The NICE way to a long and healthy life

The National Institute for Health & Care Excellence (NICE) has produced truly excellent draft guidance entitled Dementia, disability and frailty in later life – mid-life approaches to prevention.

As pointed out by David Oliver’s Kings Fund blog, which alerted this Editor to the NICE document, what is particularly exciting about these guidelines are “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”.

Put another way, this document represents a holistic approach to coordinating the principal health drivers for a long and healthy old age: a major step to helping people achieve the vision of looking forward to old age. The table on page 15 of the draft emphasises just how wide the advice goes, covering everyone from architects, builders, developers and local authority planning & housing departments through to trading standards officers, and from organisations like highway authorities through to the third sector.

Clearly government will need to find a way of encouraging this behaviour change at the policy level, as demonstrated by this editor’s recent personal experience of the NHS Health Check which NICE suggests could become a major driver of beneficial behavioural change. An example of how NICE’s suggestion can be made reality is the CardioPod this editor was involved in developing when he worked in Medvivo. This used point-of-care-testing to deliver blood tests results in a single sitting, and so was able within a matter of minutes to show patients the immediate benefits of lifestyle changes in terms of their reduced personalised mortality projections, and was thus a very powerful way of encouraging people to live more healthy lives, as well as being integrated into the practice’s electronic patient record so that appropriate monitoring and follow up could be done most efficiently. (The CardioPod has apparently since been replaced by the HealthCheckPod which appears, as part of a “solution”, to offer even greater benefits.)

This contrasts markedly with the reality of when this editor had his NHS Health Check for real in his local GP surgery recently and ended up having to threaten reference to Dame Fiona Caldicott’s Independent Information Governance Oversight Panel merely to get the results of the blood test emailed to  him, let alone any advice on how to make his lifestyle healthier (although the practice manager assured him that the nurse would “write to pts found to have a high risk score so appropriate action can be taken”). Whilst practices get paid a standard amount for an NHS Health Check, there is clearly a strong financial incentive to take the latter approach even though it is of far less benefit to the patient than the former approach.

This is high level guidance so, just as it stops at the point of recommending improved dietary behaviour, it also makes no mention of, for example, the use of electronics to get the message across to the public, and possibly to coordinate actions across he public sector too. Perhaps this is the one weakness: whilst most people involved in policy formulation are aware of the importance for example of reduced salt and fat and increased fibre in diets, sadly there still seem to be many that are oblivious to the benefits that apps and games can deliver in terms of behaviour change. Including the Government Digital Service in the recommendations would have made the point nicely.

Although only just covered by the Kings Fund, the NICE consultation began some while back, in July, and so sadly will close on 5th September – details on who can respond and, if you can, how to respond, are here.



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