Tackling society’s biggest challenges

Our aim is to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances

NICE public health guidelines can be used by local authorities, the NHS, schools, workplaces  and the wider public and voluntary sector to help prevent disease and promote good health of both individuals and populations.

In 2013/14, our public health guidance looked to tackle some of the biggest preventable health problems facing today’s society particularly early deaths caused by smoking, obesity, and a lack of physical activity.

We set out, in October 2013, recommendations to help local authorities and the NHS do more to support families to help them tackle the time-bomb of obesity in children and young people.

Obesity rates are on the rise across England with around 3 in 10 children aged 2 to 15 now classified as either being overweight or obese. In some parts of the country, the NHS has performed weight-loss surgery on obese children as young as 14.

We recommended that commissioners in local authorities and the NHS, and providers of community-based services, understand the challenges faced by families in their area in accessing support to address their weight.

Parents and carers should be helped to recognise that their child may be overweight or obese and then encouraged to help their child to change their behaviour.

A lifestyle approach should be taken to helping overweight or obese children which encourages long-term changes in behaviour rather than quick fixes.

In December 2013, we issued guidance calling for NHS hospitals and clinics to become completely smoke-free to create a culture where smoking is no longer considered the norm.

Our aim is to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances by providing help and support for people who are addicted to nicotine quit while in hospital.  This guidance can help hospitals make the sight of groups of smokers outside hospital entrances a thing of the past.  The guidance aims to make NHS secondary care an exemplar for promoting healthy behaviour.

Patients who smoke should be offered smoking cessation drugs, nicotine patches, and counselling as soon as they are admitted to an acute, maternity or mental health setting to encourage them to quit.

NHS staff, visitors, and family members should also be encouraged to stop smoking as part of a cultural shift in the way in which the NHS tackles smoking.

“It is absurd that smoking is still being tacitly encouraged within hospitals, said Professor Mike Kelly, Director of Public Health at NICE.

“Smoking has been thought to be a difficult nut to crack and so it is high time for this guidance. It recommends strong leadership and individual trusts have to own this. The professionals have to be willing to take this guidance on,” he said.

Video: Dr Sandy Gupta, Consultant Cardiologist at Whips Cross Hospital, London, discusses the smoking guidance

We published our 50th piece of public health guidance in February 2014 which broke new ground as the first major review across all of the evidence around domestic violence. The guidance sets out recommendations for training to help identify, prevent and reduce domestic violence, and calls for society as a whole to take action against domestic violence and abuse, with integrated working between primary care, secondary care, social care, the police, local government, and the third sector.

Interview - Professor Mike Kelly, Director of Public Health at NICE

When did you first start developing public health guidance?

“The Department of Health first proposed the idea of developing the evidence base in public health in 2000 and the task was given to the Health Development Agency (HDA). A team was set up at the HDA, which I led, and the rationale for the team was to do systematic analyses and reviews of public health evidence and to try to determine what interventions are effective.

“This was the first time anywhere in the world that something like this was attempted in public health. Up until then no one else had tried to do this. Many people argued that it was impossible. That public health evidence was too different to clinical evidence, too broad, too mixed, and too uncertain that it couldn’t be done.

“From 2000 to 2005, the HDA produced a series of evidence briefings of the existing evidence in a number of public health areas like obesity, alcohol, smoking and low-birth weight in children. This demonstrated that it was perfectly possible to take an evidence-based approach to public health and to make it work. The sceptics soon began to realise that it was possible to take an evidence-based approach to public health.

“Then quite out of the blue late one Friday afternoon I got news of a merger for the HDA with NICE, which at that time was the new kid on the block!"

Was the merger with NICE a difficult time for the HDA?

“Fortunately a couple of years before all the talk of a merger, the HDA and NICE had been jointly commissioned to do a piece of work on obesity. It was a joint referral for NICE to produce a guideline on the management of obesity and for the HDA to develop guidance on the prevention of obesity.  So from 2003 to 2005 we developed a close relationship with the guidelines team at NICE. We knew a lot about how NICE worked and it was this working knowledge of NICE that helped us to hit the ground running.

“In March 2006, we produced the first two pieces of NICE public health guidance on smoking and on physical activity. It was a very exciting period for the team and we have gone from strength to strength since joining NICE.”

There are now over 50 pieces of NICE public health guidance. Which ones are you most proud of?

“The guidance on alcohol and the guidance on the prevention of cardiovascular disease stand out because they made such political ripples. The world stood up and took notice and I stand by every word in those pieces of guidance. We were seen to be right by the public health community on issues like minimum pricing for alcohol.  The evidence for this is even stronger now and so entirely vindicates our guidance.

“The suite of guidance on smoking and the suite of guidance on physical activity have both been seen as extraordinary powerful pieces of guidance in both areas. I’m also really proud of the needles and syringe guidance. Not a popular area, often considered a Cinderella subject, but the contribution this has made to helping to keep the HIV epidemic under control and preventing the spread of hepatitis B and C epidemics into the general population has been really important.”

NICE public health guidance has been criticised in the media for being too nanny state. Is this fair?

“Clearly, people should be at liberty to make their own decisions about how they live their lives. But let’s take the guidance on contraceptive services as an example. Children are surrounded by a highly sexualised environment with sexual images in newspapers and on TV. So to say that they should be left to their own devices and not offered a proper knowledge and understanding of how to protect themselves in this environment and then to say that it is nannying is foolish.

“To say that our attempts to make hospitals smoke-free is nanny state completely misses the point. Nicotine is one of the most highly addictive substances known to man and to not help smokers who are going into hospital get the help and support they need to quit seems to me to be cruel and wicked.”

With public health moving from the NHS to local government do you believe that public health has now come back home?

“Yes, I’m certainly of the opinion that it should never have been an NHS function. Councils and counsellors tend to know their populations very well. They need to know them well because they want to be re-elected. Councils all seem to get the problem of health inequalities in a way that the old PCTs never really saw it as a problem for them. Despite the funding cuts to local authority budgets I am sure that they will make it work.”