Comment

Public health nursing must evolve and forge links with other services

Nurses must speak up about the reasons for inequality and work more closely with colleagues in criminal justice, education, transport and housing
equalities

Nurses must speak up about the reasons for inequality and work more closely with colleagues in criminal justice, education, transport and housing

In one of her first acts after taking office in July, prime minister Theresa May announced an equalities audit of public services. The audit will cover how minorities and white working class people are treated in health, education, employment, welfare, skills and criminal justice. The prime minister said the review would 'shine a light on injustices'.

This review is unlikely to fix anything: it conflates two separate issues. The first is how services respond to difference and to the most vulnerable in society. The second is understanding and addressing the causes of inequalities themselves.

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Nurses must speak up about the reasons for inequality and work more closely with colleagues in criminal justice, education, transport and housing   


Theresa May has announced an audit into how minorities and white working class people are
treated in health, education, employment, welfare, skills and criminal justice. Picture: Alamy

In one of her first acts after taking office in July, prime minister Theresa May announced an equalities audit of public services. The audit will cover how minorities and white working class people are treated in health, education, employment, welfare, skills and criminal justice. The prime minister said the review would 'shine a light on injustices'.

This review is unlikely to fix anything: it conflates two separate issues. The first is how services respond to difference and to the most vulnerable in society. The second is understanding and addressing the causes of inequalities themselves.

A different approach 

I am not decrying the need to investigate whether we treat people equally in our public services. However, we need to take a different approach to the causes of inequalities, and this should come first.

Health services are a microcosm of the cultural changes affecting wider society, and they can perpetuate and deepen that inequality. What should be considered are the rabid effects of austerity, welfare cuts, a lack of meaningful work, poor housing and a steepening social gradient.

Some of the actions needed to address these issues are highly political, and require changes in national policy and legislation. Others are about new ways of approaching public health.

Places, not services 

My home town of Manchester is leading the way, through a devolution agenda. We are looking at a socio-economic whole system model of change, focusing on places and not services. Greater Manchester is looking for a change in public health.

The equalities audit – which may or may not change organisational culture – should lead to the question: how can we respond to rising inequality?

Nurses have to speak up more often about how inequalities arise and their impact on public services. A public health approach that focuses on health promotion, prevention of ill health and health protection – what we in New NHS Alliance call 'the 3 Ps' – is no longer enough.

Causes of wellness

We are now calling for a better understanding of the 'causes of wellness’, which are not about the avoidance or treatment of illness, but about how nurses can create conditions where people feel happy, fulfilled and productive. We are calling this 'the 3 Cs' of health creation.

Essentially this is about having control over your life, having meaningful social contact and having the confidence to move forward.

At the most senior level, nurses must get stuck into the debate about sustainability and transformation plans. And public health nursing must evolve.

Beyond health

There should be less focus on the 3 Ps of public health, and more time spent in discussion with our partners about how to enable people to get decent jobs, homes and social connections that support them. This means forming partnerships beyond health and social care and into criminal justice, education, transport and housing. 

Co-production – with people, not patients – can lead to better solutions, because professionals don't always know why things happen as they do, and self-help encourages strength and resilience. Creating a focus on service delivery can foster dependency and drive up demand.

Local people have different strengths, experience and knowledge. They are the solution, not the problem. 

To find out more about health creation go to nhsalliance


About the author

heather

Heather Henry is a Queen’s Nurse, independent public health nurse and co-chair of the New NHS Alliance

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