Making Every Contact Count DH Nursing Policy and Vision

Pauline Watts – Professional Officer for Health Visiting, PH and Dementia Nursing

The Challenge: what we are facing and the rationale for change

We face significant challenges to public health …

•England has one of the highest rates of obesity in the developed world.

•Two thirds of adults are overweight or obese, a leading cause of type 2 diabetes and heart disease

•In 2008-10, the gap between areas with the highest and lowest life expectancy was around 12 years

•Smoking claims over 80,000 lives a year.

•1.6 million people are dependent on alcohol.

•Over half a million new sexually transmitted infections were diagnosed in 2010

•Major health threats persist, ranging from risk of new pandemics to the potential impact of terrorist incidents.

… with significant costs to health and to the economy

• Drug related crime costs £13.9bn per year• Smoking costs the NHS £2.7bn a year• Obesity costs the NHS £4.2bn a year• Dementia costs the UK £17bn a year• Sexual health treatment costs NHS £1.2bn a year

SoS priorities

• Long term conditions• Care – quality of care• Dementia• Reducing mortality from preventable causes

The new Public Health System will build on existing success

Vision / OutcomesHow do we

see the future?

Mission What does

the PH system have

to do?

• Focused on outcomes: improve and protect health and wellbeing for all the people of England and reduce health inequalities

• We will have succeeded if, as a nation, we are living longer, and in better health; and if the gap in health between rich and poor is reducing.

• Improving outcomes for all at all stages of the life-course

We will improve and protect health and wellbeing – through:

• Empowering local leadership and encourage wide responsibility across society to improve health and wellbeing, and tackle the wider factors that influence it

• Strengthening self-esteem, confidence and personal responsibility

• Positively promoting healthier behaviours and lifestyles

• Adapting environments to make healthy choices easier

• Protecting the public from health threats – with a strong nationally integrated system that offers expert advice to the NHS, local government and the public

Helping people to stay independent, maximisingwell-being and improving health outcomes

Improving care, improving outcomes for individuals families and communities

New relationships …. New responsibilities?

Public Health practitioners/SCPHNIncluding health visitors, school nurses,

occupational health nurses, specialist midwives

Nurses and midwives with specific primary and secondary prevention roles: practice nurses,

mental health nurses, community nurses, sexual health nurses,

All nurses and midwives maximising their role in health and wellbeingEvery contact counts

Individual

Individual/caseload/

registered list

Individual/community/population

Nurses and midwives opportunities and responsibilities for ‘improving the public’s heath’

Core Actions: - applicable to all nursing and midwifery groupsIndividual Level

• Provide direct health care to individuals across in all settings • Adopting an holistic approach to the care of individuals, making

“every contact count” to improve health and wellbeing at every opportunity

• Offer and provide accurate information on health and wellbeing on specific issues to others to individuals on how to improve health and wellbeing

• Signpost individuals to people and agencies that can help them improve their health and wellbeing

• Communicate with people about their health and wellbeing and the actions they may take to achieve improvement

• Listen to and support individuals to communicate their views of and concerns about health and wellbeing, refer others with consent.

Actions to maximise the nursing and midwifery contribution to improving health and wellbeing at individual level

National Actions: Policy and Programmes • Making every contact count• Developing accessible evidence based on NICE guidance• The public health role of midwives• Maximising the leadership role of SCPHN including health visitor and

school nursing programmes• ‘No health without Mental Health’• Dementia Challenge • Actively engaging across sectors, leading work effectively,

integrating health, care and support

Local Actions:• Make ‘every contact count’• Support nurses and midwives to maximise their contribution to the

Dementia Challenge• Ensure practice is supported by appropriate technology

Call to Action:• Develop skills as ‘health promoting practitioners’ making every contact

count

A life course approach – initial priorities

At the start of life : reducing health inequalities and variation in infant mortality

•Lifestyle indicators

•Breast-feeding rates

•Screening (preconception, sexual health, baby checks)

•Maternal mental health generally (post-natal depression particularly - spotting the risk factors and early signs)

•Immunisation - mother (pertussis) and baby

Children, Families and Communities: Health Visiting and School nursing

•Health and wellbeing of children, young people families •Delivery of the Healthy Child Programme and enabling positive public health outcomes•Appropriate infant nutrition and lifestyle changes to tackle rising obesity and related illness in later life•Enabling strong early attachment and infant emotional wellbeing•Connecting children, families to resources Supporting children and families with additional or complex needs•Reducing formal safeguarding through early identification and intervention•Partnership working

Children, Families and Communities: Health Visiting and School nursing

‘National model’ – delivering theHCP 0-19

Universal services : Healthy child programme

SAFEGUARDING

Universal Plus services : Early identification and intervention

Universal Partnership Plus services

Ongoing multi agency support

Your Community

5-19Led by SN

0-5Led by HV

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•Using knowledge to support and deliver care to individuals and local populations

•Supporting all long term conditions management including through:

supporting the expert patient

delivering health protection and health promotion e.g. providing immunisations, screening and advice

utilising data to ensure targeted care for groups within practice populations

Working age adults and older adults: vision for practice nurses

Optimising health of the population within the community

No health without mental health

•Tackling stigma and discrimination•Supporting positive maternal and infant mental health – midwives/HV•Supporting positive parenting including Nurse Partnership and Health Visiting•Supporting work to prevent suicide and manage self-harm•Improving the mental health and wellbeing of people with long term physical conditions•Integrating mental health and wellbeing into campaigns and communications

Making every contact countProviding opportunistic public health interventions and supporting the health and wellbeing of carers

Supporting patient choiceWorking with patients and carers to encourage active participation in care and decision-making

Supporting transition of careWorking with partners to provide seamless support including discharge planning, transition to residential or hospice care

Recognising riskReducing social isolation through supportive care co-ordinationSupporting the needs of carers

Integrated working with health and social careDeveloping strengthened ways of working with partners to maximise resources

New technology to enhance careUse of tele-health and mobile technology to support complex care in the home

Older people : Vision for District Nursing

Services with strong foundations

Services embracing innovation

•Making the importance of the nursing contribution to dementia care visible and valued

•Maximising our contribution to the dementia challengethrough:

ensuring dementia awareness for all nurses

raising public awareness and reducing social stigma

early identification and signposting to appropriate services and resources to build community capacity

developing appropriate environment of care

promoting wellbeing and living well with dementia

promoting public health messages of the healthy heart and healthy head (vascular dementia)

The Dementia Challenge

Providing excellent care throughout the care pathway to the end of life

Nurses and midwives: pioneers in public health – again!

•What needs to happen?•Generating the ‘will’ across the professions to embrace ‘wellness’ and to act as health promoting practitioners•Increasing confidence in nurses and midwives in their contribution to public health •Increasing capacity and developing competence in new public health skills for specialist practitioners •Maximising opportunities e.g. increase in health visitors•Effective leadership that builds and sustains partnerships•Active engagement e.g. health and wellbeing boardsMaking Every Contact Count