1. Making Every Contact Count DH Nursing Policy and Vision
Pauline Watts – Professional Officer for Health Visiting, PH and Dementia Nursing

2. 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 , 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

3. 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?

4. 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

5. New relationships …. New responsibilities?

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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