Developing a working relationship:embracing the prevention agenda

and integrated care

Helen DonovanRCN Professional Lead for Public Health Nursing

Why does it now matter? Getting public health and prevention at the heart of

health and social care as well as the wider society… The role of nursing staff - valuing and engaging with

the profession Embracing the contribution of all nursing and

midwifery staff

This is not new! Improving life expectancy Reducing years spent with morbidity Reducing inequalities

The Black Report 1980: inequalities were not mainly attributable to failings in the

NHS, but rather to many other social inequalities influencing health: income, education, housing, diet, employment,

and conditions of work.

Wider Public Health workforce

Untapped Potential?

• Social movement for health

• Liaison and discussion across multiple departments and organisations

Developing the Public Health Workforce ‘Fit for the future’

Building on ‘Relationships and Reach’

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Population

Community

Family

People

All HCPs

Primary and community

care

Public Health

• All healthcare professionals have an important population health role when caring for individuals and families.

• More specialist public health professionals relationships and reach means their focus goes beyond the individual, to the community or population.

Qualified HVs and SNs hold a qualification in Specialist Community Public Health

From PHE

Resource pressures may lead to further re-design of roles as

increased focus on outcomes

Integration of services will impact on skills required and may make some

traditional distinctions between occupations redundant

Increasingly diverse health and

social care employers

Implications for the health workforce?

Focus on prevention and population-level

health

Skill mix and an evolving

workforce delivering care closer to home

Utilizing and motivating health care staff - using skills and attributes and bringing health staff with us to get prevention integrated across all systems

“‘as HV I would have been better placed working for a housing association or the

benefits department as I spent a lot of time on both!”

Nursing Skills Unique access to people, and carry a very

high level of trust – is this fully capitalised on. Nurses in all sectors using wider

opportunities to support public health; e.g. A&E nurses huge potential role in tackling alcohol and substance misuse issues.

Supporting and promoting lifestyle behaviour changes

MECC - possibly just common sense, but increasingly within commissioning and service specs makes it more achievable in busy settings.

RCN report 2016 Nurses4PH

Learning form other examples Dutch community

nursing model ‘Buurtzorg’

Holistic care Self care and

health care technology

A&E nurse thinking about her PH role?

“I never once asked a patient whether they had heating in

their house or turned it on and if not why not which would have

helped me have more of a holistic picture of that patient

and their social needs.”

Closing the gaps: 10 commitments to support action of nursing, midwifery and care staff

NHS E nursing strategy

Public Health is a key element of the NHS E nursing strategy (2016)

PHE All Our Health - ‘call to action’

Use relationships Work with

individuals and communities. Using

Public’s trust to support improving

health and reducing inequalities.

Focus on prevention and health promotion.

Enhancing individual’s & families capacity to improve

their own health

Use multiple opportunities to influence health choices

and behaviours.

All OUR Health (AOH) is a ‘Call to Action’ to healthcare professionals (HCPs) individually and collectively, to contribute to the Five Year Forward View’s call to -

– close the health and wellbeing gap– contribute to radical upgrade in prevention and public

health – develop a social movement for health

What is the All O R Health Programme?

AOH provides guidance and resources for all nurses, midwives and care staff.Evidence and metrics for developing practice and demonstrating impact.•Complement structural and large scale sustainability and transformation with professional mobilisation•Provide solutions to HCPs concerns re developing ‘health promoting practice’•Reduce time for adoption of preventative practice•Promote engagement with practitioners leaders and educators changing practice now and for the future

‘All Our Health’: www.gov.uk/government/publications/all-our-health-about-the-framework/all-our-health-about-the-framework

HCPs identified some concerns/barriers re developing and embedding ‘health

promoting practice•Difficulty in starting and holding ‘hard conversations’•Lack of confidence in own knowledge and •the lack of easy access to evidence•Concerns re own health choices and effect on credibility/perceptions as ‘poor role models’•Views that health campaigns and professional messages often poorly coordinated making local action more difficult•Perception that ‘value’ is not well articulated and how can HCP measure impact•Time pressures

What is the All O R Health Programme?

‘All Our Health’ aims to address these though

•Accessible evidence for practice, resources and tools •Metrics and outcomes measures•Education •Alignment with and support through other programmes•Alignment with public facing health campaigns •Culture change and social movement•Building capability

A Call to Action Action by Action through Action onAll health care professionals are

a vital resource for health. Working with patients, people and population for our healthy society… preventing

illness, protecting health and promoting wellbeing

• Increasing the visibility of health care professionals in prevention and population health and measuring impact

• Being a vibrant force for change and building a ‘culture of health’ in our society

• Working with people, families and communities to equip them to make informed choices and manage their own health

• Making Every Contact Count

• Contributing to Place based services, including Sustainability and Transformation plans

• Taking Life Course approaches to holistic prevention and care

• Responding to local population needs and wider factors affecting health and people’s ability to make healthy life choices

• Supporting resilience and independence

• Wider determinants of health: social factors, variation and inequality

• Health improvement: for people, communities and workforce

• Health protection: protecting health of communities and providing safe care

• Avoidable premature mortality: prevention is a central part of health care practice

Building on Relationships and Reach Impacting on indicators in the Public Health Outcomes Framework

Population

Community

Family

People

All HCPs

Primary and community care

Public

Health

Improving the wider determinants of health

Health improvement

Health protection

Healthcare public health and preventing premature mortality

• Homelessness

• Best Beginnings• Supporting

Adolescence• Smoking and tobacco• Obesity• Childhood obesity • Alcohol• Sexual Health• Falls• NHS Health Check

(Blood pressure)• Physical activity

• AMR• Tuberculosis• Pressure ulcers

• Respiratory health

• Liver Disease• Dementia

Supporting Health, Wellbeing and ResilienceMental Health, Learning Disability, Workplace Health

Throughout Life CourseBest Beginnings, Supporting Adolescence, Dementia and Falls

Creating Healthy PlacesMeasured by Public Health Outcomes Framework:

• increased healthy life expectancy • reduced differences in life expectancy and healthy life expectancy between communities

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‘the model’

Thank you

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