Why do we have nice people? Do we really need nice people or are they just a myth? Have you ever wondered why there is always someone nice at every party, and why they are always invited to be the first person to say “Cheese!” at a cookout? Or why the waitress always smiles when you order extra deli mustard and a second bottle of wine?

The National Institute for Health and Clinical Evidence is an independent executive body of the UK government, which publishes guidelines on five aspects of health: quality of care, health, social impact, practice and patient satisfaction. In 2021 the NHS commissioned a public consultation on whether it was necessary to introduce a new policy on “Nice” and if so, how best to communicate the policy. The consultation received responses from stakeholders who were concerned about the quality and effectiveness of healthcare provision, as well as how to best communicate the policy to the public. The views of the stakeholders were broadly consistent with the key priorities of ensuring high quality patient care and maintaining good relationships between health care professionals and patients and carers.

One of the key recommendations of the consultation was that a clinical guideline on “Nice” should be introduced alongside a statement outlining the different types of behaviours that constitute a nice behaviour. The draft of the guideline included wording such as “Smiling is a recognised means of expressing good health” and “behaving nicely in a caring way can reduce stress”. It also recommended that healthcare organisations develop a website which contained information on treating patients with kindness, as well as resources and examples of nice behaviour. The draft also included a link to the national coordinating centre for healthcare services (NICE), which was recommended to be incorporated into the website and to provide information on implementing a nice culture in the workplace.

Another recommendation of the consultation was for healthcare organisations to conduct a series of case studies to determine the impact of introducing “nice” into their workplace and whether it was cost effective. The case studies identified four key elements for judging whether introducing “nice” policies would have positive benefits for staff, patients and employers. Firstly, clinical guidelines should encourage people to report instances of social care being poorly experienced by the service user. Secondly, there should be a requirement for providers of pharmaceuticals and surgical supplies to offer a range of nice behaviour towards their customers, in order to create a “friendly” environment. Thirdly, guidelines should point out that there is evidence that nice behaviour has the effect of reducing staff workload, lowering costs and raising productivity.

The fifth element of the recommended clinical guidelines was that a provider should ask if a drug or surgical supply would be more expensive if offered to a person who is wearing a nice uniform or if the purchase of the drug or equipment would be higher if a patient wearing a nice uniform were treated with kindness. The element considered was not addressed in the report because it did not make sense from a cost-effectiveness perspective. The sixth element of the recommended guideline was that healthcare organisations should provide training to personnel to show them how to use evaluation forms properly. Again, the six elements did not make sense from a cost-effectiveness perspective, as training would take time and money and would not likely be cost-effective for most organisations. The seventh and final element was that staff should be provided with a “listening tour” when they are called on to attend to an emergency. This is hardly necessary if the purpose of an appraisal is to determine whether a provider is being “nice” in its attitude.

I was asked to review the report by external independent parties, which led me to conclude that the above recommendations represented a very weak set of guidelines. Very few health services are providing training in how to give genuine nice, warm and friendly treatment to patients, so this guidance would be extremely limited. Most internal companies and hospitals would be expected to follow best practice within their organisation, rather than the directions of these highly unhelpful guidelines. An appraisal of this report should not be based on cost-effectiveness alone, as the effects of some of the recommendations could have severe consequences for staff morale, and for the general reputation of the NHS. Providers must strive to operate in an atmosphere of constant communication with their patients and with one another to build trust, not simply rely on cost-effectiveness as their only guide.