Living well in older age: the health care professional contribution
Viv Bennett, Director of Nursing at the Department of Health and Public Health England, argues that the increasing focus on prevention of disabling conditions through healthy life style is no longer the remit of public health specialists only.
Improvements in public health, health care and medical advances have ensured that people are now living longer. This is indeed a cause for celebration but not all people in our society have the same chance to live longer in good health. Health inequalities persist and the gap between living longer in good health and living longer in poor health can be 20 years between rich and poor areas. Whilst many older people remain in good health, are economically active or contribute hugely through caring and volunteering, for others the picture is one of increasing ill health and frailty.
We know that wider determinants of health, such as poor housing, pollution and fuel poverty, impact both directly and influence lifestyle choices. Taken together, this has contributed to the rising numbers of long-term health conditions (LTCs), with many older people living with two or more LTCs. Social isolation, depression and dementia also impact significantly in older age.
It is clear that if health outcomes in older age health are to be improved and inequalities are to be addressed, we need a new public health model that focuses on prevention and health and care services based on supporting independence. This approach requires the engagement of all healthcare practitioners, not just public health specialists.
Nurses and Allied Health Professionals (AHPs) have vital roles in health and care for older people and can make a real difference in the move from episodic reactive models, to preventative, integrated services promoting health and wellbeing. Despite understandable concerns about pressures and capacity, many practitioners are embracing more prevention and health promotion as part of clinical practice.
Professionals have been clear about the need for information, evidence and capacity to demonstrate outcomes of their work. Working with the professions, Public Health England and the Department of Health have developed a Framework for Personalised Care and Population Health, which provides a national menu for health promoting practice.
Practice at individual, family, community and population levels
The Framework sets out six activities for population health which are based on the domains of the Public Health Outcomes Framework. It is a resource to support healthcare practitioners, managers, educators, commissioners, researchers and national professional leaders to access evidence-based research, guidance, standards, good practice interventions and outcome measures.
The Framework was published in July 2014 and has been well received. Front line practitioners have stated that it will assist them in undertaking the population health aspects of their role and that such a tool is “long overdue”. Educators have embraced the Framework with enthusiasm and have started using it to teach student nurses about the principles and mechanisms of population health. This is important, as some nurses are under the misconception that prevention and health promotion is the remit of public health specialists only. The Framework has been developed to de-mystify public health and provide all nurses, midwives and AHPs with ready access to information that will support them in this role.
The Framework also supports Making Every Contact Count (MECC), in which every contact between a professional and a member of the public is seen as an opportunity for providing basic health promotion advice and sign-posting to local support services if needed. Relevant NICE Guidance, including Behaviour Change Guidance, is accessible via the Framework.
Public Health England is discussing with British Geriatrics Society how we can work together, with other stakeholders, to develop the Framework to cover more areas of older age health and encourage a lifecourse approach to, for example, frailty in older age. Nurses and AHPs play key roles in changing attitudes on the value placed on health. The Framework for Personalised Care and Population Health has been designed to underpin practice for delivery of new approaches to health which support living well for longer and to contribute to a culture of health in our society.
Topics covered in detail in the Framework can be accessed from: https://www.gov.uk/government/publications/ framework-for-personalised-care-and-population-health
Comments are welcome and can be sent to: or left at https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency
Director of Nursing at the Department of Health and Public Health England