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Nice one NICE: developing the policy narrative on preventing disability, frailty and dementia in later life

As we commemorate the 100th anniversary of the outbreak of the First World War, it is easy to forget that in 1914, UK life expectancy at birth was only 49 for men and 53 for women. Advances in societal wealth, nutrition, employment, environmental health, housing, perinatal care and preventative and curative medical treatment mean that the era in which those servicemen and their families lived is almost unrecognisable. Life-expectancy is now 79 for men and 83 for women, and when we reach the age of 65 we can expect to live another two decades on average.

Living longer lives is a cause for celebration but there are still major inequalities in life expectancy and healthy life expectancy at birth, in rates of premature deaths, and in life expectancy at 65 between different socioeconomic groups. We also face a rising prevalence of long-term conditions, dementia, disability and frailty related to rapid population ageing, which has big implications both for individuals and for health and social care systems.

The holy grail of prevention would be to reduce inequalities in the health of older people, to improve their overall health and to ‘compress morbidity’, delaying the onset of poor health until the last few years of life. The King’s Fund has contributed to this debate with its work on adult behaviour change and improving care for older people, and its Time To Think Differently programme of work. But now, somewhat surprisingly, the National Institute for Health and Care Excellence (NICE) has added its voice, in the guise of guidelines released for consultation on preventing disability, frailty and dementia in later life.

‘So what?’ you cry, yet another bunch of stuff to wade through. But this time it’s different – what is so interesting about these guidelines is not so much the detail but the principles and linking themes behind them, and the fact that, instead of just advising clinicians, the guidelines include direct advice to the government on health and wider social policy.

So what’s in it? For starters, NICE calls for government interventions to make smoking and drinking less affordable and accessible; and to make the maintenance of healthy weight and regular exercise more affordable and accessible. Hardwiring these recommendations on affordability into local and national public health strategies is a challenge to those, of any party, who do not see price as a policy lever on behaviours other than tobacco use. Given that Public Health England also supports minimum unit pricing of alcohol, two important government health bodies have now put their cards on the table.

But beyond this, in these guidelines NICE has developed a policy narrative for integration and prevention that is more convincing than much of what the political parties have thus far committed to print. NICE’s vision encompasses the NHS and local government but goes beyond that to house-builders and architects, businesses and employers, as well as individuals themselves. It starts to flesh out a story that – at last – links the policies and roles for public health and prevention with those for long-term conditions, co-morbidities and integration. These areas have been left to develop in their silos for too long, partly, but not solely, due to the fragmentation of the reforms. Integration cannot just be about treating frail older people, we need to think beyond health and social care, and NICE is leading the way with this thoughtful contribution.

So will any of this be taken on board? Watch this space. But our view is that the consultation is not just for clinicians and academics, it is something that politicians and those seeking to influence them really should engage with too. If you have time do read the guidelines and respond.