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Implementing NICE guidance

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1 Implementing NICE guidance
Behaviour change Implementing NICE guidance NOTES FOR PRESENTERS: ABOUT THIS PRESENTATION: This presentation has been written to raise awareness of the NICE public health guidance on behaviour change (www.nice.org.uk/PH006). It is aimed at NHS and other professionals with direct or indirect responsibility for helping people to change their health-related knowledge, attitudes and behaviour. This includes national policy makers and those working in local authorities and the community and voluntary sectors. It is also relevant for the research community, social and behavioural scientists, and health economists working in the area of health-related knowledge, attitude and behaviour change. You should hand out copies of the quick reference guide at your presentation so that your audience can refer to it. The quick reference guide can be downloaded from or you can order copies – for more details please see the notes of the ‘Access NICE guidance and other support tools online’ slide. You can add your own organisation’s logo alongside the NICE logo. We have included notes for presenters amplifying the content of the slides: please feel free to adapt, amend or remove these as you see necessary. You may want to refer to the full NICE public health guidance 6 on Behaviour change if you are planning specific actions in relation to the behaviour change guidance. The full guidance can be found on the NICE website at This slide set is compiled in collaboration with the group that developed the guidance and with professional and community groups (such as the Department of Health, Department for Communities and Local Government, the Central Office of Information, the National Family & Parenting Institute and the Care Services Improvement Partnership [CSIP]). DISCLAIMER This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself. October 2007 NICE public health guidance 6

2 Benefits of implementing NICE guidance
Helps NHS organisations meet DH ‘Standards for better health’ Helps local authorities fulfil remit to promote economic, social and environmental wellbeing of communities Helps organisations improve health and meet government indicators and targets to reduce health inequalities Can help save money by identifying opportunities for disinvestment or re-directing resources Provides a focus for local partnerships NOTES FOR PRESENTERS: NICE public health guidance aims to ensure that promotion of good health and patient care in the NHS are in line with the best available evidence. Public health guidance helps healthcare professionals in their work, but it does not replace their knowledge and skills. It helps: NHS organisations meet DH standards for public health as set out in the seventh domain of ‘Standards for better health’ (updated in 2006). Performance against these standards is assessed by the Healthcare Commission, and forms part of the annual health check score awarded to local healthcare organisations. NHS organisations and local authorities (including social care and children’s services) meet the requirements of the government’s ‘The NHS in England: operating framework for ’ National and local organisations within the public sector meet government indicators and targets to improve health and reduce health inequalities. Local authorities fulfil their remit to promote the economic, social and environmental wellbeing of communities. Local NHS organisations, local authorities and other local public sector partners benefit from any identified cost savings, disinvestment opportunities or opportunities for re-directing resources. Provide a focus for children’s trusts, health and wellbeing partnerships and other multi-sector partnerships working on health within a local strategic partnership.

3 What this presentation covers
Background Recommended principles Costs and savings Resources from NICE NOTES FOR PRESENTERS: This presentation covers the background to the behaviour change guidance, the key recommendations and implementation advice to support putting the guidance into practice. It contains information about the costs and savings that are likely to be incurred in implementing the guidance and practical tools that are available from NICE to support implementation.

4 Background: why this guidance matters
Major conditions such as cardiovascular disease, chronic lung disease, some cancers and type 2 diabetes are linked to people’s lifestyles and behaviours Practitioners and others working in the area need clear, evidence- based guidance on what works in different settings and for different population groups NOTES FOR PRESENTERS: This guidance provides a systematic, coherent and evidence-based approach, considering generic principles for changing people’s health-related knowledge, attitudes and behaviour, at individual, community and population levels. There is overwhelming evidence that changing people’s health-related behaviour can have a major impact on some of the largest causes of mortality and morbidity. The Wanless report (Wanless, 2004) outlined a position in the future in which levels of public engagement with health are high, and the use of preventive and primary care services are optimised, helping people to stay healthy. This ‘fully engaged’ scenario, identified in the report as the best option for future organisation and delivery of NHS services, requires changes in behaviours and their social, economic and environmental context to be at the heart of all disease prevention strategies. The Wanless report was an important influence on the 2004 white paper, ‘Choosing health – making healthy choices easier’. This focused more on the behavioural rather than the social aspects of its priorities (smoking; obesity, diet and nutrition; sensible drinking; physical activity; sexual health, and mental health), see

5 Recommended principles
Principle 1: planning Principle 2: social context Principle 3: education and training Principle 4: individuals Principle 5: communities Principle 6: populations Principle 7: effectiveness Principle 8: cost effectiveness NOTES FOR PRESENTERS: The NICE guidance contains a set of eight generic principles that can be used as the basis for planning, delivering and evaluating public health activities aimed at changing health-related behaviours. You can find them in your quick reference guide. The guidance should be read in conjunction with other topic-specific public health guidance issued by NICE. It does not replace any of this guidance. Future NICE guidance that aims to change people’s behaviour will be based on the principles outlined in this guidance. We shall consider each in turn.

