Personalised Care and Population Health: the nursing contribution

1. Personalised Care and Population Health: the nursing contribution Dr Jean Christensen DH Feb 2014

2. Personalised care – population health: 19th and 20th century Florence Nightingale Social reformer and statistician, and the founder of modern nursing.

3. Population Health – the waves of public health • 1st wave – Public health works, such as clean water, sewers, drains • 2nd wave – Discovery of antibiotics, early vaccines, and the ability to treat and prevent infections • 3rd wave – Development of the welfare state and the NHS, tackling the Beveridge Report’s “five giants” – disease, squalor, ignorance, want and idleness [unemployment]. • 4th wave – Addressing the perils of tobacco, and then other lifestyle-related non-communicable diseases • 5th wave – The one that we are just entering and have the opportunity to shape, includes: • Looking behind inequalities/greater understanding of the social determinants of health • ‘Personalised’ public health

4. Health Care Professionals (HCPs) providing personalised care AND improving population health

5. National actions to support nurses and midwives in improving ‘the public’s health’ • Promote the public health role of nurses and midwives • Develop a ‘model’ for the public health role of nurses and midwives • Strengthen evidence base for services and practice - develop accessible evidence based on NICE guidance • Promote ‘Making Every Contact Count’ • Increase capacity, extend competence in new public health skills for specialist practitioners • Maximise leadership role of SCPHN (HV ScN nursing programmes) • Progress nursing contribution to public health in mental health, learning disabilities and dementia • Social movement • Generate the ‘will’ across the professions to embrace ‘wellness’ and to act as health promoting practitioners and increase confidence in nurses and midwives in their contribution to public health

6. The wider determinants of health • Learning Disabilities • Health inequalities • Social determinants • Poverty, poor housing • Unemployment • Social disconnectedness • Communication difficulties • Reduced health literacy • Mental Health • Stigma and discrimination • Socio-economic and environmental • Fewer qualifications • Lower employment rates • Lower incomes, poor housing • High rates of high risk behaviours • What nurses can do? • Make reasonable adjustments • Promote inclusion • Provide/promote accessible information • Support carers • Use the Health Equalities Framework • What nurses can do? • Challenge stigma • Help reduce inequalities – physical heath • Improve access to services • Strengthen the resilience of individuals • Practise preventative interventions

7. Health protection: roles at individual patient, community and population levels • Major issues in health protection: • Antimicrobial resistance- 5 year strategy published in Sept 2013 • cc • Immunisation and vaccination • Population levels current programmes • New immunisation programmes • Health screening programmes • Rates of tuberculosis • National surveillance strategy • Examples of nursing contribution: • Practise and champion high quality infection control • Contribute to high level population immunity by advice on immunisation, staff uptake (HepB & flu) and lead and provide new immunisation programmes • Promote national screening programmes by knowledge, advice and signposting direct involvement • Reduce TB rates by raising awareness of signs/symptoms, local epidemiology care, contact tracing and referral • Support surveillance through supply accurate data/information

8. Health Care Public Health Role of hospitals in population health Making every contact count

9. Lifecourse: Healthy Start - pregnancy to five years National Healthy Child Programme Priorities for demonstrating success and building sustainable services: • Transition to parenthood and the early weeks       • Maternal mental health (PND) • Breast feeding (initiation and duration) • Obesity to include nutrition and physical activity • Health and wellbeing (development of the child two year old integrated review and support to be ‘ready for school’ • Managing minor illness and reducing accidents  (reducing hospital attendance/admissions)

10. Lifecourse: The developing years 5-19, Children and Young People • Understanding and responding to the needs of young people to improve wellbeing and protect health (including extended immunisations/new vaccines) • Work with young people and their organisations e.g. National Children's Bureau, British Youth Council • Listen to what young people receiving services have to say e.g. school nurse champion pilot and GOSH Young People’s Forum • Develop evidence based practice • Professional pathways & guidance, including: • Emotional health & wellbeing • Sexual health • Young carers • Complex needs • Work with partners - including voluntary bodies, head teachers, local government

11. Lifecourse: Adults and older peopleCommunity Nursing Development ProgrammeAim: to enable patient centred care through delivery close to home • Actions: • New professional pathways focussing on supporting carers • Fact sheets to promote the programme to key audiences • Approaches for robust service user feedback to ensure quality • Approaches to promote technology in community care • Case studies to improve quality and reduce variation/inequalities

12. Working in the now! Technology and social media Improving access and reach using technology In synch with my life Right here –right now Apps Text Blogs Website Tele health Welcome to my world Smarter working The next generation 12 Public Health Nursing and Midwifery

13. Health Improvement: • dementia a 21stcentury public health challenge • Nursing contribution across whole pathway: • Contributing to reduction of social stigma surrounding dementia • Being dementia aware (e-Learning) and providing sensitive advice • Promoting health messages that protect against some types of dementia (eg vascular dementia) • Contributing to timely diagnosis and appropriate post-diagnosis support • Implementing a living well with dementia approach to services and practice …..including supporting independence, choice, personalisation, I statements, support for carers • Supporting improved access to appropriate services • Promote dementia-friendly environments wherever people receive care • Providing high quality care at the end of life

14. Supporting independence • Mrs M is an 84 year old widow who has lived alone for 18 months. She’s independent although she has a little help with the cleaning. And, because of her deteriorating sight she can no longer drive but has become adept at using the local buses. • She has a heath problem. And a plan. The plan is about prevention, early intervention and avoiding hospital admissions. • The plan works when people listen….when they don’t - the plan doesn’t work. • Share the story of Mrs M’s experience* it is about listening to people, hearing what they want and need, treating them respectfully as experts in their own care and helping them protect their independence. • *http://vivbennett.dh.gov.uk/cipdavidfoster/

15. Personalised care and population health: 21st century?

16. Social movement for Health and Wellbeing? Progress by nurses and midwives: • First PHE conference in June 2013 ‘Key Roles of Nurses and Midwives in Public Health’ – oversubscribed and highly positive evaluation with requests for more information on promoting health and wellbeing in different client groups • Blog site got over 1300 views over the week and there were over 940 tweets/re-tweets, with a further 880 tweeting during the @WeNurses chat. • This week sees a ‘week of action’ in relation to Action Area 1 of Compassion in Practice, with a focus on Health Protection. • Blogs: http://bit.ly/1bLbjFf Twitter: #NMProtectHealth • Or make a pledge: @NHSChangeday