Matter for discussion, submitted by the RCN Public Health Forum
That this meeting of Congress debates whether we are disabling our patients by focusing on illness rather than wellness.
Public health in 2017 is challenged by funding cuts alongside widening health inequalities. The focus within the NHS and health care in general has tended to be on a ‘medical model’ of treating and preventing illness rather than creating wellness. Health care accounts for only 20% of health so it is time for nurses to consider what this means for their clinical practice.
Obviously it is essential to focus on illness at certain times, but the danger long term is that it perpetuates illness. Social problems such as grief, loss of employment, poor housing and family breakdown are accepted parts of living. However, for some this can lead to mental and physical health problems, if people feel unable to cope with them. Nurses can, and do, flex between delivering care and enabling wellness to build resilience. Anecdotally, nurses say they are keen to embrace approaches that promote wellness, but are often prevented by resources, culture and attitude.
Cuts to public health spending have been significant and yet, in England, the cost of treating illness and disease arising from health inequalities has been estimated at £5.5 billion per year. The Realising the Value report demonstrated good evidence that investment in person and community-centred care could generate significant savings: £22m per CCG and £4.5bn per annum for peer support and self-management. Can nurse-led wellness solutions save more money in the long term?
There is evidence for these approaches across the UK;
Disadvantaged fathers in Salford demonstrated that social isolation compounded by an inability to be emotionally open was affecting their wellbeing and linked directly to depression, suicide, anxiety and agoraphobia. As a result the fathers, supported by a nurse, established a Saturday dads and kids club enabling them to talk openly about their problems father -to-father.
'All In This Together' the social movement in Wales builds on traditions of mutuality and community and gives an opportunity for Welsh nurses to engage with their communities.
Scotland still experiences significant health inequalities across its population and the RCN itself has published work, through its Nursing at the Edge programme, that profiles the positive contribution of nursing staff working to improve health outcomes for people in some of the country's most marginalised communities.
In Northern Ireland the 'Making Life Better' charter discusses how to enable communities and create conditions for people to flourish. The Carnegie Trust has undertaken work with the Northern Ireland Executive to focus on a post-conflict approach to wellness emphasising the need for a public voice in health policy.
It is clear there is a disconnect between the needs of the health system and wider society. Genuine savings and a better quality of life could be achieved if nurses were given the opportunity to innovate and flex between traditional caring and enabling people and communities to find their own solutions.
Heather Henry from the Public Health Forum, proposer of the item, started the debate by saying the management of illness and the creation of wellness are two different things. She said as nurses “we are more like lifeguards in the river” rather than stopping people falling in. Heather asked Congress: “Are we managing illness and creating dependency on the NHS?”
Andy McGovern, Inner North West London Branch said care is a big spectrum with illness at one end and wellness at the other, and nurses managing journeys through that spectrum.
Many members spoke of personal experiences. Rosemary Wheeler, Cheshire East Branch, talked about the introduction of wellbeing plans on non-admitting wards. As an active document, it includes a patient’s short-term and long-term goals and patients can be referred to third party providers to achieve those goals.
Heather Mercer, South East Regional Board member spoke of the importance of joined up care with CCGs, care teams and local groups.
Several members mentioned focusing on both the physical and mental health needs, not just the illness and symptoms, in order to deliver compassionate and holistic care to patients.
Jeni Watts, Devon Branch talked about the role of the public health nurse and that “wellness should be encouraged at the earliest possible stage.” Jeni also talked about the decline in the number of health visitors in England and how they can educate people, help create wellness and keep people out of hospital.
Early intervention and a multidisciplinary approach were both considered key in promoting wellness with social media also being highlighted as a way of engaging and interacting with communities.