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The NICE approach to public health guidance

Thara Raj
Implementation Consultant for London
National Institute for Health and Clinical Excellence

I work for an organisation that provides a rationale for some of the things that I did almost intuitively when I first started working in public health departments up and down the country.

At the start of my career, I became interested in two things: bringing information about what works to professionals on the front line; and working with communities. This passion has informed every aspect of my work ever since.

In the early days, I used a variety of interventions, applying some of the theory that I learnt in my Masters, as well as "good practice" gleaned from conferences that the budget would stretch to. There were good-quality research papers but these were not always readily accessible when you had just a few hours to get the job done. I always wanted to know "was there a more effective way"?

In 2000, I was tasked with drafting a UK-wide programme for reducing class A drug use among young people, working with the former drug czar and others. I commissioned the National Addiction Centre to review the evidence and they did a great job in pulling together what little evidence there was.

At the same time, I undertook a Winston Churchill Travelling Fellowship, searching other countries for evidence and ways of working effectively with communities (again, pursuing my passions). I was left feeling that a great deal of money was being spent on drug prevention and treatment in the USA and Europe, based on very little evidence.

Now, we have the National Institute for Health and Clinical Excellence (NICE), which not only brings the evidence together but interprets it to guide people in how best to promote good health and to prevent and treat ill health. NICE has produced six pieces of guidance on drug prevention, management and treatment and I was reassured about some of approaches I had taken in the past. But what I find most helpful is that the guidance tells you what to stop doing, such as "do not offer ultra-rapid detoxification".

NHS Evidence, which is being led by NICE, takes this a step further by enabling people to search for accredited and other sources of relevant information on health and social care.
 
In 2004, Wanless challenged the NHS through public health action to have an eye on the public purse.1 NICE, with its emphasis on what is effective, as well as the cost-effective use of public resources, gained its remit for the production of public health guidance. From its first piece of public health guidance (Brief interventions and referral for smoking cessation in 2006) to, at last count, the 19th (Managing long-term sickness absence and incapacity for work in 2009), NICE has interrogated the evidence for public health in areas ranging from how to change behaviour and the environment to promoting physical activity.2,3

As an Implementation Consultant for NICE, I work with local authorities and NHS trusts. I help to ensure regular interaction with NICE stakeholders, supporting them in putting NICE guidance into practice and feeding back to NICE on how we can improve the way we work with those who implement our guidance.

I also get to hear about how, in London, as in other parts of the country, people are implementing NICE guidance locally – and I encourage healthcare professionals to submit examples of their own experience to our shared learning database (preferably before the end of September, when there is a chance of winning a cash prize of £1,000).

More information on how to submit your examples, and about NICE and NHS Evidence, can be found on the NICE website (www.nice.org.uk) or contact me, Thara Raj, Implementation Consultant (London) by email (Thara.Raj@nice.org.uk).

References
1. Wanless D. Securing Good Health for the Whole Population: Final Report. London: The Stationery Office; 2004. Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
2. National Institute for Health and Clinical Excellence (NICE). Brief interventions and referral for smoking cessation in primary care and other settings. Public Health Intervention Guidance no. 1. London: NICE; 2006. Available from: http://guidance.nice.org.uk/PH1/Guidance/pdf/English
3. National Institute for Health and Clinical Excellence (NICE). Managing long-term sickness absence and incapacity for work.  Public Health Intervention Guidance no 19. London: NICE; 2009. Available from: http://guidance.nice.org.uk/PH19