6 Planning Work in partnership with individuals, communities, organisations and populations to develop plans for the target audience based on their needs and the challenges facing them Take people’s circumstances into account (especially the socioeconomic and cultural context) Prioritise evidence-based approaches that can be tailored and used at key times when people are likely to be open to change NOTES FOR PRESENTERS: Principle 1: planning interventions and programmes (for details of this recommendation see quick reference guide) Target audience Policy makers, commissioners, service providers, practitioners and others whose work impacts on, or who wish to change, people’s health-related behaviour. Suggestion for action Plan carefully interventions and programmes aimed at changing behaviour, taking into account the local and national context and working in partnership with recipients Use local area agreements (LAAs), local strategic partnerships, local safeguarding children boards and other planning and commissioning opportunities. Joint strategic needs assessments (JSNAs) could be a useful way of developing long-term plans for programmes to support attitude and behaviour change. The Local Government and Public Involvement in Health Act (2007) places a duty on upper-tier local authorities and PCTs to undertake Joint Strategic Needs Assessment (JSNA). JSNA is a process that will identify the current and future health and wellbeing needs of a local population, informing the priorities and targets set by Local Area Agreements and leading to agreed commissioning priorities that will improve outcomes and reduce health inequalities.

7 Social context Identify and try to remove social, financial and environmental barriers to change Take into account the social and environmental context Support changes to the physical environment or the way services are delivered to help those who find it difficult (or who are not motivated) to change NOTES FOR PRESENTERS: Principle 2: assessing social context (for details of this recommendation see quick reference guide) Target audience NHS and non-NHS policy makers and commissioners planning behaviour change interventions or programmes for communities or populations, especially disadvantaged or excluded groups. The ‘Independent inquiry into inequalities in health’ (Acheson 1998), gave priority to the socioeconomic and environmental factors affecting health. (See: Its recommendations strongly influenced current policy on health inequalities. See, for example, the 2003 cross-government strategy, ‘Tackling health inequalities: a programme for action’ (Department of Health 2003) at: and the most recent progress report, ‘Tackling health inequalities: status report on programme for action – 2006 update of headline indicators’ (Department of Health 2006), see Suggestion for action Ensure plans address health inequalities. Tackling health inequalities is a major government target. More socially deprived groups have poorer health and find it more difficult to change their health-related behaviours. For example, only 18% of men and 16% of women in managerial and professional groups smoke - compared to 32% of men and 29% of women in routine and manual groups. The health of those who are more socially deprived needs to be prioritised. However, this poses a number of challenges. For instance, an emphasis on written communication may be less appropriate for socially deprived groups, who tend to have lower literacy levels.

8 Education and training
Review current education and training practice in this area, and disinvest in approaches that lack supporting evidence Ensure practitioners and volunteers have fair and equal access to training and support Relevant national organisations should consider developing standards for these skills NOTES FOR PRESENTERS: Principle 3: education and training (for details of this recommendation see quick reference guide) Target audience Policy makers, commissioners, trainers, service providers, curriculum developers and practitioners. Practitioners need to be able to: identify and assess evidence on behaviour change understand the psychological, social, economic and cultural determinants of behaviour interpret data on local or national needs and local characteristics design, implement and evaluate interventions and programmes aimed at changing people’s behaviour work in partnership with members of the target population(s) and those with local knowledge. The guidance notes that the capacity of the public health workforce should be assessed. In addition, an education and training strategy to support those involved in helping to change people’s behaviour (within both NHS and non-NHS settings) could improve effectiveness. National training standards to reflect the skills described in the recommendations would help support their implementation. Existing occupational and professional standards relevant to behaviour change National occupational standards for the practice of public health outline the actions needed to meet these standards in relation to behaviour change (see Also consider education and training needs of community members and volunteers with a responsibility for behaviour change.

