Investigating the barriers and facilitators of the implementation of NICE's public health guidance and quality standards in
Lead Research Organisation:
University College London
Department Name: Clinical Health and Educational Psych
Abstract
As well as its clinical guidelines and appraisals of new medicines, NICE produces public health guidance. This is designed to deal with various public health problems. For example NICE has produced guidance on tobacco control, alcohol abuse, preventing obesity and promoting physical activity. The guidance is based on a rigorous examination of international evidence and an assessment of the cost effectiveness of the interventions. Until 2013 the public health system in England was led by the NHS. This responsibility transferred to local authorities in April 2013. At the same time NICE acquires responsibility for producing quality standards in social care and public health. The principal audience for the guidance and the quality standards are local authorities. Until now local authorities have had no necessary link nor obligation to comply with NICE guidance. As the public health system changes, it is important that NICE is able to adapt its portfolio. As an organisation whose main currency is scientific evidence, it is proposed to study the process of knowledge transfer from NICE to local authorities in a systematic and scientific way. This research, instigated by NICE, is designed to capture a scientific understanding of the system changes, what will be required to meet the needs of the system and how best to engage with it.
The study will investigate how the public health and social care guidance and quality standards produced by NICE will be received and implemented within local government and what systems will be developed to use it. It will study the barriers to and facilitators of information flow and implementation between NICE and local government, and within local government organisations. In consultation with relevant professional associations, it will also seek to identify areas in which effective processes have been set up and good outcomes achieved. Finally, it aims to develop a feasible method for monitoring the implementation of NICE's guidance and quality standards in local authorities.
The work will be led by a partnership between NICE, University College London and the Local Government Association and a steering group set up to ensure the input of those at the "coal face" e.g. Chief Executives of Local Authorities, Directors of Public Health.
The research will be carried out in three phases:
1.A survey of officers and elected members in local authorities to obtain a detailed description of the current knowledge of public health, the new system, NICE and the evidence based approach to public health.
2.Five case studies in five different councils in England to examine the usage / non usage of NICE guidance and standards. The case studies will be undertaken to provide descriptions of local systems and infrastructures, the processes for planning, strategic working, and interagency activity, partnerships, and intra local authority activity and inter NHS-local authority activity, including the Clinical Commissioning Groups and work with Public Health England. The descriptions will be obtained by reviewing formal local documentation and web-based resources, including the Joint Strategic Needs Assessments, and by a series of interviews with portfolio holders, other councillors and key members of staff, especially, Directors of Public Health, Leisure and Recreation, Planning, Transport, Housing, Children's and Adult Services and members of the Health and Wellbeing Boards. If possible, the operation of Health and Well Being Boards will be observed.
3.A conference convened by LGA to share the initial findings from the survey and the case studies with a broader group of local authority stakeholders to further elaborate the evidence and test its findings.
The project will aim to further understanding and closer collaboration between NICE and local government as well as producing information of value to both organisations as the new public health structures and functions are developed in England.
The study will investigate how the public health and social care guidance and quality standards produced by NICE will be received and implemented within local government and what systems will be developed to use it. It will study the barriers to and facilitators of information flow and implementation between NICE and local government, and within local government organisations. In consultation with relevant professional associations, it will also seek to identify areas in which effective processes have been set up and good outcomes achieved. Finally, it aims to develop a feasible method for monitoring the implementation of NICE's guidance and quality standards in local authorities.
The work will be led by a partnership between NICE, University College London and the Local Government Association and a steering group set up to ensure the input of those at the "coal face" e.g. Chief Executives of Local Authorities, Directors of Public Health.
The research will be carried out in three phases:
1.A survey of officers and elected members in local authorities to obtain a detailed description of the current knowledge of public health, the new system, NICE and the evidence based approach to public health.
2.Five case studies in five different councils in England to examine the usage / non usage of NICE guidance and standards. The case studies will be undertaken to provide descriptions of local systems and infrastructures, the processes for planning, strategic working, and interagency activity, partnerships, and intra local authority activity and inter NHS-local authority activity, including the Clinical Commissioning Groups and work with Public Health England. The descriptions will be obtained by reviewing formal local documentation and web-based resources, including the Joint Strategic Needs Assessments, and by a series of interviews with portfolio holders, other councillors and key members of staff, especially, Directors of Public Health, Leisure and Recreation, Planning, Transport, Housing, Children's and Adult Services and members of the Health and Wellbeing Boards. If possible, the operation of Health and Well Being Boards will be observed.
3.A conference convened by LGA to share the initial findings from the survey and the case studies with a broader group of local authority stakeholders to further elaborate the evidence and test its findings.
The project will aim to further understanding and closer collaboration between NICE and local government as well as producing information of value to both organisations as the new public health structures and functions are developed in England.
