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INTERVIEW


MIKE KELLY


Professor Mike Kelly, director of the Centre of Public Health Excellence at NICE, tells Julie Cramer why the organisation is determined to get GPs prescribing exercise and physical activity


“W


e’re not talking about a new virus or germ – it’s something


within our grasp to do something about, in a fairly straightforward kind of way,” says Mike Kelly, director of the Centre of Public Health Excellence at NICE (the National Institute for Health and Clinical Excellence). Kelly is not referring to some


infectious disease requiring the attention of the medical community, but to the newly-defi ned set of lifestyle diseases – Type 2 diabetes, cardiovascular disease, hypertension – that are linked to obesity and physical inactivity and which now urgently require a wider approach. “We’re facing an epidemic of non-


communicable diseases related to the way we live our lives – the diets we consume, the physical activity we don’t do,” says Kelly. “It’s not that we [as leaders] don’t know what to do. It’s the fact that we haven’t so far taken a systematic approach across the whole of society.” The grim predictions by government health offi cials are that by 2050, more than half of the adult population in England will be obese. Current trends show that 26 per cent of adults and 16 per cent of children are now classed as obese – a condition that can have grave consequences for their long-term health, as well as placing a huge cost burden on the NHS (currently over £5bn a year and rising rapidly). In its role as health watchdog, NICE


is there to offer independent, evidence- based guidance on ways to prevent and treat illness and poor health, not only to the NHS but also to local authorities and anyone with responsibilities in healthcare, public health and social care.


Should we expect exercise advice from GPs? Kelly says the kind of scientifi c


evidence and data related to lifestyle diseases that NICE has been reviewing in recent years is now pointing to one very signifi cant conclusion: “The evidence about the benefi ts of physical activity and the disbenefi ts of not being active are now scientifi cally utterly compelling. The issue is now one of implementation. “We can argue about exactly how


much physical activity, plus there’s an ongoing debate about weight loss and physical activity [calories in or calories out], but the problem is not a scientifi c one – it’s the will to make it happen”.


GP FRAMEWORK NICE has therefore recently taken the signifi cant step of recommending that


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physical activity be included in the QOF (Quality and Outcomes Framework) indicators for GPs. GPs are currently incentivised fi nancially to optimise and record treatment to patients for a range of health issues such as asthma, mental health, diabetes, coronary heart disease and hypertension. Exercise is not currently on the list of incentivised treatments, but given what is known about its physical and mental benefi ts, offering patients exercise advice would be a major step forward. Kelly explains: “QOF is a complex system that doesn’t involve NICE directly. NICE lines up the sort of things that could go into the QOF and then the Department of Health in the four home countries and representatives from the medical profession negotiate on them. But given the compelling evidence, physical activity is something that we will be continuing to push to the foreground as a candidate for QOF.” The changing political health


landscape is another area where Kelly sees more opportunities. Health powers will become devolved with the advent of the Health and Social Care Act, and the formation of health and wellbeing boards within local authorities on 1 April 2013 will present more ways to tackle the issue. Kelly says: “The changes to local authorities’ responsibilities represent the biggest change in public health since the 1970s. I believe there’s a really big appetite to do it well. Effectively, prevention of heart disease and diabetes become the responsibility of the local authorities.” To assist, Kelly says NICE will publish a series of public health briefi ngs to help identify things local authorities can do quite quickly to improve the public health agenda.


February 2013 © Cybertrek 2013


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