NICE will create standards on obesity and use of tobacco and alcohol

BMJ 2013; 346 doi: (Published 15 May 2013) Cite this as: BMJ 2013;346:f3150
  1. Nigel Hawkes
  1. 1Birmingham

The National Institute for Health and Care Excellence (NICE) is to create new quality standards for public health, the Department of Health for England has announced.

At NICE’s conference in Birmingham, the health minister Earl Howe said that the first three standards would cover tobacco, harmful alcohol use, and obesity—three topics that he admitted had not been difficult to select. He expected that the new quality standards would provide a key tool for Public Health England in tackling the three issues.

A consultation will follow on other public health issues that NICE will cover, amounting eventually to a “growing portfolio” of quality standards. Since its formation in 1999 NICE had earned a worldwide reputation as a leader in evidence based interventions, and it has had a remit for public health since 2005.

NICE’s growing influence, which also now encompasses social care, was reflected in a huge attendance at the conference. David Haslam, NICE’s chairman, said that the audience, which overflowed the Birmingham International Conference Centre, was a tribute to the success of his predecessor, Michael Rawlins, in establishing the organisation.

The conference’s opening session on Tuesday 14 May heard from the recently appointed chief executive of the Care Quality Commission, David Behan, who promised that clinicians would in future be involved much more with the CQC’s inspections of hospitals. “We want to move away from generic inspections by people who know about hospitals to those involving specialists who know about services,” he said. He envisaged clinicians being seconded to CQC, perhaps for a two year period, to provide their expertise to improve the process.

Bruce Keogh, national medical director of NHS England, echoed the thesis by claiming that there were now more clinicians involved in running the NHS than ever before—in clinical commissioning groups, clinical senates, clinical networks, and academic health science centres. But, he was asked, would clinicians stand up and be counted when they saw something going wrong, such as at Mid Staffordshire?

“No, not yet,” he admitted, saying that it was the job of NHS England to give people the confidence to make their feelings known. He defended the 111 urgent care helpline number, whose mishandled introduction has been strongly criticised.1 “It’s not my baby,” he said. “It was Andrew Lansley’s idea”—which provoked laughter—“but I think it’s an idea with a lot of merit. There were problems in execution, but the principle of a single number you can ring for advice and to arrange appointments is a great principle.”

The health minister Earl Howe was frank about the failings of the system, though claiming that in most of the country it was providing a “good, if not excellent, service.” Problems were limited to the south west and the southeast coast, he said. “We’re not happy about that, but we’ve got to keep it in proportion,” he added.

Asked whether deviations from clinical standards should be a criminal offence, as recommended by Robert Francis QC in his report on Mid Staffordshire, Earl Howe said that the government agreed that they should but had yet to decide whether actions should be taken against individuals in such circumstances.

“I’m nervous about any criminal prosecution at the individual level,” he said. The risk would be that the threat of prosecution would act against the culture of openness and candour that the government was trying to create in the NHS, he said, hinting that organisations, rather than individuals, may face legal sanctions.


Cite this as: BMJ 2013;346:f3150