NICE Work - the NICE guidelines for the workplace Trent Occupational Medicine Symposium, Nottingham, 6 th October Professor Mike Kelly, PhD, FFPH, Hon FRCP. The Centre for Public Health Excellence, NICE, London, UK

NICE The National Institute for Health and Clinical Excellence (NICE) is the independent organisation in the UK responsible for providing national guidance to the NHS and the wider public health community on the promotion of good health and the prevention and treatment of ill health. Has had a public health role since 2005.

Audiences for public health guidance The NHS Local government The workplace Education The utilities Industry Retailers DH and other government departments The public National policy makers

The pillars of our work Comprehensive evidence base Expert input Patient and carer involvement Independent advisory committees Genuine consultation Regular review Open and transparent process.

Methodological principles governing all NICE’s work Base recommendations on the best available evidence. To determine cost effectiveness using the QALY. To be clear about scientific and other values To allow contestability. To be seen to be and to be independent of government, the pharmaceutical industry and other vested interests.

NICE methods for public health S econd edition (April 2009) Third edition (April 2012) The NICE public health guidance development process An overview for stakeholders, including public health practitioners, policy makers and the public

The workplace guidance

Workplace physical activity Focuses on activities either based in the workplace or outside the workplace but initiated or endorsed by employers. Small, medium and large organisations Public, private and voluntary sector organisations Benefits to employers: - Better staff retention - Increased staff loyalty - Reduced sickness absence

Recommendations –Policy and planning –Physical activity programme –Supporting employers

Develop a physical activity plan or policy that: –maximises the opportunity for all employees to participate –involves staff in planning and development –has dedicated resources –sets organisational goals –links to relevant national and local policies Policy and planning

The programme could include: –flexible working policies –policies to encourage walking, cycling or the use of other transport involving physical activity –dissemination of information, for example, on local opportunities to be physically active –ongoing advice and support –confidential, independent health checks The physical activity programme (1)

The programme should: –encourage employees to walk, cycle or use other forms of transport involving physical activity to travel to and from work –help employees to be physically active during their working day –Encourage employees to set physical activity goals –take account of the nature of the work and any health and safety issues The physical activity programme (2)

Supporting employers Organisations with responsibility for increasing physical activity or for occupational health should provide support to employers who are implementing this guidance. This should ideally be in the workplace and include: –advice and other information on local resources –resources, for example, the services of physical activity experts If initial demand exceeds resources a targeted approach is suggested.

Smoke free workplaces

Benefits for employers Reduced sickness absence Increased productivity Improved employee health Increased compliance with smokefree legislation

Effective interventions Nicotine replacement therapy (NRT) and bupropion Individual behavioural counselling Group behaviour therapy programmes Self-help materials Brief advice Telephone counselling and quitlines

Effective interventions Pharmacotherapies: NRT and bupropion Individual behavioural counselling with a trained smoking cessation counsellor Group behaviour therapy: at least two group meetings offering information and support plus a behavioural intervention

Effective interventions Brief interventions: opportunistic advice and support offered in minutes Self-help materials Telephone counselling and quitlines

What should employers do? Make information on local stop smoking support widely available Offer to help employees who smoke to quit. Be responsive to individual needs and preferences Where possible, provide on-site stop smoking support Work with staff and their representatives to develop a smoking cessation policy

What can employees do? Contact local stop smoking services for information, advice and support Encourage employers to provide advice, guidance and support to help employees who want to stop smoking

The business case 72% of smokers want to quit A non-smoking working environment encourages people to quit Loss of productivity of 33 hours per year per smoker Use the NICE business case and other costing tools to help identify costs and savings

Long term sickness absence

Background Being in employment, either paid or unpaid, can be good for people’s health and wellbeing In 2006, an estimated 175 million working days were lost due to sickness absence in Britain Sickness absence and ‘worklessness’ in Britain are estimated to cost over £100 billion a year About 2.7 million people receive incapacity benefit

Scope of guidance Help employees return to work following long-term sickness absence Reduce the re-occurrence of short- and long-term sickness absence Prevent or reduce the number of employees moving from short- to long-term sickness absence Help those on incapacity benefit to return to paid or unpaid full- or part-time employment

Pre-requisites and considerations –Employer and employee should jointly agree any plans to help the employee return to work –The employee should have someone they trust to liaise with at every stage –The person liaising with them should be a good communicator and aware of discrimination law and relevant health and safety practices

Recommendations Three recommendations are relevant to employers and relate to long-term (or recurring bouts of long- or short-term) sickness absence Recommendation four is relevant to commissioners of services for unemployed people in receipt of incapacity or similar benefits

Initial enquiries Employers should identify someone who is impartial to undertake initial enquiries with the employee, to: o identify reasons for sickness and barriers to returning to work o discuss the options for returning to work and jointly agree what action, if any, needs to be taken If necessary, employers should appoint a case worker/s

Detailed assessment Only if needed, arrange for a relevant specialist/s to carry out a detailed assessment. This could include: o specialist advice on diagnosis and treatment o use of a screening tool o a combined interview and work assessment o development of a return-to-work plan, including if needed, interventions or services

Interventions (if needed) Ensure the employee is consulted and jointly agrees to all planned interventions, services and the return- to-work plan Coordinate and support delivery of planned interventions and services

Level of interventions (if needed) In addition to usual treatment and care consider: ‘light’ interventions for those who are likely to return to work An ‘intensive’ programme of interventions for those who are unlikely to return to work

Incapacity for work Commissioners of services for unemployed people in receipt of incapacity or similar benefit, such as the Department for Work and Pensions to: –commission an integrated programme to help claimants return to work (paid or unpaid) –evaluate the programme (including any specific components).

Cost savings This guidance is likely to lead to cost savings for employers by reducing the annual number of sick days taken The business case template produced to support this guidance helps organisations to estimate the local cost impact

Find out more Visit for the: –guidance –quick reference guide –business case template and costing report –checklist for employers and employees –guide to resources

Conclusion

The future topics for the workplace Working with DWP Working with employers and trades unions. Occupational health and public health. Future updates

GABBAY, M., TAYLOR, L., SHEPPARD, L., HILLAGE, J., BAMBRA, C., FORD, F., PREECE, R., TASKE, N., KELLY, M.P.(2011) NICE’s Guidance on long term sickness and incapacity, British Journal of General Practice, 61: British Journal of General Practice 2011; DOI: /bjgp11X