NICE - helping more people to be more active

Deborah O’Callaghan - Implementation Consultant

30th June 2015

Overview

• Brief reminder of the role of NICE

• Highlight resources to support the uptake of physical

activity

• Overview of how these NICE resources can be used to:

– Ensure and provide assurance that services are safe,

effective and value for money

– Inform scrutiny and service review

– Identify high impact areas for improvement

– Develop a clear case for investment (or funding bid)

• A quick guide to accessing NICE guidance and

resources

The role of NICE

• To identify good 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

NICE guidelines

• recommendations based on the best available evidence

to help you plan, deliver and evaluate successful

programmes

• an objective and authoritative summary of the research

and evidence, reviewed by independent experts from a

range of backgrounds and disciplines

• an assessment of the effectiveness and cost

effectiveness of public health interventions

“Following NICE's recommendations on physical activity

will help you make the best and most efficient use of

resources to improve the health of people in your area”

Physical activity guidance

• Exercise referral schemes to promote physical

activity (PH54) (September 2014)

• Four commonly used methods to increase physical

activity (PH2) (March 2006)

• Maintaining a healthy weight and preventing excess weight

gain among adults and children(NG7) (March 2015)

• Maternal and child nutrition (PH11) (March 2008)

• Obesity (CG43) (December 2006)

• Physical activity and the environment (PH8) (January 2008)

• Physical activity: brief advice for adults in primary

care (PH44) (May 2013)

Physical activity guidance cont.

• Prevention of cardiovascular disease (PH25) (June 2010)

• Promoting physical activity for children and young

people (PH17) (January 2009)

• Promoting physical activity in the workplace(PH13) (May

2008)

• Walking and cycling: local measures to promote walking

and cycling as forms of travel or recreation (PH41)

(November 2012)

• Weight management before, during and after

pregnancy (PH27) (July 2010)

Maintaining a healthy weight and preventing

excess weight gain among adults and children –

March 2015

1 Encourage people to make changes in line with existing advice

2 Encourage physical activity habits to avoid low energy expenditure

3 Encourage dietary habits that reduce the risk of excess energy intake

4 Further advice for parents and carers of children and young people

5 Encourage adults to limit the amount of alcohol they drink

6 Encourage self-monitoring

7 Clearly communicate the benefits of maintaining a healthy weight

8 Clearly communicate the benefits of gradual improvements to

physical activity and dietary habits

9 Tailor messages for specific groups

10 Ensure activities are integrated with the local strategic approach to

obesity

NICE pathways

NICE Pathways

NICE Pathways

• present all NICE guidance for a

specific subject

• include NICE guidance and NICE

quality standards

• Link to NICE implementation

resources (e.g. costing and

commissioning resources, training

resources)

• offer an easy and intuitive way to

access NICE guidance

Quality standards

Physical Activity Quality Standards

• Physical activity: encouraging activity in all people in

contact with the NHS (March 2015)

• Mental wellbeing of older people in care homes (Dec 2013)

• Falls in older people – Assessment and prevention (March

2015)

• Antenatal Care (Sept 2012)

• Postnatal Care (July 2013)

• Diabetes in adults (March 2011)

What are NICE guidance and quality

standards?

Evidence Guidance Quality

Standards

A NICE quality standard is a

concise set of statements

designed to drive and

measure priority quality

improvements.

A set of systematically developed

recommendations to guide decisions for

a particular area of care or health issue

Research studies - experimental

and observational, quantitative

and qualitative, process

evaluations, descriptions of

experience, case studies

Source guidance

• Behaviour change: individual approaches (2014) NICE

guideline PH49

• Physical activity: brief advice for adults in primary

care (2013) NICE guideline PH44

• Walking and cycling: local measures to promote walking

and cycling as forms of travel or recreation (2012) NICE

guideline PH41

• Promoting physical activity for children and young

people (2009) NICE guideline PH17

• Promoting physical activity in the workplace (2008) NICE

guideline PH13

Domain Objectives and indicators

1 Improving the wider determinants of health

ObjectiveImprovements against wider factors which affect health and wellbeing and health inequalitiesIndicators1.9 Sickness absence rate1.16 Utilisation of outdoor space for exercise/health reasons1.18 Social isolation* (ASCOF 1I)

2 Health improvement ObjectivePeople are helped to live healthy lifestyles, make healthy choices and reduce health inequalitiesIndicators2.5 Child development at 2–2½ years2.6 Excess weight in 4–5 and 10–11 year olds2.8 Emotional wellbeing of looked after children2.12 Excess weight in adults2.13 Proportion of physically active and inactive adults2.17 Recorded diabetes2.22 Take up of the NHS Health Check programme – by those eligible2.23 Self-reported wellbeing2.24 Injuries due to falls in people aged 65 and over

4 Healthcare public health and preventing premature mortality

ObjectiveReduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communitiesIndicators4.4 Under 75 mortality rate from all cardiovascular diseases (including heart disease and stroke)** (NHSOF 1.1)4.5 Under 75 mortality rate from cancer** (NHSOF 1.4i)4.7 Under 75 mortality rate from respiratory diseases** (NHSOF 1.2)4.11 Emergency readmissions within 30 days of discharge from hospital** (NHSOF 3b)

Driving quality improvement work

What are NICE guidance and quality

standards?

Evidence Guidance Quality

Standards

A NICE quality standard is a

concise set of statements

designed to drive and

measure priority quality

improvements.

