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

What does the PH system have to do? The new Public Health System will build on existing success Vision / Outcomes How do we see the future? 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 Mission What does the PH system have to do?

Helping people to stay independent, maximising Improving care, improving outcomes for individuals families and communities Helping people to stay independent, maximising well-being and improving health outcomes

New relationships …. New responsibilities?

Nurses and midwives opportunities and responsibilities for ‘improving the public’s heath’ Public Health practitioners/SCPHN Including health visitors, school nurses, occupational health nurses, specialist midwives Individual/community/population Individual/caseload/ registered list Nurses and midwives with specific primary and secondary prevention roles: practice nurses, mental health nurses, community nurses, sexual health nurses, Individual All nurses and midwives maximising their role in health and wellbeing Every contact counts

Actions to maximise the nursing and midwifery contribution to improving health and wellbeing at individual level Core Actions: - applicable to all nursing and midwifery groups Individual 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.

A life course approach – initial priorities 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

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 the HCP 0-19 Delivering the HCP 0-19 S A F E G U R D I N Your Community Universal services : Healthy child programme Universal Plus services : Early identification and intervention Universal Partnership Plus services Ongoing multi agency support 0-5 Led by HV 5-19 Led by SN

Optimising health of the population within the community Working age adults and older adults: vision for practice nurses 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 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

Services with strong foundations Services embracing innovation Older people : Vision for District Nursing Making every contact count Providing opportunistic public health interventions and supporting the health and wellbeing of carers Supporting patient choice Working with patients and carers to encourage active participation in care and decision-making Supporting transition of care Working with partners to provide seamless support including discharge planning, transition to residential or hospice care Recognising risk Reducing social isolation through supportive care co-ordination Supporting the needs of carers Integrated working with health and social care Developing strengthened ways of working with partners to maximise resources New technology to enhance care Use of tele-health and mobile technology to support complex care in the home Services with strong foundations Services embracing innovation

Providing excellent care throughout the care pathway The Dementia Challenge Making the importance of the nursing contribution to dementia care visible and valued Maximising our contribution to the dementia challenge through: 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) 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 boards Making Every Contact Count