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Health promotion in every day practice

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The government agenda of making community services centre stage in the health and social care system of the future, is the cornerstone of “ Our health. our care our say”, and hospitals will be for only those who really need them. ( DH 2006) It is a laudable vision but the execution, as we all know, requires fundamental changes in the attitude, expectation and delivery of care, both on the part of clinicians and the public. The empowerment of older people in terms of making them partners with clinicians and commissioners brings with it responsibilities whereby the patient needs to embrace alternatives and learn to manage conditions previously controlled by health professionals. Professionals too, must learn to think differently and more broadly about their roles and responsibilities in supporting older people, and be able to give guidance about issues they may have previously felt were outside their areas of concern. Everyone must be aware of how to support people in the community in more than just the traditional ways.

An example of transcending the traditional boundaries:

A Community Matron received a referral for a 76 year old man, who had been discharged from hospital for the fifth time that year. He had also received numerous GP visits. He had a number of conditions including COPD and a heart condition. He had poor mobility, a poor appetite and had suffered a number of falls. As part of her assessment she became aware of the impact that his cold, damp house was having on his health. She not only undertook a physical assessment and reviewed his medication, but spoke to him about the heating in his house and the mould on the walls. He had no central heating, the temperature in the lounge was 16o C and the only heating he used was a convector heater. He did not believe he could afford any central heating, and did not believe he was entitled to any grants. With his permission she telephoned the Energy Efficiency Advice line, the Pension Service and the Home Fire Safety Service, and referred him for assessment. In just 10 minutes all three referrals were made, and within a few weeks, the man had received a substantial increase in benefits, loft insulation, a grant for central heating and a free smoke detector! Furthermore, together with her more traditional skills and interventions, the gentleman was not admitted to hospital all winter.

As part of the Government’s modernisation agenda, inequalities in health care remains the hardest nut to crack. The Department of the Deputy Prime minister launched “A Sure Start for older people” in January 2006 (Office of the Deputy Prime Minister 2006). This document graphically illustrates how little has changed in fighting inequality and highlights the impact of poverty, social exclusion and inequity in healthcare. The Social Exclusion Unit is working to encourage all government departments to work in partnership in developing “joined up” strategies to tackle poverty, discrimination and ill health through engagement with older people as well as voluntary and independent sector providers. Strategies have to take account of housing and pensions service as well as health and social care. A pilot programme called Link-Age Plus will test the sure start programme for older people and the model will also be piloted through the Partnerships for Older People Projects ( POPPS) and Local Area Agreements.

Pump priming is again the way that the initiatives are being promoted. However, it is not always money alone that can move an initiative forward. Prevention, public health and health promotion must not be seen any longer, as the domain of Public Health Workers. If older people are to be helped to manage their health more effectively, all health professionals must widen their horizons and ensure that all opportunities are taken to reduce health inequalities. We must all learn to look beyond the traditional health assessment, diagnosis and treatment, and embrace the wider definition of health as part of the role.

In Crawley West Sussex, the PCT has worked with Borough Council for the past two years running a “Healthy Heating” campaign. The campaign is simple, healthy heating champions from many organisations receive two hours training in the effect of fuel poverty on health, and fuel efficiency and are given a training resource pack to brief their colleagues. They then cascade the information including key telephone numbers and free leaflets to staff who work with frail and vulnerable people. Organisations who participate have ranged from Community Matrons to Age Concern house cleaning teams. This year, following the development of a multi agency partnership group in Crawley called the 60+ Network, the Pension Service and Fire and Rescue Service have joined the campaign to inform participants how they can assist in reducing ill health caused by Fuel Poverty.

Encouraging some health professionals to open their minds to thinking beyond the traditional medical intervention has been a challenge, whether they work in hospital or in the community, doctors or nurses; but there is evidence that when a health worker has attended the course, the change in their view and approach to the care of a person is dramatic.

Whether a person is being seen in a clinic, is being assessed for discharge from hospital or in their own home, it is the responsibility of all clinicians to think about the management of the person beyond the traditional boundaries, and to ensure that we address and signpost all the issues that impact on health. Most of all, we need to open our minds to working in partnership with all agencies, especially those who we previously may not have considered to be part of the health agenda.

References
Department of Health (2006) Our health, our care, our say: making it happen www.dh.gov.uk
Office of the Deputy Prime Minister (2006) A sure start to later life ending inequalities for Older People. London www.dh.gov.uk

by Lynne Phair
Consultants Nurse for Older people, West Sussex PCT

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