A set of systematically developed

recommendations to guide decisions for

a particular area of care or health issue

Research studies - experimental

and observational, quantitative

and qualitative, process

evaluations, descriptions of

experience, case studies

How to use NICE quality standards

Help to identify local priorities for quality improvement

• NICE quality standards can highlight key areas for

improvement. An initial assessment should consider:

– relevance to the organisation

– how services compare

– what evidence is available

– actions to improve

– risks of not improving

Sources of information to support initial

assessment could include:

• baseline assessments/actions plans for NICE clinical

guidelines

• new or existing service user feedback

• complaints or Serious Untoward Incidents (SUIs)

• audit information (including national audit data)

• prescribing or activity data

• views of the service/team

• process maps

• service user experience interviews

The initial assessment

• A positive assessment can:

– provide assurance

– could be included in the trust’s quality account or

organisation’s quality profile

• An assessment indicating areas requiring quality

improvement can:

– inform local quality improvement work/programme

planning

– support discussions with commissioners

• Inform the organisation’s annual audit programme (by

identifying priority areas for audit) and business planning

• Inform local risk management, in collaboration with the

service’s commissioners

Do we require our service providers to include advice about physical activity in the feedback that we give to parents?

Is this reflected in the service specification?What is the content of the advice – does it include information about local

opportunities to be physically active?What format is this advice in and at what stage is it given?

Endorsement statement for Living well through activity

in care homes

“This toolkit supports statements on participating in

meaningful activity and personal identity in the NICE quality

standard for mental wellbeing of older people in care

homes. In addition, it also supports the recommendations

relating to occupational therapy interventions and training

within the NICE guideline onmental wellbeing in over

65s: occupational therapy and physical activity

interventions”

National Institute for Health and Care Excellence

June 2015

Scrutiny and service review

NICE guidance & quality standards can provide a useful

reference tool for those scrutinising services

Ask services:

• whether they have a systematic approach to NICE

guidance and quality standards, and what it is

• how they are using NICE quality standards to improve

quality of care provided or commissioned

• specific questions developed from quality standard

statements

Case study – Greater Manchester Sector

Led Improvement

• NICE guidance & quality standards are pivotal to Greater

Manchester's sector-led improvement approach to driving

improvements in public health

• Process of self-assessment and peer review

• Local action plans are developed and reviewed regularly

by LA peers to ensure that NICE guidance & quality

standards are being implemented and that performance

against PHOF (Public Health Outcomes Framework)

measures improves in the long-term

Practical Support

Into Practice Guide

Self assessment/Audit tools

Costing reports and templates

Online learning resources

Case scenarios

Shared learning database

Medicines Information

NICE and BNF apps

Field team

We provide a range of resources to help local implementation of our guidance and

use of our quality standards.

www.nice.org.uk/about/what-we-do/into-practice

Implementation - practical support

Shared learning

• My best move – GP training for physical activity for

patients with long term conditions (NHS London)

• Implementation of NICE guidance on promoting physical

activity in young people (NHS Oxfordshire)

• National database to evaluate the effectiveness of

outdoor activity based initiatives (Natural England)

• Leicester Square to Covent Garden walking corridor

(Westminster City Council)

• Walking away from type 2 diabetes (Loughborough Diet

Lifestyle and Physical activity Biomedical Research Unit)

• Community based Falls Prevention in Older People

(Anglesey County Council)

Return on Investment Tools

• Each tool enables the user to evaluate a

portfolio of interventions in their geographical

area and models the economic returns that can

be expected in different payback timescales

• 3 published so far:– Tobacco

– Alcohol

– Physical Activity

Local Government briefings

• These briefings provide advice for local

government on the public health actions that are

most effective and provide best value for money,

based on NICE guidelines

• Briefly summarise NICE recommendations

• Outline prevalence and high level costs and

savings

• High impact ‘vignettes’

• Links to other useful resources and advice

Physical activity related briefings

• Physical activity

• Walking and cycling

• Encouraging people to have NHS Health Checks and

supporting them to reduce risk factors

• Behaviour change

• Preventing obesity and helping people to manage their

weight

• Workplace health

• Community engagement to improve health

• Health inequalities and population health

• Tackling the causes of premature mortality

Physical activity (LGB 3)

• Introduction

• What can local authorities achieve by encouraging

people to be more physically active?

• What NICE says

• Developing an action plan

• Costs and savings

• Facts and figures

• Support for planning, review and scrutiny

• Other useful resources and advice

“In England, the costs of lost productivity have been

estimated at £6.5 billion per year from sickness absence

and premature death.

Physical activity programmes at work have been found to

reduce absenteeism by up to 20%: physically active

workers take 27% fewer sick days. Getting employees

involved in a physical activity programme can also lead to

net savings while boosting productivity”

“There is potential for increasing the number of journeys

taken by bicycle. Currently, these trips make up just 2% of

all journeys in Britain. Twenty percent of all trips made

cover less than 1 mile – and just over half of all car

journeys cover less than 5 miles (Transport trends 2009).

Although most children can cycle, only 2% of trips to school

are made by bike (Taking part: The national survey of

culture, leisure and sport. Adult and child report

2009/2010)”

Behaviour change

• Behaviour change interventions are coordinated sets of

activities that seek to change specific health-related

behaviours.

• What to consider when commissioning behaviour

change interventions and programmes

• What NICE says

• Developing an action plan

• Costs and savings

• Support for planning, review and scrutiny

• Other useful resources and advice

If you can’t find what you’re

looking for….

Keeping up to date• Sign up for the NICE News

• Log on to the website and register your details at

www.nice.org.uk

• Register as a Stakeholder for Social Care Guidance and

Quality Standards: socialcaresh@nice.org.uk

• Email: deborah.ocallaghan@nice.org.uk