RESEARCH
MIKE KELLY
Director of the Centre of Public Health Excellence at NICE, Professor Mike Kelly, tells Julie Cramer why the organisation is determined to get GPs prescribing exercise and physical activity
“W
e’re not talking about a new vi- rus or germ, it’s something with-
in our grasp to do something about, in a fairly straightfor- ward 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- defined set of lifestyle diseases (Type 2 diabetes, cardiovascular disease, hypertension) linked to obesity and physical inactiv- ity, 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 lead- ers] 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 officials are that by 2050, more than half the adult population in Eng- land 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 health, and place a huge cost bur- den 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
It's important to identify the barriers to physical activity
the NHS, but also to local authorities and anyone with responsibilities in health- care, public health and social care. Kelly says that the kind of scientific
evidence and data related to lifestyle diseases that NICE has been reviewing in recent years is now pointing to one very significant conclusion. “The evidence about the benefits of
physical activity and the disbenefits of not being active are scientifically ut- terly 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 scientific one, it’s the will to make it happen”.
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GP FRAMEWORK NICE has recently taken the sig- nificant step of recommending that physical activity be in- cluded in the QOF (Quality and Outcomes Framework) indica- tors for GPs. GPs are currently incentivised financially to opti- mise and record treatment to patients for a range of health issues – such as asthma, men- tal health, diabetes, coronary heart disease and hyperten- sion, but not exercise. This move could change that. Given what’s known about
its physical and mental bene- fits, offering exercise advice to patients would represent a ma- jor step forward, and a move that would be hailed by the greatest proponents of physi- cal activity – the sport, health and fitness industries. Kelly says: “QOF is a complex system that doesn’t involve
NICE directly. It involves the Department of Health in the four home countries and representatives of the medical profession. “NICE lines up the sort of things that
could go into the QOF and these bod- ies negotiate on them. But given the compelling evidence, physical activity is something that we continue to push to the foreground as a candidate for QOF.” The changing political health land-
scape is another area where Kelly sees more opportunities. Health powers have become devolved with the advent of the Health and Social Care Act, and the establishment of health and wellbeing boards within local authorities (LAs) on 1 April 2013 has presented many more ways to tackle the issue. Kelly says: “The changes to their [LA’s]
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