Understanding the value and contribution of nurses and midwives to public health in the UK - presentation at the Faculty of Public Health annual conference 2016

1. Nursing at the heart of
public health:
Understanding the value and
contribution of nurses and midwives to
public health in the UK
www.nurses4ph.org.uk
Helen Donovan
Professional Lead for Public Health Nursing, RCN, UK
Nigel Davies
Professor of Healthcare Workforce Development, University of Bedfordshire

2. Public Health Nursing where have we
come from and where next…
• The Public Health challenge
• The RCN work on understanding the value of
public health nursing
• Celebrating success

3. Davies S, Winpenny E, Ball S, Fowler T, Rubin J, Nolte E (2014)
For debate: a new wave in public health improvement. Lancet. DOI:
10.1016/S0140-6736(13)62341-7
Public Health – past present and future
Social Movement for
health

4. Context and background
 RCN - Need to embrace PH and RCN stakeholder
event
 UK governments' health policies
 MECC - public health as everyone’s business to
supporting behaviour change.
 PHE - Chief Nursing Office work; ‘All our Health’
Framework for Personalised Care and Population Health
for Nurses, Midwives, Health Visitors and Allied Health
Professionals.
 Lord Willis: Shape of Caring - ‘Raising the Bar’
 NMC – nurse revalidation
 PHSKF - review

5. All OUR Health (AOH) is a ‘Call to Action’ to healthcare
professionals (HCPs) individually and collectively, to
contribute to NHS England’s Five Year Forward View to:
– close the health and wellbeing gap
– contribute to radical upgrade in prevention and public health
– develop a social movement for health
AllO RHealthProgramme?
AOH provides an opportunity to
• 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
Public Health Outcomes Framework: www.phoutcomes.info/

6. Project overview
 A mixed methods study asking commissioners
and designers of public health services their
views:
 What’s happening? Development of case studies
to showcase the diversity of work and roles to
present nursing’s contribution to public health.
Overseen and supported by an
Expert Reference Group

7. Study objectives and design
 Objectives:
 To explore the perceived value and contribution of nursing to public
health in the UK and to identify gaps between perceptions, expectations
and need.
 Study design:
 A mixed methods sequential explanatory design in two phases.
 Methods:
 Phase 1: National on-line survey of commissioners, managers and
practitioners responsible for service design of public health services
(response: n=219).
 Phase 2: In-depth interviews (n=16) with a purposive sample of survey
respondents and stakeholders. The interviews sought to illuminate the
survey findings.

8. Key findings
The main themes emerging from both the survey and the
interviews were:
 Nursing involvement and the hidden nature of some
aspects of public health nursing
 The quality of public health nursing provision and nurses
unique local knowledge
 Current perceived challenges related to re-organisations
and specifically diminishing local nursing leadership.

9. Nursing involvement
(actual vs. desired)
In all areas respondents believed
nursing should be involved in
public health more than it
currently is.
– Notable differences (around
40% points) between desired
and actual involvement in 7
areas
0
20
40
60
80
100
Frequency of current and desired nursing
involvement in public health
Always or often frequently involved
Always or often should be involved

10. However – nursing involvement is often
hidden
• Responses to some questions in the
survey ran counter to professional
knowledge
E.g. the perception that nurses were not involved
in some health protection areas
• Comments in the interviews.
• This was also highlighted from a
strategic perspective in relation to
workforce decisions where the variety
of job titles used by nurses disguise
their public health roles.
“the public
see nurses giving a ‘flu
vaccine but other aspects
like advising someone
about alcohol
consumption aren’t
recognised.”
“only specialist public
health nurses can be
counted”

11. Skills looked for when designing PH services
4 types of personal qualities and competence came out
strongly (> 50% of responses) - out of 17 themed
qualities.
 Local Knowledge
 Research and Project Management Skills
 Communication
• some mentioned interpersonal skills
 Behavioural Characteristics
• care, compassion, determination, motivation, commitment

12. Reasons for utilising nursing in public
health services
Top 5
Percentage of respondents identifying reasons for using or employing nurses in PH
43%
44%
46%
55%
69%
Commissioning
Communication Skills
Local Knowledge
Competence
Care Specialist

13. Local knowledge equips nurses to better
provide public health
• Detailed understanding of the local
community
• Accessibility and ability of clients
and service users to approach
nurses.
• Potential for fragmentation especially
when services were organised functionally
rather than around the client group or patient.
• Local knowledge of the invisible nature of some
vulnerable client groups
“Basing people
in large hubs with hot-
desking … it just doesn’t feel
local enough. I’ve got a team
based in a health centre seven
miles … [from] the population
they work with … They’re not
there, or visible.”

14. Challenges
• The top three challenges to commissioning care and the
nursing contribution were derived from open ended
questions in the survey.
Public Health
improvement
not achieved
Issues with
Knowledge,
training and
skills
Lack of
resources
Problems with
commissioning

15. Diminishing Leadership
• Challenges linked to diminishing nursing leadership at a local level
• No longer prominent senior public health nurses;
• Concerns were often linked to moves to recent re-organisation with
fears decisions about cuts would be made without the nursing
contribution being understood
• The variety of service models meant nursing leadership was implicit
rather than explicit in many senior nurse leader roles
“there are
no public health
nursing posts at a local
level above
band 7”
“nurses were
making headway with new
programmes of study but
since changes and funding
and integration this has
reduced”
 This contrasted with national nursing
leadership in public health which was
recognised in all UK countries.

16. Recommendations from the study
 The nursing profession needs to:
 focus on increasing the visibility of nurses in public health by articulating
the value and contribution nurses make bridging population health with
individual patient care.
 Educationalists need to:
 increase the focus on public health in all nursing education programmes.
Public health across the curricula should be mapped not only where it is
directly taught but also where attendant skills are developed.
 Nursing leadership:
 Champion at a local as well as national level to make sure nursing teams
are contributing to public health at all applicable opportunities.
 Ensure they are “skilled-up” to work with commissioners so meaningful
key performance indicators, service level agreements and local incentive
targets (e.g. Commissioning CQUINs) are set which reflect public health
nursing.

17. Case Studies
• Criteria for inclusion was
based on:
• the description of the work or
project
• the nursing contribution
• the outcomes and impact.
• Show-cased on line at
www.nurses4PH.org.uk
• Presentation materials and
some with audio interviews
with practitioners and service-
users.

18. Thank you
Questions…
Comments… Ideas?
@nurses4PH
Contact details:
helen.donovan@rcn.org.uk @HelenDon_RCN
nigel.davies@beds.ac.uk @nigelwpdavies

19. Links / References to this work:
Donovan, H. & Davies, N. (2016) The Value and Contribution of Nursing to Public Health in the
UK. Final Report, Royal College of Nursing (published online January 2016)
Davies, N. & Donovan, H. (upcoming) Exploring commissioners’ and service planners’ views of
public health nursing in the UK: national survey and stakeholder analysis.
Merrifield, N. (2016) More nurse involvement wanted by public health commissioners, Nursing
Times, 17 February
Stephanie Jones-Berry, (2016) RCN calls for more nurse input into public health: Survey
describes where nurses could apply their knowledge and skills to care in the community,
Primary Health Care. 26, 2, 7
Public Health England (2016) All our Health: about the framework (Online) available at
https://www.gov.uk/government/publications/all-our-health-about-the-framework/all-our-health-about-the-
framework
www.nurses4PH.org.uk
Other references
RCN (2012) Going upstream: nursing’s contribution to public health, London, Royal College of
Nursing.
Davies, S. et al (2014) For debate: a new wave in public health improvement. Lancet, 384, 1889-
95 (Nov 22)