A Showcase Conference for Community Nursing Research in Wales “Small Improvements Make the Biggest Difference” Wednesday 5th November 2014, Swalec, Cardiff http://www.wspcr.ac.uk/cnrs-conference-2014.php

1. Community Nursing
Research
Professor Jean White
Chief Nursing Officer/
Nurse Director NHS Wales

2. This
presenta,on
1. Core
challenges
for
health
services
2. Core
priori,es
for
services/government
3. Relevant
Welsh
Government
policy
ac,vity
4. Prudent
healthcare
5. Innova,on

3. Popula,on
challenges

4. Inequity

5. …..
Social
gradient
persists
rate per 100,000 population
Avoidable, amenable & preventable mortality in Wales, 2001-2012
(note: some avoidable deaths are classed as both preventable and amenable)
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
300
250
200
all avoidable
150
preventable
100
50
amenable
0
Source: Office for National Statistics
They
are
s,ll
too
frequent
…..
Es,mated
that
quarter
of
all
deaths
are
avoidable.
CMO
2012
report
–
equated
to
7486
deaths
in
Wales.
…and
unfair

6. Shared
Priori,es
• Tackle
popula,on
demand;
inequality;
effects
of
poverty
especially
on
early
years
• Preven,on;
engagement
with
ci,zens;
keeping
people
healthy
and
at
home
• Delivery
of
services;
reputa,on
• Listening
and
engaging
with
service
users
• Service
configura,on;
innova,on;
new
approaches
to
make
a
difference
• Working
across
the
NHS
and
across
public
services
6

7. Primary
and
Community
Policy
ac,vity
• Se[ng
the
Direc,on
–
development
of
clusters
• Addi,onal
funding
£3.5
million
2014/15
includes
developing
roles,
targe,ng
deprived
areas;
eye
care;
cardiovascular
care
• New
Primary
Care
Delivery
Plan
–
engagement
exercise
begins
6
Nov
• Work
on
unscheduled
care
delivery
–
na,onal
clinical
lead
7

8. Professional
ac,vity
• Advanced
prac,ce
development;
extended
roles/skills
• Acuity
and
dependency
workforce
tools
• Early
years
work
–
Flying
Start;
healthy
child
programme
implemented
from
April;
smoking
in
pregnancy
• Public
health
role
for
all
nurses
and
midwives
–
being
led
by
PHW
&
linked
to
WHO
Health
2020
8

9. Prudent
Healthcare
Principles
9
Do no harm
Minimum appropriate interven1on
Only do what only you can do
Promote equity
Co-­‐produc1on

10. Applying the principles
Citizen
o Recalibrating the relationship between the citizen and the state/the patient
and the service.
o Using co-productive methods to help individuals take responsibility for
creating the conditions for good health in their own lives.
o Tackling health inequalities.
“The NHS cannot afford to pay for life saving treatments in the future if giant swathes of us
continue to make destructive lifestyle choices.”
Western Mail editorial

11. Applying the principles
Population Health
o Public health education has succeeded in changing people’s attitudes and
intentions, but not necessarily their actions.
o A focus shift is required away from education to motivation.
o Moving attention to changing the environments in which people live to
enable them to turn good intentions into behaviour change.
“And then let the doctors quit the centre stage
To usher in the prophylactic age.”
From ‘Superfluous Doctors’ – Prof. Archie Leman Cochrane

12. The
Caerphilly
Study
Substan,al
reduc,ons
in
serious
health
condi,ons
linked
to
healthy
lifestyle
behaviours:
– non
smoking;
– a
low
BMI;
– regular
exercise;
– a
plant
based
diet;
and
– alcohol
consump,on
within
guidelines.
By
adhering
to
4
or
5
of
these
healthy
behaviours,
there
was
a
73%
reducDon
in
type
2
diabetes,
67%
reducDon
in
vascular
disease,
18%
reducDon
in
cancer,
and
64%
reducDon
in
demenDa.

13. The
role
of
legislaDon
• Ac,ve
Travel
Act
• Social
Services
and
Wellbeing
Act
• Wellbeing
and
Future
Genera,ons
Bill
• Public
Health
White
Paper

15. Why
Innova,on?
We cannot solve our problems using the
same thinking we used when we created
them

16. R & D
• Essential we create an
evidence base for practice
• Need to innovate to meet new
demands
• Economic benefits to Wales
• Embed R&D in clinical roles
• Need hubs of activity not
individual projects
• Over to you!