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Advancing our health: prevention in the 2020s – consultation document

24th July 2019

A blog by Dr Cheryll Adams on the Prevention green paper “Advancing our health: prevention in the 2020s“.

Dr Cheryll Adams CBE, Executive Director, iHV

The Institute of Health Visiting very much welcomes the long awaited Prevention green paper, Advancing our health: prevention in the 2020s. In particular its desire to put prevention at the centre of all NHS and care decision-making.

The paper includes a focus on personalised prevention, a commitment to modernise the Healthy Child Programme and, as expected, a focus on the role of new technologies such as genomics and smart devices for individuals to monitor and control their own health.

This is a consultative paper and hence provides a great opportunity for the health visiting community to shape and influence the final policy commitments. We will highlight the relevance of the work that health visitors do improving outcomes for children with benefits felt by numerous government departments in our response, but health visitors need to respond too, citing case study examples to make their case from across England.

As inevitable from a Green Paper, it lacks the detail needed to determine whether the ambitions will be supported by a real funding uplift and the workforce support required to implement them in full. It does, though, make clear that to succeed it will require national and local government working together, as well as individuals playing their part.

Specific content of interest to health visitors and child public health:

This really is a very interesting and thorough document and as such it should become a core text for health visiting students.

Chapter 3 of the paper is: Strong Foundations and discusses the importance of our early days to our future health. It advises moving from dealing with the consequences of poor health to promoting the conditions for good health.  This is very welcome rhetoric which will chime with every health visitor.  There is also a welcome focus on the importance of healthy relationships in the home, and support for all parents who need it. Health visiting is non-stigmatising and has high levels of acceptability to the public and, as such, health visitors are well-placed to provide this support. However, this is time-consuming work and hence it can’t happen without reinvestment into the health visiting service.

Also highlighted is a very welcome focus on the early identification of need: it’s vital that families and their children who need extra support are identified early and receive tailored support. That way, we can prevent problems from arising in the first place, rather than dealing with the consequences. An example given is how the importance of early diagnosis for conditions such as autism can help a child’s development.

Helpful too is a specific focus on toothbrushing schemes in school and preschool, and a revisiting of water fluoridation which could so dramatically reduce childhood tooth decay.

The Institute is especially delighted that the Healthy Child Programme is to be modernised starting in early 2020. We particularly welcome the ambitions to achieve universal reach with a personalised response, alongside the importance of early identification and tailored support for families and their children who need extra support. However, we need to remain realistic about how long it will take to produce a really robust document – this is definitely not the “quick fix” that we need to reverse the current problems experienced by local authorities and health visitors struggling to deliver best practice.  That aside, we are delighted that the Healthy Child Programme will receive the attention it deserves and we will do all we can to support this piece of work to improve outcomes for children and their families and would recommend that government planning for it starts immediately to support the earliest possible publication.

There is a strong focus on health inequalities with the question asked: Which health and social care policies should be reviewed to improve the health of people living in poorer communities or excluded groups? We hope that health visitors will want to join us in responding to this as it really is the ‘bread and butter’ of our work.

There is a focus on sleep, perhaps for the first time in such a document.  This was the topic for the very first iHV campaign when we launched the Institute, recognising as we did that poor sleep leads to so many negative public health consequences in families.  For families, we recommend that sleep is looked at holistically considering the needs of parents and infants and children alongside the impact of the wider determinants of health such as poor housing or living somewhere noisy.

As expected, there is a prioritising of preventing and reducing obesity and its many consequences for health, and this acknowledges the need for government level interventions as well as those taken at local level and by the individual.

Health visitors will be particularly delighted by the content on breastfeeding and the reinstatement of the infant feeding survey. We will though be pointing out in response to the question: How can we better support families with children aged 0-5 years to eat well? the negative consequences of closing child health clinics across the country, as these provide such an important opportunity to discuss good nutrition with parents.

Addressing mental illness and its consequences also takes its place in the recommendations, as it should, with an emphasis on parity of esteem in prevention and addressing risk and protective factors during childhood including strong attachments. It is less clear on the detail of the importance of fostering infant mental health to combat obesity and adult mental health problems, but this can be included in the Healthy Child Programme refresh.

As well as the specific topic focuses, there is a wider focus on healthy places and the impact of spending time in the natural environment and getting outdoors – not only for physical activity, but also for mental health.  This feels very timely and important as screen time is becoming such a challenge to individual physical and mental health.

Within its conclusion, ’Advancing our Health’ makes this bold statement about delivery:  It will mean the government, both local and national, working with the NHS, to put prevention at the centre of our decision-making. Surely that must point to reinvestment into public health services as the next step?

The recent unhelpful emphasis of just five mandated health visitor contacts isn’t going to allow health visitors to contribute fully to this paper’s implementation (read our full Position Statement: Ticking the box but missing the point). Families need continuity of care by one health visitor with the opportunity for that health visitor to work autonomously, offering a personalised level of support based on need and agreed in partnership with the family. As we all know, families and their members do not fit neatly into boxes, health needs change over time and it also takes time to develop a level of trust with the health visitor.

This is an overview of just some of the content, do read it in its entirety. Overall we very much welcome it and its helpful recommendations and we will play our part in ensuring that they are delivered.

The Advancing our health: prevention in the 2020s consultation closes on 14 October 2019.  Please make the time to send in a local response – your voice needs to be heard now.

Dr Cheryll Adams

July 24, 2019