Shared learning database

Gateshead PCT
Published date:
February 2011

Active and Healthy Gateshead Directors Group, within Gateshead Borough Council, agreed to use NICE guidance to support the prioritisation of interventions designed to improve the health of the local population, and maximise effectiveness. One objective of this work was to embed evidence-based practice into the culture and planning of work within the local authority setting. Initial work consisted of audits using diverse elements of guidance which identified a number of gaps in understanding and so it was agreed to host a multi-disciplinary workshop facilitated by representatives from NICE. The Behaviour Change guidance (PH 6) was chosen to assess the degree to which a draft Council Health Strategy 'The Big Shift', was evidenced based. The findings resulted in amending the strategy, to improve its links with the evidence.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of the initiative was to audit and stimulate the extent to which evidence-based practice was embedded into the culture, planning and delivery of work throughout Gateshead Borough Council's organisational structure and provide recommendations to inform future practice. Six Public Health NICE guidance documents were identified as relevant for audit within specific Directorates of the Local Authority. These being: Behaviour Change (PH 6), Community Engagement (PH 9), Physical Activity and the environment (PH 8), Obesity (CG 43), Workplace Health promotion: How to encourage employees to be physically active (PH 13), Workplace health promotion: How to help employees stop smoking (PH 5). Whilst work has been completed on all six guidance documents, the focus of attention has been on the Behaviour change guidance, because it applies to all services and in particular the Big Shift Strategy for Health. To audit elements of local authority work against identified public health NICE guidance. To establish a baseline of evidence-based practice currently operating within Gateshead Borough Council, generating a gap analysis and action plan. To identify key recommendations / actions to progress the initiative and embed evidenced based practice into the planning and work of Gateshead Borough Council in all future work. To work in partnership with representatives from NICE to facilitate a multi-disciplinary workshop and thus raise the profile of NICE as a body that can support local authority work programmes.

Reasons for implementing your project

Active and Healthy Gateshead Directors Group, within Gateshead Borough Council, are a proactive multi-disciplinary group with a remit to improve the health of the Gateshead population. The jointly appointed Director of Public Health is an active member within this group, who continually strives to prioritise work programmes and strategies that are underpinned, where possible, by a strong evidence-base. In August 2009 the group agreed to audit key elements of work against identified public health NICE guidance to establish baseline knowledge of how well the local authority, as a whole organisation, adopted and utilised evidence-based recommendations. Using 'How to put NICE guidance into practice to improve the health and well-being of communities - practical steps for local authorities', audit templates were created and disseminated for completion as a pilot initiative. In January 2010 Active and Healthy Group reviewed the pilot work and found that local authority respondents had struggled to complete NICE audit templates, and thus the return rate was patchy. The content of audits was detailed in description but lacking evaluative information - be it quantitative or qualitative. In June 2010 a Public Health Specialty Registrar took on the role of reviewing the work to date on behalf of the group. Key concerns were captured from pilot participants and subsequent recommendations were made to Active and Healthy Gateshead Directors Group, highlighting suggestions for how to progress the evidence-based practice work within the local authority. NICE representatives were contacted to seek local support for implementing the Behaviour Change NICE guidance, using a draft Council Strategy document to focus the work. A multi-disciplinary workshop was facilitated with the aim of gaining a greater understanding of how NICE can support the work and remit of the local authority.

How did you implement the project

Corporate sponsorship at Director Level was essential for this initiative to be possible. Local Authority stakeholders, with a sound knowledge of public health practice, and an appreciation of the benefits of utilising NICE recommendations is fundamental. NICE audit tools were modified to be used within the pilot programme and high profile work programmes were identified which should have firm evidence-based foundations. There was time slippage on this initiative due to a lack of capacity to drive the work forward, but willingness and enthusiasm did not alter throughout the period at a senior level. Much effort was exerted in completing the initial pilot audit templates. However, the detail provided was descriptive, lacking quantification or evaluative information. Without the establishment of baseline information the descriptive detail provided an informative current picture of activity, but did not provide an understanding of how well NICE recommendations were being met and thus a gap analysis to inform future action plans could not be progressed. With the additional capacity of a Public Health Specialty Registrar the completed audits were reviewed in detail and subsequent recommendations and actions were presented to the Active and Healthy Gateshead Director's Group. Engagement with NICE colleagues has provided an opportunity to raise the profile of this work across the local authority and broadened out the involvement to key public health programme leaders. A multi-disciplinary workshop was facilitated by NICE colleagues focusing on Behaviour Change guidance. This provided opportunity for local authority stakeholders to hear NICE colleagues outline the role of NICE. A practical task of mapping NICE recommendations to a local authority wide Council Health Strategy was applied within the workshop, to highlight how to apply NICE recommendations. Further workshops have now been identified focusing on evaluation and audit; and the Children's Plan.

Key findings

At Director Level there was a commitment to consider evidence-based practice as an essential component of all local authority public health work. The practical steps to implementation are still being refined into mainstream activity. In order to make the most of NICE guidance, support is currently needed from public health colleagues to interpret guidance and its application in a local authority context. The following outcomes have been achieved: - Behaviour Change (PH6) Following a multi-disciplinary workshop facilitated by NICE colleagues, feedback from attendees was positive with an identified increased 'readiness' to use NICE guidance. Meetings have been held with Director's of children's services and Adult and social care services. The need for a further event to clarify the way in which evidence-based practice complements activity to evaluate, audit and quality assure processes has been identified. - Obesity (CG43) A full mapping of the Obesity Strategy was undertaken to cross reference all elements to NICE guidance (broader than just the Obesity guidance). Where gaps were identified the Obesity Strategy group were asked to review the content. - Alcohol Use Disorders (PH24) A proactive piece of work completed to ensure NICE guidance was built into the developing strategy from the outset. - Community Engagement (PH9) The Gateshead Community Development Strategy was audited against the Community Engagement NICE recommendations. A paper has been produced highlighting gaps and recommending areas for development to 'refresh' the strategy later this year. Case studies have also been included highlighting good practice in relation to community engagement. - Health promotion in the workplace (PH5 & PH13) Public Health colleagues are working in partnership with the LA Human Resources Dept to produce a more user friendly audit tool that can capture evaluative information.

Key learning points

- Corporate sponsorship at Director level within the local authority is essential to progress evidence-based practice implementation across work programmes. - A sound knowledge of the importance of evidence based practice is required at a senior level to be able to instil the virtues of using it to inform work programmes. - Identified personnel to support the work is crucial both from Public Health teams and also key stakeholders to drive the work forward within the LA. - Appropriately tailored audit tools that are jargon free and specific to the local authority context is fundamental to the successful capture of applicable data that will provide baseline information. The standard tools at the back of NICE guidance are too generic and very NHS focused. - It has been identified that if there is a lack of robust evaluation detail from work programmes then there is inevitably difficulty in completing an audit tool appropriately. It was highlighted in this initiative that there is a need to support further training on evaluation and the importance of capturing both quantitative and qualitative data to identify whether initiatives are demonstrating effectiveness. - Behaviour Change (PH6) and Community Engagement (PH9) NICE guidance are integral to planning, implementation and evaluation of all public health work programmes, especially when considering evidence-based effectiveness and efficiency. - Support form NICE colleagues has been instrumental in raising the profile of this initiative and demonstrating to local authority stakeholders the relevance of utilising evidence-based recommendations to underpin work. This is especially pertinent at a time of economic constraints when all work programmes are being scrutinised for efficiency and effectiveness.

Contact details

Gill O'Neill
Public Health Specialty Registrar
Gateshead PCT

Is the example industry-sponsored in any way?