9 Individuals Select interventions that help people to:
understand the consequences of their behaviour and feel positive about changing it to benefit their health make a personal commitment to health-enhancing behaviours by setting goals and sharing these goals with others plan change in easy steps and develop coping strategies to take account of social situations that may lead to relapse NOTES FOR PRESENTERS: Principle 4: individual-level interventions and programmes (for details of this recommendation see quick reference guide) Target audience Commissioners, service providers and practitioners working with individuals. Suggestion for action Set realistic goals. For example, it might be more realistic to set someone the goal of walking to work to increase their physical activity levels, rather than suggesting they go to the gym (which requires more effort and financial outlay). Identify and overcome barriers to change.

10 Communities Invest in approaches that:
develop and maintain supportive social networks and relationships and build people’s resilience and skills promote and support positive relationships between children and their parents or carers help organisations and institutions to promote local participation in planning and delivering services and to participate in voluntary activities promote access to the financial and material resources needed to help people make changes to improve their health NOTE FOR PRESENTERS: Principle 5: community-level interventions and programmes (for details of this recommendation see quick reference guide) Target audience NHS and non-NHS policy makers and commissioners planning behaviour change interventions and programmes for communities or subgroups in the population. Forthcoming NICE guidance on community engagement (expected publication date is February 2008) will provide more detail about effective ways of engaging communities.

11 Populations Use the needs and behaviours of the target population as the basis for all interventions and programmes Ensure population-based activities complement those delivered to individuals and communities Ensure population-based activities are assessed in terms of the risks, costs and benefits for all target groups NOTES FOR PRESENTERS: Principle 6: population-level interventions and programmes (for details of this recommendation see quick reference guide) Target audience National policy makers, commissioners and others whose work impacts on population-level health-related behaviour.

12 Effectiveness Ensure funding applications and project plans include specific provision for evaluation and monitoring Ensure appropriate process and outcome measures are used NOTES FOR PRESENTERS: Principle 7: evaluating effectiveness (for details of this recommendation see quick reference guide) Target audience Researchers, policy makers, commissioners, service providers and practitioners whose work impacts on, or who wish to change, people’s health-related behaviour. Suggestions for action Evaluate all behaviour change interventions and programmes, either locally or as part of a larger project. Wherever possible, evaluate the following elements: effectiveness acceptability feasibility equity safety cost. Where data is not readily available, people may need to consider a range of alternative indicators.

13 Cost effectiveness Collect data for cost-effectiveness analysis, including quality of life measures When researching or evaluating interventions and programmes estimate the cost savings involved (for instance, the cost of primary prevention versus clinical treatment) NOTES FOR PRESENTERS: Principle 8: assessing cost effectiveness (for details of this recommendation see quick reference guide) Target audience Policy makers, research funders, researchers and health economists. On the basis of the evidence considered, the Programme Development Group who developed the guidance believes that where interventions and programmes are applied appropriately, according to the principles outlined in this guidance and in conjunction with other topic-specific NICE guidance, then they are likely be cost effective. In some circumstances, they will save money. The 2004 Wanless report proposed three scenarios for the NHS. The ‘fully engaged scenario’, which would produce optimal performance and the best value for money, depends on a high level of individual commitment to keeping healthy. It relies on an effective infrastructure both to support healthy choices and to change social norms to make healthy choices easier to make. It requires behaviour change, taking into account the social, economic and environmental context, to be at the heart of all disease prevention strategies. ‘Securing good health for the whole population’ the Wanless report (Wanless et al. 2004), see

14 Costs and savings Some aspects, such as training and evaluation, will involve extra cost However, effective interventions should lead to cost savings within the NHS and other public sector organisations in the longer term NOTES FOR PRESENTERS: NICE has worked closely with the guidance developers and other people in and outside the NHS to look at the major costs and savings related to implementing this guidance. The guidance is unlikely to result in any significant changes based on national assumptions. However, different areas may vary from the national average and it is important to scrutinise the recommendations likely to have the most significant resource impact locally to make sure that practice matches the national average. Refer to the NICE costing statement, which can be found on the NICE website at

15 Access NICE guidance and other support tools online
Quick reference guide – a summary NICE guidance – all of the recommendations Costing statement NOTES FOR PRESENTERS: The guidance is available in several formats. You can download them from the NICE website or order printed copies of the quick reference guide by calling the NHS Response Line on Quote reference numbers N1230 for the quick reference guide.


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