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NHS: making every contact count

It's not just doctors and nurses who are able to improve people's health, what about the wider workforce? NHS frontline staff interact all the time with patients and could also make a positive difference
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Dr Wendy Richardson Dr Wendy Richardson

A cost-effective new approach to ill health prevention is set to release the untapped potential of the whole NHS workforce - not just doctors and nurses - to improve people's health.

We're missing a trick in the fight against the tsunami of preventable illness that is threatening to overwhelm our health and social care services.

The scale of the problem is highlighted in the Marmot Review[ http://www.ucl.ac.uk/gheg/marmotreview] of health inequalities in England, which says that the role and impact of ill health prevention must be strengthened to help to stem the tide.

Instead of relying solely on medically trained staff or public health professionals to promote healthier lifestyles, we need to recognise the huge potential of the wider NHS workforce.

From hospital porter to GP receptionist, every day frontline staff have millions of interactions with people that could make a positive difference to their health. Yet all too often, through lack of awareness or confidence in addressing what are often sensitive issues, they miss these opportunities.

In NHS Yorkshire & the Humber, we're changing that - through a radical and systematic approach to ill health prevention developed by a regional partnership.

A salesforce for healthier living

We call it 'Making Every Contact Count'. It is based on a competence framework that offers a simple, effective way of giving every NHS employee the knowledge and skills they need to support people in making healthier choices.

It's common sense - and it's extremely cost-effective, too. For a relatively modest investment in training, the framework can help the existing workforce to reach thousands more patients as they go about their daily jobs.

NHS Hull is one of 10 PCTs putting the framework into action. While others, including NHS Sheffield and NHS Leeds, are using it to build ill health prevention into areas such as commissioning and communicating with hard-to-reach groups, in Hull we want it to help tackle coronary heart disease (CHD) - the biggest cause of premature death in our area.

Working with Hull & East Yorkshire Hospitals NHS Trust, we want to train some of their cardiac nurses - and if possible, some consultant cardiologists - to the first level of the competence framework, giving them the basic skills to introduce lifestyle behaviour change into the conversation.

Our aim is to get more out of the contact these teams already have with patients suffering from CHD - whether that is encouraging someone to attend a smoking cessation programme or supporting them in meeting a weight loss target.

It's a natural fit with the work they already do - but the training should embed a greater awareness of the possibilities to promote change, and the knowledge to signpost support services in the right way.

Making it measurable
The biggest challenge is measuring the impact of the project. In today's tough financial climate, it's no longer enough to measure how many people we have trained and assume that benefits will come from that.

Instead, we are working with the acute trust to develop a performance management framework that might include measures such as the number of referrals to smoking cessation and the number of quits; we will then build these into our contract with the trust.

This type of hard measurement is a long way from the common view of public health work as being somehow 'fluffy'.

But everyone involved in this project - including my colleague Karen Payne, a driving force behind the framework, and all the PCTs that are implementing it - understands that unmeasured initiatives won't cut it anymore.

If we are going to make a difference to our nation's health, and address the enormous challenges laid out in the Marmot Review, we have to take action now - and we have to prove that what we are doing works.

Dr Wendy Richardson is director of Public Health for NHS Hull

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