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The new public health agenda: an opportunity for community nurses?

Cheryll Adams
D(Nurs) MSc BSc(Hons), RN RHV Dip Man
Independent Adviser, Nursing, Health Visiting and Community Health Policy and Practice
Honorary Senior Visiting Lecturer
City University

Ringfenced funding for public health activity and local incentives for demonstrating health improvement will provide a new opportunity for community nurses and health visitors to be influential in helping set the local public health agenda

At first reading, the new Department of Health white paper, Healthy lives, healthy people: our strategy for public health in England, doesn't seem very different from those that have gone before. The reason for this is that it takes more than a few years for public health priorities to change, so the old chestnuts for health improvement remain priorities.

However, there are significant aspects of this white paper that need to be appreciated, particularly by those working in the community. For instance, this policy takes a life course framework and embeds the important recommendations of Professor Sir Michael Marmot's Fair Society, Healthy Lives report. In so doing, it considers public health within the framework of the wider social determinants of health. This has been the approach recommended by public health experts working with the World Health Organization for some years.

What is most significant is the ringfencing of a public health service, Public Health England, to drive health improvement. Previously, the policy has been that public health is everyone's business and should be integrated in all that we do. That doesn't change; nor does the government's desire for the public to take more responsibility for their own health. Indeed, how else can we manage the fiscal spend? Equally, the public health priorities are those we are very familiar with, such as smoking, obesity, mental health, sexual health and disease prevention.

Something that is different, however, is an increasing emphasis on emotional wellbeing, which, as every community nurse knows, is an essential component of physical wellbeing. This government wants children to grow up with self-esteem, confidence and resilience gained in infancy, and are prepared to invest in early years services to ensure that this happens.
This explains the planned increase in the current health visitor workforce by 50% over the course of this parliament, and the ringfencing of the budget within Public Health England to deliver this.

What is also significant about this policy is that it recognises the need to start “upstream”. In other words, by promoting emotional wellbeing in infancy, it recognises that this, in turn, will promote more healthy choices being made in the later years of a person's life. For example, if you are happy as a child and develop good emotional resilience, the need to smoke or rely on food for emotional comfort becomes less likely in later life and you become less prone to heart disease and depression.

Much of the future public health activity will be decentralised and will take place from the platform of local authorities, with Directors of Public Health (DPH), though based in local authorities, working across the NHS and the private and voluntary sectors. However, the view is that local communities must determine their own priorities and influence any process of change.

For this reason, those professionals who probably best understand the health needs of the population, apart from GPs; namely, community nurses and health visitors, have the opportunity to use this agenda to bring about health gain for their patients and clients.

A current example would be that we are hearing of money being withdrawn from some children's centres to help meet the required local authority savings. It is essential that those working in the NHS with these centres help them to articulate the health gain they can achieve for young families, and stop the cuts, or help the centres carefully work out where any cuts can be made with minimal disadvantage to the clients using them.

It may be that this will, in future, require lobbying your DPH who will be the strategic leaders for public health. Alternatively, ask for your public health issue to be discussed at the local health and wellbeing board, which will be established in every upper-tier local authority.

Ringfenced funding for public health activity and local incentives for demonstrating health improvement will provide a new opportunity for community nurses and health visitors to be really influential in helping set the local public health agenda, and in some cases being at the heart of it.

The government's commitment to increasing health visitor numbers so that they may intervene more effectively early in children's lives is clear; but could this also be an opportunity to improve the level of public health intervention for the elderly and the vulnerable? I question whether we are currently doing as much to keep them healthy and safe as we once did.