Q) What are the achievements that you are most proud of this year?
It's been a big opportunity to have a director of nursing for public health nationally. The role acts across the DH and PHE with nursing teams working jointly to achieve success. Our first big challenge was to increase the visibility of nurses outside of hospitals - to create a new narrative around why nurses are so important in improving health and wellbeing, as well as providing care when people are ill. We are raising the profile and public health nurses have been recognised across all of the award ceremonies this year.
Some specific achievements include work with the QNI and RCGP around supporting carers. Particularly vulnerable are young carers, and we have a large number of them in this country. There have been competitions, badges, and trained school nurses to support young carers and that's been excellent. Also, supporting LD nurse consultants to produce the excellent health equalities framework. I am particularly delighted with the work that was done in partnership across NHS England and PHE on the early years profiles and on six high impact areas where health visiting services and teams really make a difference.
Finally, the work we have done with school nursing has been amazing. It is a very small profession vital for improving and protecting the health of children and young people through the school nurse development plan.
Q) Who is responsible for improving the public's health?
One of the first things we needed to establish in the minds of professionals, and in the minds of the public, was that public health is not a specialty that only a few people do. The public's health is something we all have responsibility for and all nurses have a role to play. For example, every single nurse can make every contact count.
We want to establish that population health and personalised care are not different things. All nurses should be delivering improved health and outcomes at every opportunity and everybody has a role in both.
Q) How can nurses in primary care approach this effectively?
AWe have drawn up a framework which helps nurses to understand personalised care and population health as something that all practitioners do, giving them the right evidence to do that. There are a number of components in the framework. The first component shows how all nurses, midwives and AHPs can make a difference - we set this out as a pyramid. The base is all nurses and midwives. So for example every single nurse can make every contact count. The next level is practitioners who also have responsibilities for prevention and for a wider population such as caseloads, practice lists and communities and then those whose main role is public health, such as health visitors, school nurses, public health practitioners, and consultants. The actions and responsibilities are additional, by which I mean, the practitioners at level two and three build on the 'all practitioner' actions in their work. So for example primary and community nurses make every contact count and have specific and additional responsibilities because they have specific and explicit roles in prevention.
We then set out six key areas of population health activity. They are: the wider determinants of health; health improvement and making every contact count; health protection; healthcare and public health; supporting independence; and taking a lifecourse approach.
This is underpinned by work done with NICE and PHE enabling people to access the evidence, and underneath that is how to demonstrate outcomes.
The initial work on the framework will be launched at the public health nursing conference in July. This will be the initial release, the work has been going on since last year's conference. It will then continue to be developed alongside PHE's health and wellbeing framework to ultimately be an interactive framework that nurses can use in their daily work. We hope that the framework will provide fully worked examples for some national priorities, and information for local services to use in developing and implementing their local priorities.
Q) What would you say are some of the public health challenges that this framework will help you and nurses to tackle?
The framework includes easily accessible information about the major health problems such as cardiovascular disease and cancer, and about changing lifestyles and supporting people in healthy choices for example on smoking, obesity, alcohol intake and other factors that contribute to poor health. We are developing 'top tips' on what primary care nurses (PCNs) can do. We are hoping to release that at the conference. A good example is alcohol. We know that drinking in this country is at levels hazardous to health across different stages of life. Some of it is visible, some of it isn't. Alcohol, together with obesity is putting pressure on health services. We need good services for people with liver disease and we need to stop the rise in people presenting with alcohol-related problems.
There are key roles for all primary and community care nurses. School nurses have a key role in educating children about alcohol. Practice nurses have opportunities to discuss drinking in a non-judgmental conversation so people are inclined to tell the truth, not what they think nurses want to hear. We need a quick and easy way of signposting these services. In terms of the alcohol challenge, how do nurses fit on our pyramid? Every nurse has an opportunity to make sure they are well informed and deliver consistent messages. Primary and community care has a role in prevention, while specialist public health nurses have a role in social action, education, campaigns and spreading the word. Nurses must be clear about where and what the evidence is. Nurses can make a judgment about when is the right time to offer that advice and how to offer it.
Q) What can you do to address health inequality?
There is a way of describing public health as the five waves of public health. There has just been a discussion paper in the Lancet by the chief medical officer and other authors. What we know is that some things are absolutely fundamental to public health, like clean water, proper sanitation, immunisation and protection from infectious disease, responsive health care services (the first three waves). The fourth wave was about improving the health of the population through legislation, such as seatbelts and tobacco, or campaigns around healthy eating.
We are in the fifth wave of public health, understanding inequalities and how people's lifestyle choices are impacted by their social circumstances and education, and trying to deliver public health in ways that both address and mitigate some of those factors. Action is needed at all levels to make it easier to do the right things for good health. Nurses have some key roles and the six activities for population health will enable professionals to mark these out.
The authors of 'fifth wave' discuss the need to build 'a culture for health'. One where our society places more value on health and wellbeing and nurses can be a real voice in building that culture. Addressing inequalities requires broad social action and there are some really specific contributions community practitioners can and are making, working with people as individuals and working with communities. There is an approach called Asset Based Community Development (ABCD). Many community practitioners work with community groups. I really like the asset based idea. These communities have a lot of strength, they've kept going through great adversities. Supporting people to bring that joint strength together can be really valuable.
Q) It sounds like the kind of challenge that can never completely overcome those adversities?
