Mike Kelly, Director of the Centre for Public Health Excellence, discusses how NICE is providing the evidence base for better public health outcomes.
This was part of the 2011 Public health system reform summit, considering reforms to local health systems and changes in power and alignments between local authorities, the third sector and the NHS.
Other summits in this series
- Social enterprise summit
- Health and wellbeing board summit
Here is a little scenario - A Director of Public Health goes in to see their new Cabinet Lead for Health. The councillor says - “the government continues to cut our core funding and I therefore need to save £2m. Give me your advice I have two services which need funding - one is a smoking cessation service - who are working according to NICE guidelines. The second is a welfare rights service - all of whose clients have chronic mental health problems with a very high proportion experiencing problematic debt and fuel poverty. I can only invest in one service - where should I invest the £2m - which one will make the greatest impact on the health and well being of the most disadvantaged?”
What advice can NICE offer these two people? My concern is that if you rely on NICE guidance this pushes us to where the evidence base is more complete - the smoking cessation service - so we end up with an approach to public health commissioning that only funds services where there is a NICE approved evidence base - even if - like smoking cessation - the services are not actually very effective or relevant if compared against services that people really really do rely on like welfare rights provision.
For example I cannot remember the last time I saw a queue of desperate people outside a smoking cessation service - something that is common place with welfare rights services.