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CiP Week of Action - David Foster on Making Every Contact Count

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DF PhotoIn the fourth of our series of blogs from the Week of Action on Helping People to Stay Independent, Maximising Well-being and Improving Health Outcomes, David Foster, Deputy Director of Nursing at the Department of Health, shares his experiences of seeing a health visitor and midwives make a difference with public health advice and his views on how we all need to make every contact count.

I confess I’ve changed my mind.  It's so obvious, it’s painful.  I spent a long part of my career as an acute nurse and midwife with the attitude that a hospital episode of care is not the time for public health messages – even with a captive audience of patients, their relatives and carers.  How wrong I was.  I’m now a convert and believe that every nurse and midwife can make every contact we have with the people in our care a real opportunity for improving health, preventing ill health and reducing health inequalities. We all need to make every contact count.  

Our influence with individuals is important but so is our reach into communities and bigger populations.  This is put in clear terms in the Public Health Outcomes Framework.  This framework will help bring about fundamental improvements in the public’s health and wellbeing, by focussing on five key priorities

Helping people to live longer by reducing preventable deaths from conditions such as heart disease, stroke, cancer and liver disease

- Increasing healthy life expectancy by tackling conditions which place a burden on many lives, such as anxiety, depression and back pain

- Protecting the population from infectious diseases and environmental hazards including emerging risks and the growing problem of antimicrobial resistance

- Supporting families to give children the best start in life, through working with health visitors, Family Nurse Partnerships and the Troubled Families programme

- Helping employers to facilitate and encourage their staff to make healthy choices.

For further information please visit

And I’ve seen this in action.  With a health visitor in Thetford, Norfolk, I was thrilled to see the sensitive way she gave smoking cessation advice to a grandfather-to-be whilst conducting a visit to his daughter who was expecting twins.  She wasn’t just armed with leaflets, but sensibly did have some printed information to leave behind.  She had a very warm, common sense approach about the realities of cutting down his smoking rather than stopping altogether by the due date. It was also fascinating to see how he and his daughter absorbed the science of toxins being carried on clothes and, despite being encouraged to smoke outside away from the babies, to realise that the fumes carried back into the house could be just as damaging. 

This health visitor did really make every contact count.  She took the opportunities of a routine visit and conversation to get across some incredibly important public health messages.  In fact she put me to shame.

On the same day my discussions with midwives led in a similar direction. Public health midwifery addresses issues such as domestic violence, teenage pregnancy, smoking, substance misuse, mental health and those in vulnerable groups, such as minority ethnic women and those seeking asylum.

All these issues concerned the midwives I met, admittedly not at a population level but as a reflection of their individual caseloads – women, their babies and families with complex needs who each needed care tailored to their individual circumstances.

This takes a great deal of professional agility, but the esteem in which midwives are held in society gives us a significant degree of influence to tackle such sensitive issues with authority and trust.

For much of my career I held the prejudice that people needing short episodes of acute care and treatment were not really subjects for public health messages.  What were they really going to do about their smoking, drinking, diet and exercise when they were so unwell they needed hospital care?  So many opportunities missed.  But it is clear to me now that as professionals we have a duty, a challenging duty I admit, to keep the good health messages flowing in all our interactions regardless of the situation.

We cannot make every contact count by telepathy. We need the confidence to speak and some training might be needed, so I was pleased, through the marvels of Twitter, to be pointed to this training resource:  (Thanks #HelloMyNameIs David@DGFoord)

Making every contact count means making that effort every time with everyone, we might never see the benefits first hand, but our impact can be profound.

David Foster, Deputy Director of Nursing, Department of Health

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