Health promotion has been relegated in nursing, so I created my own role
Over the years that I have worked in community nursing, I have seen a shift away from the fundamental aspects of health promotion and education to a more medicalised and fire-fighting scenario that we are now used to seeing.
While funding will always be greater for acute services and this is understandable, funding for preventative care has remained stagnant in contrast. Data from the Office for National Statistics shows that there was no change in the amount spent on preventative care in the UK between 2014 and 2019 when it actually dipped, and while spending on other areas increased. When we don’t invest in something, it sends the message that we don’t value it.
When we don’t invest in something, it send the message that we don’t value it
When spending did increase for preventative care (around 2020-2021), unsurprisingly, it was on immunisations and early detection programmes. That leads us to the question of how we actually define preventative care.
Early detection is not the same as prevention. Yes, it’s important, and I’ve had friends and family who have benefited from screening services (breast cancer screening, diabetes screening), but it shouldn’t be misinterpreted as preventative health care.
Early detection is not the same as prevention
Preventative healthcare addresses lifestyle factors that impact our health in the first place and it looks like:
Movement/exercise
Healthy eating
Getting enough sleep
Sun exposure
Spending time in nature
Stress management
Avoiding environmental toxins
Meaningful relationships
And the list goes on...
Secondly, how is health information and education being delivered exactly? If it’s simply leaflets and websites, this excludes a large portion of the population that are computer illiterate, don’t have access to the internet, cannot read or write, or simply take in information better by other means. This is where nurses working together with local communities really works. Collaboratively organising talks, using interpreters, visuals, space to ask questions, building connection and reducing health inequalities.
Nursing was never this medical. It was much more more holistic and cared for people across the whole spectrum of their life and across their journey of health whether that was day-to-day good practices before even setting foot in a clinic or in an operating theatre.
Much of what’s considered public health has been shifted from the NHS to local authorities. I have worked in teams that have lost their funding and the same is happening across midwifery, Health Visiting and school nursing with the closure of Children’s Centres and outreach teams being cut. From an anecdotal, front-line perspective, I have seen the role of health promotion being left to community organisations to pick up. There is nothing wrong with this. In fact, community is where health is built as people have relationships and trust with each other. But, if we don’t want a disjointed system and want improved access to healthcare when needed, we need the support of community nurses.
Community is where health is built
When we relegate the grassroot activities that we underestimate like nurse outreach projects going into community day centres, schools, places of worship etc., it can actually have devastating consequences. Because community nursing, midwifery and health visiting is much more than just teaching people about their health. It helps orient people to their locality and support services as well as acting as a safety-net for those that are vulnerable. This can be life-saving in some circumstances, I’ve seen it first-hand, but the incidents are too tragic to repeat here.
We’re looking ahead at health innovation but we haven’t put money at the core foundations of health which is sharing and teaching each other how to look after ourselves in the first place. Smart watches are great, but if we don’t know what to do with that information, they’re useless. Investment at early intervention and prevention stages will cascade and save both health and money down the line.
So, we’re left with smaller nursing teams that are over-stretched as they work with a society that is increasingly over-stimulated, under-nourished, and stressed out. The demand for health services has never been higher.
…nursing teams that are over-strethced as they work with a society that is increasingly over-stimulated, under-nourished, and stressed out
I won’t pretend I have the answers to this. But, I do have a wish list. And that’s for the fundamentals of health maintenance to be appreciated. Only then will we see the direction of funding change. By not concentrating on this and squeezing services, it leaves too much opportunity for things to go wrong.
The NHS is a special organisation but constraints in money and resources means it’s losing its flexibility and creativity. There is a gaping hole in our healthcare system and decentralised care is picking this up. Until I can see some change, I’m carving out my own ideal role for community health promotion as an Ayurvedic Nurse Practitioner.
References:
Office for National Statistics. Healthcare expenditure, UK Health Accounts: 2020 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2020
Office for National Statistics. Healthcare expenditure, UK Health Accounts: 2021 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2021