NICE Public Health Briefings Peninsula Public Health Network 7 th Annual Conference

1. NICE Public Health Briefings Peninsula Public Health Network7th Annual Conference Stephen Judge, NICE Implementation Consultant Dr Rachel Kettle, NICE Public Health Analyst

2. The role of NICE • To identify good clinical and public health practice using the best available evidence • To help resolve uncertainty for the public, patients and professionals • To reduce variation in the availability and quality of practice and care. April 2013 – social care guidance and standards

3. Public Health Briefings

4. Introduction • Key Messages • What can Local Authorities Achieve • What is Effective • Good practice examples • Action planning • Costs and Savings • Background to recommendations • Support from NICE • Other useful resources . • Summarise key issues on many public health topics • Suggest effective interventions • Web based, and signpost further information • Intended for audiences less familiar with public health or with NICE • Appeal to others such as CCGs and local public health teams • Written in a way we hope is appealing to readers (don’t worry about ‘proportional universalism’ – there are glossaries !)

5. What are health inequalities ? • Differences between people due to social, biological or geographical factors • Can result in huge disparity in expectations of long and healthy lives • Some causes, such as ethnicity, are fixed. Others we can tackle . . . • Low ‘social position’ means likely worse health

6. . . . in a nutshell . . .only those in least deprived circumstances are likely to have any disability-free retirement

7. Local authorities are well placed to make a difference

8. What might be achieved ? • The cost in lost taxes and higher welfare payments arising from health inequalities has been estimated in the region of £28-32 billion. • Continuing to reduce smoking prevalence can have significant local impacts, and is very clearly linked to health inequalities, with the more deprived being more likely to smoke and to smoke more heavily. • In Lancashire, halving the health gap between the least deprived fifth and the rest would avoid 1500 premature deaths, gain the population as a whole an extra 1.3 life years and almost double that (2.5) in disability free life years- tha gains would be greatest in the deprived • Strategy willneed a mixture of both targeted and universal services

9. Quick Wins ? • Preventing unintentional road injuries in under 15se.g. 20mph speed limit zones • Smoking cessatione.g. access to cessation services (see ROI tool) • Reducing teenage pregnanciese.g. LARC, emergency contraception • Improve the economy by reducing sickness absence – e.g. workplace physical activity programmes –Business case tool for promoting physical activity in the workplace

10. Acting on Information • Identifying local need is the first step • The Public Health Observatory network provides health inequality data which can help contribute to local JSNA Step two is to identify groups and target interventions (see NICE PH15 - identifying and supporting people most at risk of premature death) PH 15

11. Planning services • Always ‘equity proof’ policies and programmesto help identify and address health disparities – even those without an explicit health focus • Equity auditing as part of the JSNA process is recommended • Use health impact assessment to assess the potential health impact of a proposal and mitigate against unintended consequences Using these tools can result in changes to programmes that give: • equal access for equal need (e.g. increased availability of free fruit in schools with pupils in greater need) • equal use for equal need (e.g. increase access to smoking cessation in lower income workplaces) • equal quality of care (e.g culturally specific maternity services for BME communities) • equal outcomes for equal need (e.g. greater reduction in CHD in more deprived groups)

12. Equal impact for all A public health intervention where all are affected equally means, everyone’s health state improves equally… BUT The gradient remains the same and health inequality has not changed.

13. Proportionate universalism A public health intervention where the intensity of effort is signified by the size of the arrow and determined by the needs of the group… The gradient flattens and health inequality has reduced.. AND Everyone in the population has had health gains.

14. Public Health Outcomes Framework and NICE One of two overarching aims – reduce health inequalities NICE have mapped relevant guidance and standards to the 4 domains of the PHOF • NICE guidance; • Is based on the best available evidence • Is compiled by independent experts • Assesses effectiveness and cost effectiveness of interventions

16. Harmful behaviours? • Alcohol – see NICE Pathway on prevention strategies • Obesity – see ‘physical activity pathway’ where recommendations for workplaces and environmental interventions can be found • Smoking – NICE recommendations tailoring or targeting services for minority ethnic and disadvantaged communities • Unintentional injuries – refer to NICE guidance for preventing accidents in under 15s by reducing the speed of drivers

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18. NICE Pathways – set out all that NICE have to say about a particular topic or condition in an easy to navigate graphical format. As well as providing summary information at each ‘node’, they also provide links to the underlying guidance, quality standards and supporting tools. Now optimised for Ipad too ! . Some topics feature summary descriptions of effective interventions – treatments or actions that have been shown to work

19. Costs and Savings • The QALY (Quality adjusted life year) • More people at risk and treated – lower QALY • Public Health interventions overwhelmingly suggest the biggest return – albeit you may have to wait a while for the outcome (e.g. obesity) • Savings, or avoided costs, may materialise in different departments, organisations or even sectors – a powerful reason to consider integrated budgeting and commissioning

20. Initial QALY loss due to side effects New treatment Currenttreatment QALYs gained Quality Adjusted Life Years • Combines both quantity and health-related quality of life (QoL) into a single measure of health gain • QoL (utility) determined using validated questionnaires • Conversion to numerical utility values reflecting preferences over health 1 Health-related quality of life 0 Length of life (years)

21. ROI Tool

23. . If reading this online, click the links below to download; Guidance app for AppleGuidance app for Android Also available – the app for the British National Formulary BNF app for AndroidBNF app for Apple

24. Want to know more ? • Website www.nice.org.uk • Sign up to receive monthly NICE News • NHS Evidence www.evidence.nhs.uk • Email stephen.judge@nice.org.uk

26. Don’t mention the • Name two interventions you think would make a real impact on reducing inequality • What do you see as the key barriers to introducing those changes ? • What would help to overcome those barriers ? • From what you have heard in this session, how might you utilise NICE’s support ?