Evidence based public health: A review of the experience of the National Institute of Health and Clinical Excellence (NICE) of developing public health guidance in England

Kelly, Michael P.; Morgan, Antony; Ellis, Simon; Younger, Tricia; Huntley, Jane; Swann, Catherine

doi:10.1016/j.socscimed.2010.06.032

Cited by 146 publications

(149 citation statements)

References 14 publications

Supporting

Mentioning

147

Contrasting

Unclassified

Order By: Relevance

“…The UK National Screening Committee (NSC) is a standing advisory committee which invites public consultation and publishes all stages of its review process and the committee minutes on its website (UK National Screening Committee, 2010). Similarly, the National Institute for Health and Clinical Excellence (NICE) employs widespread stakeholder consultation and transparency of the decision-making processes (Kelly et al, 2010). Although lacking the legislative backing for their recommendations, these bodies use deliberative processes to maximise the impact of evidence and their consultative and transparent approach makes it much more difficult for a government to reject those recommendations without justification.…”

Section: Independent and Public Review Of The Evidencementioning

confidence: 99%

Getting evidence into policy: The need for deliberative strategies?

Flitcroft

Gillespie

Salkeld

et al. 2011

Social Science & Medicine

View full text Add to dashboard Cite

Getting evidence into policy is notoriously difficult. In this empirical case study we used document analysis and key informant interviews to explore the Australian federal government's policy to implement a national bowel cancer screening programme, and the role of evidence in this policy. Our analysis revealed a range of institutional limitations at three levels of national government: within the health department, between government departments, and across the whole of government. These limitations were amplified by the pressures of the 2004 Australian federal election campaign. Traditional knowledge utilisation approaches, which rely principally on voluntarist strategies and focus on the individual, rather than the institutional level, are often insufficient to ensure evidence-based implementation. We propose three alternative models, based on deliberative strategies which have been shown to work in other settings: review of the evidence by a select group of experts whose independence is enshrined in legislation and whose imprimatur is required before policy can proceed; use of an advisory group of experts who consult widely with stakeholders and publish their review findings; or public discussion of the evidence by the media and community groups who act as more direct conduits to the decision-makers than researchers. Such deliberative models could help overcome the limitations on the use of evidence by embedding public review of evidence as the first step in the institutional decision-making processes. Highlights Achieving evidence-based policy implementation is much harder than the rhetoric suggests.  Our case study showed traditional voluntarist approaches are not enough to overcome institutional filtering of the evidence.  Deliberative strategies open up the decision-making processes to greater expert and public scrutiny.  Our framework illustrates the potential for deliberative strategies to increase the relative weight of evidence in policy.2 | P a g e  This article challenges researchers and policy-makers to acknowledge and address the institutional context of decision-making.

show abstract

Section: Independent and Public Review Of The Evidencementioning

confidence: 99%

Getting evidence into policy: The need for deliberative strategies?

Flitcroft

Gillespie

Salkeld

et al. 2011

Social Science & Medicine

View full text Add to dashboard Cite

show abstract

“…Furthermore, the available evidence is often patchy and sometimes of less than ideal quality. 29 Finally, the evidence reviewed for this guidance considered interventions that were delivered in a primary care and/or workplace setting. Although the emphasis was on work-related interventions, the review searches also identified some studies that contained evidence of the effectiveness of clinical (treatment-related) interventions delivered in the workplace or in primary care.…”

Section: Discussionmentioning

confidence: 99%

NICE guidance on long-term sickness and incapacity

Gabbay¹,

Taylor²,

Sheppard³

et al. 2011

Br J Gen Pract

View full text Add to dashboard Cite

Long-term sickness absence and incapacity benefits (disability pension) rates have increased across industrialised countries. Effective measures are needed to support return to work. The recommendations of this guidance were informed by the most appropriate available evidence of effectiveness and costeffectiveness. Public health evidence was provided by research using a variety of study designs that attempted to determine the outcome of a particular intervention by evaluating status before and after the intervention had been effected, and was not limited to randomised control trials. Where the evidence base was depleted or underdeveloped, expert witnesses were called to give their opinion on the best available evidence and emerging interventions. The process enabled challenge and contestability from stakeholder groups at different points as the guidance was developed. Forty-five heterogeneous studies were included in the review of interventions to reduce long-term sickness absence and transitions from short-term to long-term absence (mainly covering the former and also mainly examining musculoskeletal conditions). The analysis of evidence was restricted to descriptive synthesis. Three general themes emerged from an analysis of the studies that were more likely to report positive results: early interventions; multidisciplinary approaches; and interventions with a workplace component. Two further reviews were undertaken, one on interventions to reduce the re-occurrence of sickness absence, which identified seven studies on lower back pain, and concluded that early intervention and direct workplace input are important factors. The final evidence review focused on six studies of interventions for those in receipt of incapacity benefit. The evidence was that work-focused interviews coupled with access to tailored support are effective and cost-effective interventions. Practitioners should consider the impact of interventions and management options on work ability for patients of working age. Work ability should be considered a key outcome for future intervention studies.

show abstract

“…For example, where interventions are designed to bring about health behavior change, it can be argued that they differ from medicines, devices, and procedures in terms of intended mechanisms of action. Here, notions of mechanism of action confined to biological interactions within single individuals have been significantly developed and refined, [6][7][8][9] to accommodate importance of interaction with the health and social care system, or the wider social environment.…”

Section: Guidementioning

confidence: 99%