Over the past decade, demographic shifts coupled with burgeoning economic pressures
have presented severe challenges to providers of health and social care services in the UK.
We've developed a very crisis focused system in both health care and in adult social care
where if you have a really severe needs or crisis then you get quite a good response.
But over time we've reached a situation where if people have got quite low level needs
they actually get denied help often altogether until they have a major crisis in their health.
Increasingly, local authorities have been looking to invest in 'prevention services'
so as to reduce, delay and prevent the development of crises, rather than simply
reacting to them once they occur.
Prevention is a spectrum.
So at one end of that spectrum we might be trying in health terms to prevent future cancer
by stopping people from smoking in the first place or helping them to give up smoking
if they've already started.
We might be trying to prevent future health problems by encouraging children to be
healthy in an era of childhood obesity.
At the other end of the spectrum we might be working with people who've got
quite significant health and social care needs who are already using quite large amounts
of service, perhaps domiciliary care and we
might be trying to provide a more rehabilitative, more of a reablement approach.
People don't want to become ill.
People don't want to lose their independence.
And of course for an organisation like adult social care we don't want to be paying out for
costly services when an early intervention or prevention would have
stopped that happening.
So it is to a large extent partly because it's cost effective but it's also what people want.
People want to engage in their communities and many of the services that prevent people
becoming unwell are actually the sort of services that people find added value in.
They are the things that connect them into their communities.
The benefits of prevention and early intervention are increasingly recognised.
However, health and social care commissioners face challenges in moving
towards a more preventative approach.
One of the biggest problems we've got is that everyone recognises the need to develop more
of a preventative agenda but nobody really knows how to do it and how to do it at pace
and at scale.
And part of the difficulty is a lack of a significant and substantial evidence base.
Against this background, SCIE, the Social Care Institute for Excellence,
has been commissioned to develop a 'Prevention Library': an online resource
which will be a knowledge hub for information and resources about emerging practice and
related research.
We're really pleased to have been asked by the Department of Health, to develop in
conjunction with them and the local Government Association and
the Association of Directors of Adult Social Services an online hub
which brings together the best of prevention practice.
If we get prevention right people can participate in communities for longer, live active lives,
contribute to things happening in their communities using their abilities, their knowledge,
their skills to add to community life.
Hosted on the SCIE website, the Prevention Library is intended to support
and help inform commissioners making decisions around prevention provision.
The library shares knowledge of what works, collating examples of existing prevention
services from the public and voluntary sectors, both pilot and established, and, includes
recent research publications, providing a growing and easily accessible evidence base.
Plans for future development include offering a platform where commissioners can interact,
sharing knowledge and information around the issues, challenges and successes related to
service provision in their local areas.
Through the Care Act of 2014, the provision of prevention services has become a statutory
duty for local authority commissioners.
A prime focus of the Care Act is on wellbeing, enabling people to live in safety and comfort
in their own homes which is where most people want to be.
So what commissioners of services want is to know what's happening around the country
that enables these objectives to be achieved.
The SCIE Prevention Library is really important and it's going to be the first time
that we've ever had a really good range of different examples.
And some of those have had some really good research behind them and others
which are just emerging models we can just look at examining in further detail.
One of the advantages of resources like the SCIE Prevention Library is that it gives to
access to a range of different options so you can go on there, contact people
find other ways of doing things.
And what's interesting is that some of those interventions are relatively small and cheap.
So you think, oh, that's what we could do with that bit of money or you can encourage your
local group to try and develop services in that area.
An example from the SCIE Prevention Library demonstrates how approaches to prevention
can be highly innovative.
Some years ago we had a vision of how our services could be designed in conjunction with
people who use our services and carers.
Halton Day Services is run by the Council for people with learning disabilities,
providing daytime activities to help meet people's needs.
When two of their community centres closed, Halton Day Services approached
Norton Priory Museum and Gardens with the idea of running the kitchen there.
The pilot's success has lead to an expansion of the project at the priory, to include a fully
functioning brewery and bottling facility, as well as a tea room and an ice cream parlour.
Since we have introduced this model of service we have found that behaviour that maybe
challenges our service is greatly diminished.
People are engaged and focused on every level.
Dairy ice cream.
In Leeds, the city council has developed a full programme of prevention services
over a number of years.
We want to do two things, one of which is that we really want to make sure that prevention,
keeping people well is embeded in all services.
Really generic important services like homecare may be focused on care and support but again
you would expect that someone delivering homecare would be able to spot that somebody
was living in a cold house, wasn't getting about as much as they used to and maybe wasn't
eating as well and could signpost them accordingly.
It's also vital to have very specific services targeted at the various populations that we
support to help people to keep well, keep healthy, keep active.
An example of a project supported by the council is The Crossgates & District
Good Neighbours' Scheme.
We try to offer as wide a variety of opportunities for older people in the area
to socialise as we can.
We've got a range of arts and crafts opportunities, creative opportunities generally.
We have a walking group, a cross country walking group that goes out every Monday
afternoon three of four miles across fields.
And we have social, purely social opportunities like the drop in coffee morning where we also
push our advice and information service really, we bring in other agencies so people, to
support people's independence.
So that's what we're trying to do really.
We're trying to support people's independence, reduce isolation and promote wellbeing.
It's something different and there's some people they never talk to anybody,
for you know, days on end.
Well they can chat away here.
Oh I like to go on the trips, yes, and it's somewhere to go and it's something different.
Where, if I didn't go on the trips I'd be sat at home.
Much of Crossgates' success relies on volunteers from within the local community,
who assist with running the centre itself, as well as transport.
People that volunteer are really, really good you know they give their time.
Some are older than us.
The role of the voluntary sector in prevention is a significant one.
One national example from the library is the British Red Cross,
which supports about 450,000 people a year through its independent living services.
The voluntary sector has a huge role to play in providing preventative services.
Volunteer based services can be especially reabling and preventative and we all know for
example that social isolation can have a really big impact upon physical and mental health
and wellbeing and our volunteer based services can really support people to regain the skills
and confidence they need to reconnect in their community.
The provision of prevention services, the design of programmes and making
the financial case for them, can be daunting to commissioners
new to this area of service provision.
While SCIE will continue to develop the Prevention Library,
its success ultimately depends on commissioners both using
and submitting material.
The whole area of early intervention and prevention is very, very broad.
There is a lot of stuff going on and I think using the library is a really good sense of,
oh that's working somewhere else, that would work really well in Leeds,
that would work really well in Brighton or wherever you're coming from and that
ability to share and learn is really important.
So this is an unashamed plug.
If you've got practice that you'd like to share with us please do so.
Give us feedback on how helpful this resource is now and certainly give us
your examples of what works in prevention practice.