Developing a working relationship: embracing the prevention agenda and integrated care - presentation at the Faculty of Public Health annual conference 2016

1. Developing a working relationship:
embracing the prevention agenda
and integrated care
Helen Donovan
RCN Professional Lead for Public Health Nursing

2. 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

3. 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.

4. Wider Public Health workforce

5. Untapped Potential?
• Social movement
for health
• Liaison and
discussion across
multiple
departments and
organisations
Developing the Public Health Workforce
‘Fit for the future’

6. Building on ‘Relationships and Reach’
Healthandcare
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

7. 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

8. 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!”

9. 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

10. 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.”

11. Closing the gaps:
10 commitments to support action of
nursing, midwifery and care staff
NHS E nursing strategy

12. 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.

13. 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

14. 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

15. A Call to Action Action by Action through Action on
All 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 Resilience
Mental Health, Learning Disability, Workplace Health
Throughout Life Course
Best Beginnings, Supporting Adolescence, Dementia and Falls
Creating Healthy Places
Measured by Public Health Outcomes Framework:
• increased healthy life expectancy
• reduced differences in life expectancy and healthy life expectancy between communities
Healthandcare
‘the model’

16. Thank you
Let us know
what’s happening