NICE have pulled back from their public health function in the last few of years. I think Mike left NICE in 2014

NICE guidance is still mainly for the NHS. The NHS is essentially a collection of services – and despite various attempts to make it more accountable locally it is really an aggregation of different clinical health specialisms bound together by a post war policy commitment – these are managed by NHS England on behalf of the Department of Health.

Being a collection of services – the focus is on delivery. Respective governments  have created a performance management system that focusses on individual service performance rather than their total  impact on population health.  NICE guidance works in this policy context.

In general NICE guidance focusses on one of 3 areas:

  1. technical practice with individuals,
  2. how services should work
  3. what systems should do.

Most NICE guidance focusses on areas 1 and 2; however, NICE Public Health Guidance for understandable reasons has a greater focus on areas 2 and 3. Even here emphasis is more on services rather than systems. I have looked at the 65 NICE public health guidelines of these only 13 specifically mention that the intended readership includes system leaders such as elected members, Health and Wellbeing Boards, Local Strategic Partnerships etc. My working out is here.

Most NICE guidelines are operational and conservative. By this I mean they tell us what is already known. The aim is to ensure that good practice is used consistently. It’s not surprising that elected members are largely unaware of them – most are not aimed at them and those that include them are produced infrequently.

Local Councillors head up significant local democratic institutions who use their mandate to ensure that the interests of their population are served. They are responsible for shaping what it feels like to live in that area, the local authority power of wellbeing is a recognition of this.

Many are trying to improve health and reduce health inequalities in a world that doesn’t  work according to the same rules as NICE guidelines.

It is quite understandable that local councillors have little interest in much of the guidance that is produced by NICE. Having said that I think that when it existed the Centre for Public Health at NICE must have recognised this problem because they produced a series of Local Government Briefings that attempt to speak to local authorities in their system role. While I think they still struggled with the operational nature of NICE evidence nonetheless they strike me as an attempt to reach out to system leaders like Councillors.

Unfortunately NICE is now pulling away from this innovation – see below:

Councillors are primarily concerned with strategic challenges which can include structural inequalities, access to employment, financial insecurity, social cohesion, health and care system integration etc.

Unfortunately these strategic public health issues are just not on the NICE agenda reasons include:

(Caveat – this blog has been written over a few evenings – I’m not claiming that it is a full representation of all NICE work on Public Health. Declaration of interest I used to work for the Health Development Agency)

What do you think?

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