Prevention services in adult social care

Jenny Collieson, Senior Information Specialist, Social Care Institute for Excellence introduces their new Prevention Library and its policy context

Over the past decade, demographic shifts coupled with growing economic pressures have presented severe challenges to providers of health and social care services in the UK. There are nearly 1.5million people over 85 living in Britain with this figure projected to increase to 5 million by 2050 1.  People are living longer which is a cause for celebration but the needs and aspirations of the population continues to grow whilst resources are shrinking.

The 2014 budget summary 3 from the Association of Directors of Adult Social Services (ADASS) highlights that since 2010 spending on social care has fallen by12% at a time when the population of those looking for support has increased by 14%. This has requiring savings of 26% (£3.5bn) over the four year period. The overall local authority investment in prevention is currently very low with only 6.8% of the net adult social care budget being invested in 2014-15 according to ADASS.

A crisis-focused system has developed in both health care and adult social care which is both costly and places enormous pressure on services particularly in relation to admissions to hospital and the provision of residential, domiciliary and related care and support services. Increasingly, local authorities have been looking to invest in “prevention services” and the argument for prevention in adult social care is clear – investing early should reduce and delay the need for crisis intervention later. Prevention is not just about reducing the need for intensive services however; if delivered effectively a local prevention strategy should also improve the health, wellbeing and quality of life of individuals and local communities – key themes underpinning the Care Act 2014

The Act introduces major reforms to the legal framework and funding systems for care, new duties and responsibilities for local authorities and new rights for local people.  From April 2015 a local authority must provide (or arrange for) the provision of services for adults which prevent or delay the need for care and support, working together with partners in health, welfare, housing and employment services. These services must also be provided for carers as well as direct service users. Personalisation and co-production should be at the heart of the prevention agenda. A paper from the charity National Voices 7 advocates proven, evidence based approaches which involve people in their health and care to improve care quality and lead to better outcomes. It sets out how services should operate and the common characteristics they should display, including greater emphasis on promoting health and preventing illness.

Prevention takes place in health care, in social care and in communities and a preventative approach requires a broad range of interventions tailored to local  demographics and the needs of specific groups including older people, people with long term conditions, and adults with learning disabilities or mental health problems. A recent report from NHS England and Public Health England 9 emphasises the importance of local authorities and the NHS in building confident connected communities to improve health and reduce inequalities.

The term “prevention” covers a broad spectrum of activity from primary prevention for example, preventing falls in older people or targeting smoking or obesity, to secondary and tertiary interventions such as re-ablement following hospital discharge, the use of assistive technology, (telecare and telehealth), community navigators, mental health or dementia cafes. The provision of services which aim to reduce social isolation and loneliness particularly among older age groups are currently receiving a lot of attention in the media. Silverline and Contact the Elderly are examples of two national charities which offer befriending services, one through a telephone helpline and the other through Contact tea parties held by volunteers.

Partnership work and continuing integration of health and social care services are crucial in delivering a successful prevention outcomes 5.  Much of that work at local level is being done by Health and Wellbeing Boards, the forums where leaders from health and social care collaborate and plan to deliver more targeted services, often using pooled budgets resourced by the Better Care Fund. Making the financial case for prevention services can be daunting to commissioners new to this area of work. Public Health England and NHS England produced a 5 step framework intended to help clinical commissioning groups working with public health directors (based in local authorities since 2013) think about how to commission effective prevention services, starting with identifying and analysing the top health problems in their localities 8

More research is needed to deliver evidence of what works – particularly economic evidence - and the fragmented and contested nature of the current evidence base is highlighted by Kerry Allen and Jon Glasby in their report which reviews the national and international evidence around ten different policy measures and interventions 2. Two areas of prevention work where the economic arguments have been explored in more detail are mental health and re-ablement services. The economic and social costs of mental health problems in England are estimated at around £105 billion each year and mental ill health is the largest single cause of disability in the UK. The Department of Health commissioned a project which analysed  the costs and economic pay-offs of fifteen interventions in mental health promotion/prevention, requesting that the findings be presented to support the commissioning process 6. The role of the voluntary sector is a valuable one in respect of re-ablement - The British Red Cross supports 450,000 people a year through its independent living “At Home” service which uses volunteers to support people and reconnect them with their communities. A discussion paper found that the total savings identified amounted to more than five times the cost of the service itself 4.

It is in this policy context that the Social Care Institute for Excellence was commissioned by the Department of Health to develop a new Prevention Library for commissioners in local authorities in England. The Library, which was launched in January this year, will become a knowledge hub for emerging practice and related research about the provision of prevention services. It features a growing number of service examples, both pilot and more established, developed with local authority commissioners and highlights recent research findings.  It will also offer an embedded networking platform for shared discussion around the challenges and successes of prevention provision with the aim of sharing good practice, delivering greater efficiency and better outcomes for people

Notes

1) Age UK. Improving later life: understanding the oldest old. 2013. Accessed:  3rd March 2015

2) Allen, Kerry and Glasby, Jon. 'The billion dollar question': embedding prevention in older people's services - 10 'high impact' changes. Health Services Management Centre, University of Birmingham, 2010. Accessed:  3rd March 2015

3) Association of Directors of Adult Social Services. ADASS budget survey report 2014. Accessed:  3rd March 2015

4) Dixon, Josie et al. An analysis of the economic impacts of the British Red Cross Support at Home Service. Personal Social Services Research Unit, LSE, 2014. Accessed:  3rd March 2015. Accessed:  3rd March 2015

5) Glasby, Jon & Dickinson, Helen. Partnership working in health and social care: what is integration and how can we deliver it? Policy Press, 2008

6) Knapp, Martin, McDaid, David & Parsonage, Michael. Mental health promotion and mental illness prevention: the economic case. Dept. of Health, 2011. Accessed:  3rd March 2015

7) National Voices. Person centred care 2020: calls and contributions from health and social care charities, 2015. Accessed:  3rd March 2015

8) Public Health England and NHS England. A call to action: commissioning for prevention. 2013. Accessed: 3rd March 2015

9) Public Health England and NHS England. A guide to community-centred approaches for health and well-being, 2015. Accessed: 3rd March 2015