Does anyone like NICE? It has been around since 1999 and has made a predictable number of enemies in the pharmaceutical industry and media, which see it as a rationing puppet of the Government. But it approves far more drugs and devices than it denies and its guidance is sought and bought all over the world, not least by the Americans who use it to band their insurance policies. Despite hinting of it at a bonfire of the quangos, it’s unthinkable that the Tories will do away with such a useful political firewall, and indeed NICE’s budget has grown exponentially as it takes on new remits, such as public health and NHS Evidence. But for all its success and respect, there is a sneaking suspicion that the public don’t like NICE.
Does this matter? I’m just off to Manchester to chair my fourth NICE conference in a row, and so I’ve had a privileged peek at the public face of our most powerful health quango. And I reckon the niceness of NICE does matter. There’s a wealth of communication research that shows how important likeability is in getting people to take your messages on board and change their behaviour. Conversely, you can be the best scientist in the world, but if your public face is dry, humourless, and uninspiring, all those fine meta-analyses are laid to waste. Your peers may line up to listen to you drone through another tedious presentation, but the media (and hence the public) will take no notice at all. Likeability is crucial in politics, medicine, and life.
The evidence for this is neatly summarised in a new book ‘Don’t be such a scientist’, written by Randy Olson, a PhD and professor of marine biology who has a second career as a filmmaker. He argues very cogently that experts—politicians, doctors, scientists, and lawyers—need to pay attention both to substance and to style. We have to engage both sides of the brain to connect to an audience: not just the rational, evidence-based intellectualising left side, but also the intuitive, instinctive story-telling right side. It’s a paradigm shifting call for the communication of science.
This made me think of NICE. I’ve sat through some inspiring talks over the years, but also some pretty vacuous and/or dull ones. The talks that engaged me most were stories, such as one by a group of nurses who set up a buddy system for patients with chronic obstructive pulmonary disease (COPD) that demonstrated the ability of patients to help each other. The buddies also had COPD but both they, and the patients they helped, improved their mental and physical health by helping, advising, and being there for each other. Why we aren’t doing this for all chronic diseases is beyond me.
I was also blown away by a chief executive who got a warning shot from Dr Foster that his mortality rates were way off the scale, as worrying as Mid Staffs or Basildon. But instead of denying the problem, or finding statistical arguments to discredit the figures, he asked his board, and his consultants, ‘What if these are true?’ Together, they developed an excellent monitoring and quality control system that has seen an extraordinary reduction in death rates by ignoring counterproductive Government targets and focusing entirely on basic nursing and medical care.
We know from recent scandals that despite record NHS investment, NICE, the Bristol Inquiry, and assorted inspection regimes that started a decade ago, we still don’t have a high standard of care across the NHS. Part of the responsibility must lie with quangos and regulators not getting their messages across. But when it all hits the fan, the temptation is for everyone to get macho and defensive and rip into the weakest links, even when the evidence clearly shows that to change behaviour you need to be likeable, constructive, and understanding, and tell uplifting stories of success to inspire those around you. The NICE conference is full of nice people who shy away from the media spotlight. Time for NICE, politicians, and the Care Quality Commission to prove their worth and inspire us to change. G
Dr Phil’s new book Sex, sleep, or scrabble? is out now.