There are all sorts of things that are at national government level, things that local authorities are doing, things that PHE are doing. There are things at community level, we still need to help people to deal with the situation they are in and we still need to make it easier for people to do things that are good for their health on a personal level. Things like not having sweets machines in schools, questioning whether local authorities should allow takeaways near to the school, etc.
Q) How can the gap between the public's perception of primary care nurses and the reality of what they are trying to achieve be addressed?
Because of concerns about the acute physical ill health sector, many nurses who work in primary and community health have felt invisible. All branches of nursing must be visible to the public but also to people who might become the next generation of nurses. There is a fantastic breadth of opportunity in a nursing career which we must make people aware of. There is always an opportunity for nurses to raise awareness of what they do. People who have been in contact with specialist nurses of any kind speak very highly of them. Those receiving amazing care from community nurses know how knowledgeable, skilled and vital they are. The public in general may not have this regular contact with PCNs. The challenge for us is to help them understand that the primary care nursing workforce is highly skilled and knowledgeable. One way of raising the public's awareness of PCN's is through social media.
Q) How has social media helped raise people's awareness and perceptions?
Primarily social media was used to connect with the profession and engage them in the debate. As part of the national strategy for compassion in practice, 6CsLive! began running 'weeks of action'. At the end of last year, we ran the first Week of Action to raise awareness that all nurses were part of the commitment to improving health. It was well received and achieved good coverage. Earlier this year, we ran the second one about health protection. We covered immunisation, TB and antimicrobial resistance. Certainly, antimicrobial resistance is a massive public health challenge, where nurses have an important role in educating the public.
We had NHS Change Day around health protection - 650 pledges this year and we are aiming for 1000 next year. The notion of protecting physical health, mental health and developing emotional resilience was most commented on. The third Week of Action precedes the conference. We want to continue to raise the visibility, continue to connect within the framework and tell nurses what they can do to improve health. We will have a whole range of activities during the week (23 to 27 June), testing out some of the framework, giving people tips on whatever the topic is. We will do nursing chats online and we will visit a whole range of services.
The weeks of action are one of the healthcare profession's contributions to building a culture of health and I encourage nurses to get involved by following us on Twitter or reading my blog.
Q) How can technology can be used to better effect in primary care nursing?
There are a number of things about technology that we are working to improve. The nursing technology fund has been very important. One of the important things is establishing technology as a part of practice. We had a dialogue before that about other groups needing technology to practice effectively with the emphasis on technology that saved nurses time so they could do the real job. For primary and community care nurses, it is part of the real job. District nurses are only just beginning to get the technology they need for real mobile working. The right technology for the right task is something that we have not always got right. It's about how clinical practice advises the technology. Compatability of systems is something that needs to be sorted in certain areas and sharing information protocols has been an issue in areas. All of those things are very well developed in some places and less well developed in others. Our community mobile working pilots really demonstrated how to get better quality and efficiency if you invest appropriately in technology.
Q) You mentioned pilots, what will happen next there?
The learning from the pilots have been used for people applying to the nurse technology fund, to find out what works. That was the last piece of work around improving community services and it was published quite a while ago. We have taken it into the nurse technology fund. It is not the only source of funding, but it is a focus.
Q) How do you see the patchiness being alleviated?
We need investment and good practice that works so money is not wasted, and for practitioners to engage. At the end of the day it is a local decision for a local organisation about which technology they use. The understanding that nurses need technology to do their work and that community nurses work can be made better through technology is being invested in.
Q) How can more primary care nurses be encouraged into leadership and management positions?
There are different issues for different bits of the primary care profession. For practice nurses it is more challenging because they often work in an isolated way. In big practices, you may have a career progression pathway for practice nurses, but for people working in smaller practices, there is not clear progression, particularly for management. We need to think about leadership and management as different things, so there are leadership opportunities without hierarchies. Such as practice work and clinical work where a nurse can take the lead in a particular area. For NHS organisations there is a more visible management hierarchy while in new forms of organisations like social enterprise there is often a flatter more dispersed management arrangement. Both have opportunities for progression.
We have had a lot of discussion about leadership at the point of care, and dispersed leadership. I think in terms of being professional, and progressing professionally it is about taking those opportunities. Then, if you decide to progress to be a team leader, you bring that with you. Some public health roles have an inherent leadership role. For health visitors and school nurses as leaders of the healthy child programme there is leadership inherent in what we ask them to do. I do a lot of teaching on leadership programmes for those roles.
Take those opportunities, learn all you can, think about where you might want to progress, and understand that you must build a portfolio of skills for when you do progress.
Leadership and management are different things. There are lots of ways to be a leader. The work we do encourages primary and community nurses to be champions and leaders in population health. They are seen as absolutely key professionals for taking this work forward. The confidence to be a leader is the first step.
Q) Your conference takes place on 1 July. What will it be about and who should attend?
The conference is called At the Heart of it All: Personalised Care and Population Health. It was insired by a short video I saw, which showed nurses as the key people globally providing health and care. I hope that we will get a really good mix of delegates: nurses, midwives, healthcare assistants.
I encourage people to visit the website. The chief executive of PHE Duncan Selbie will be opening the conference, and speaking about how important he considers the contribution of nursing is to the system. The minister for nursing Dan Poulter will speak, I will be presenting 'learning and looking forward' which introduces the framework, and the chief nurse and chief health officer will be speaking. Masterclasses will cover the six areas of the framework. We will take key areas of interest for nurses and AHPs and give detailed information and top tips, outcome measures, etc. We will then produce worked examples for every area. Delegates will have the chance to look at it and provide feedback on how we should move forward, as part of the overarching framework for the country.