Planned Impact
This project is of direct and immediate relevance to the new and emerging structures of public health in England. On April 1st 2013 the largest single change to the organisation of public health since 1948 came into effect when local authorities took on responsibility from the NHS for the commissioning of almost all preventive and health improvement functions in public health. NICE has been supporting the NHS deliver its public health responsibilities by producing public health guidance since 2005. The new system will receive the NICE public health guidance, but little is currently known about how this knowledge will transfer to, and in, the new system. The main beneficiaries therefore are (i) NICE in terms of learning how best to work with Local Government to promote implementation of their evidence-based guidance, (ii) Local Government in terms of developing more effective and efficient methods for engaging with NICE and therefore delivering their public health outcomes and responsibilities, (iii) the public health community in England as the new responsibilities of local government for public health take effect (iv) the UK population in terms of increasing the likelihood of access to high quality health and social care and preventive health measures and (v) the research community who will be able to use the methods developed within the project.
Publications
Atkins L
(2019)
From the National Health Service to local government: perceptions of public health transition in England.
in Public health
Atkins L
(2017)
Reversing the pipeline? Implementing public health evidence-based guidance in english local government.
in Implementation science : IS
Kelly MP
(2017)
Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government.
in Journal of public health (Oxford, England)
| Description | The main findings from the project are reported in three peer-review publications. Data were analysed from in depth interviews with 31 elected members and officers, including Directors of Public Health, from four very different local government organisations. These are summarized below. "Evidence-based medicine meets democracy: The role of evidence-based public health guidelines in local government." Journal of Public Health (under review). This paper reports on how the guidelines were received in the new environment in local government. Participants reported that (i) there were tensions between evidence-based, and political decision-making; (ii) there were differences in views about what constituted 'good' evidence; and (iii) that organizational life is an important mediator in the way evidence is used. Democratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made. "Reversing the pipeline? Implementing public health evidence-based guidance in English local government." Implementation Science (under review). This paper reports on three aspects of implementing national evidence-based recommendations for public health within a local government context: influences on implementation, how useful guidelines are perceived to be and whether the linear evidence-guidelines-practice model is considered relevant. Contextual issues such as budget, capacity and political influence were important influences on implementation. Guidelines were perceived to be of limited use, with concerns expressed about recommendations being presented in the abstract, lacking specificity and not addressing the complexity of situations or local variations. Local evidence was seen as the best starting point, rather than evidence-based guidance produced by the traditional linear 'evidence-guidelines-practice' model. Local evidence was used to not only provide context for recommendations but also replace recommendations when they conflicted with local evidence. There is a tension between the traditional model of guideline development and the needs of public health decision-makers in local government. Re-engineering the traditional pipeline of guideline development by starting with local need and examples of effective local practice rather than starting with evidence of effectiveness synthesised from the international scientific literature. "From NHS to local government: perceptions of public health transition." In preparation for submission to Public Health. This paper reports on the perceptions of those involved in this transition and how public health is being established in local government. The transition from NHS to local government was seen by many as a 'homecoming', providing the opportunity to influence and collaborate with other relevant departments, e.g. housing, transport and planning and to to promote evidence-based practice across local government. However, professional roles of public health and individual public health practitioners were perceived to have less influence, certainty and autonomy than in the NHS. Public health practitioners perceived the need to develop other skills to fulfil their roles in local government. A second key change was that the shorter timescales for action and pressure for faster responses was associated with less regular seeking and using of evidence to inform policy and decisions than in the NHS. |
| Exploitation Route | By local authorities looking for best practice in how to apply NICE guidance and other evidence-based guidance to public health work. By NICE as they review and revise guidance and the way it is presented in order to make it more relevant and useable by local authorities. |
| Sectors | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
| Description | Preliminary findings from the project were presented at a conference convened by the Local Government Association (LGA) to share findings with a broader group of local authority stakeholders to further elaborate the evidence and test its findings. These included representatives from Public Health England (PHE), LGA, elected council members and members of public health teams. Findings from this project also informed a seminar organised by University College London (UCL) Public Policy and the UCL Centre for Behaviour Change in conjunction with NICE to discuss behaviour change and implementation support at a national level - chiefly how recommendations in evidence based guidelines could be supported by guidance on implementation. The seminar was attended by implementation researchers from across the UK and representatives from PHE and NHS. Findings from this project on barriers and facilitators to public health guideline implementation were useful in framing discussion on possible structure and content of guidance on implementation. |
| First Year Of Impact | 2014 |
| Sector | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
| Impact Types | Policy & public services |
| Description | School of Medicine and Public Health, University of Newcastle, Australia. Behaviour Change Technique Taxonomy Workshop. |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Description | NICE Local Government conference, London. Public Health in Local Authorities. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Initiated discussion of implementing evidence-based guidance in local authorities. Interest from event participants in training in behaviour change. |
| Year(s) Of Engagement Activity | 2014 |
| Description | Public Health England and Local Government Association. Evidence into Practice: Behaviour Change. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Talk sparked questions and discussion afterwards Interest in UCL Centre for Behaviour Change work |
| Year(s) Of Engagement Activity | 2014 |
| Description | UK Society for Behavioural Medicine Annual Scientific Meeting: Symposium on Implementing evidence based guidelines for public health in local authorities |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Findings from the the project were presented by Professor Susan Michie and Professor Mike Kelly alongside research in similar areas which stimulated discussion on how to improve implementation of public health guidance in local authorities in the UK. The discussion period after the talks permitted exploration of how findings were received by conference participants and how they could be further interpreted for the planned peer-review publications. |
| Year(s) Of Engagement Activity | 2015 |