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Nurse leader says 'strong case' must be made for public health

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The country’s top public health nurse has said the case needs to be made “very strongly” about the benefits of investment in public health, in the wake of concerns about budget cuts by councils.

Professor Viv Bennett, chief nurse at Public Health England, faced questions on the future of health visiting and threats to public health budgets yesterday from delegates at the Royal College of Nursing’s annual conference in Bournemouth.

“What we need to do is not lose more ground. We have to keep going on that really vital work”

Viv Bennett

Samantha Spence, from the RCN’s Outer North West London branch, asked Professor Bennett how she thought commissioning changes for health visiting would “impact on public health outcomes for children”.

Councils are due to take over the commissioning of health visiting services in October from NHS England, as part of a wider policy of putting public health spending in the hands of local authorities.

But concerns have been raised that the services may become vulnerable to cuts from councils under pressure to make savings.

Professor Bennett, who has played a leading role in overseeing the recent increase in health visitor numbers in England, said the healthy child programme and health visiting service was “very dear to my heart”.

She argued that national work to grow and modernise the area meant that “we are now in a very good place for describing a health visiting service” to local authorities. In particular, she highlighted the new 4-5-6 Model.

“As we start to have conversations with local authority commissioning colleagues, we’ve been so much a better place than we were four years ago when health visitors could not articulate their vital and visible [role], their embedding and extending of public health,” she said.

She told the conference that Public Health England had reached agreement with 150 out of 152 local authorities on their commissioning model for local health visiting services.

She added: “NHS England are working with them on continuity of contracting and we are working with them, particularly in September, around really making sure they have the evidence and the impact to be able to commission health visiting services to do their very best for local populations.”

Meanwhile, Heather Henry, from the RCN’s Central Manchester branch, asked her what her response was to government proposals to reduce public health budgets by £200m this year.

The proposed cuts – revealed by chancellor George Osborne earlier this month – amount to 7% of the £2.7bn 2015-16 public health budget that is routed to councils from the Department of Health via Public Health England.

In response to the question, Professor Bennett noted that no one wanted to be in the position of making cuts to public health budgets.

“The Public Health England view is we have to continue to work with colleagues… to provide really strong evidence and to minimise the impact of those reductions in resources available to local directors of public health to commission services,” she said.

“We have to continue to make the case very, very strongly – professionally through our health economics work at Public Health England, though our evidence – about the return on  investment in public health,” she stated.

“Because what we need to do is not lose more ground. We have to keep going on that really vital work,” she emphasised to delegates.

Public Health Bennett

Viv Bennett at RCN Congress 2015

Earlier in her keynote speech, Professor Bennett had called for more “personalised public health”, which she said was an area that “nursing can be huge in a leadership role in taking it forward”.

“What we need to do is understand all those vital determinants of health and bring them down to the level of the person or people in front of us, and help support the kind of behavioural change that we need,” she said.

She highlighted that different parts of society faced different public health challenges, both in terms of unhealthy behaviours and also the ability to change them.

“Those kinds of behaviours are not evenly spread though the population and the ability to make those changes are not evenly spread through the population,” she said.

For example, she noted access to green space to exercise and financial constraints on eating healthily.

Professor Bennett told delegates that there was a need for health professionals to understand the “context in which people are living their lives to be able to give care and advice that really makes a difference”.

“We as practitioners need to understand how people live,” she said. “We have the roles and relationships to do this.”

However, she acknowledged that the nursing profession needed to raise its profile in public health work, suggesting that a lot of existing work by nurses on prevention was not “always recognised”.

“We can be a key part of tilting the focus to include prevention as much as treatment”

Viv Bennett

Nurses as a public health resource needed to be “an awful lot more visible”, she said, and that to do this they needed to “demonstrate and measure” their impact.

In addition, she revealed to the conference that she had been commissioned by the chief nursing officers of the UK and also the Republic of Ireland to “undertake a piece of work” on how to “realise the potential of the contribution” of nurses and allied health professionals to improving health outcomes.

She highlighted ways of doing this through Public Health England’s recently launched public health outcomes framework, and also the newer personalised care of population framework.

“We can make a difference to individual patients, families and communities with preventing avoidable illness and through promoting wellbeing and resilience,” she said.

“We are a big, big profession, we can be a key part of tilting the focus to include prevention as much as treatment,” she added.

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Readers' comments (2)

  • The whole commissioning process is a shambles, services have been cut to the bone, many , many people in children's services and health promotion in general have been forced out in various and on-going re organisations.
    Sadly the only people who will suffer in the long term is our service users, ie children and the vulnerable.
    Shame on the government for pushing this through and shame on the NHS higher ups for letting this get through unchallenged.

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  • Arguments lost are not necessarily ones that were not made, anon 9.00am, so we don't know that the decisions were 'unchallenged.' Having said that, you are right that those who will suffer most are the children and vulnerable - and 7% is a huge cut to be made in the local government public health budget, quite unprecedented in terms of anything seen so far in NHS, bad though that is.

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