4. Supporting greater prevention and early intervention

Across health, social care and public health, we want to focus on prevention and early intervention to help people maintain their independence and improve their health and well-being. Read more about prevention and early intervention…

What do you think?

a. What do good outcomes look like? Where is there practice-based evidence of interventions that support/enable these outcomes?
b. How could organisations across the NHS and local government, communities, social enterprises and other providers be encouraged and incentivised to work together and invest in prevention and early intervention including promoting health and wellbeing?
c. How could we change cultures and behaviour so that investment in prevention and early intervention is mainstream practice rather than relying on intervention at the point of crisis? How could we create mechanisms that pay by results/outcomes?
d. How could individuals, families and communities be encouraged to take more responsibility for their health and wellbeing and to take action earlier in their lives to prevent or delay illness and loss of independence? How could we promote better health and wellbeing in society?
e. How could innovation in prevention be encouraged, identified and nurtured?

Please add your comments in the box below. Comments published on this website are subject to moderation

In Priorities: areas for discussion | Tagged , , , , , ,

12 Responses to 4. Supporting greater prevention and early intervention

  1. Dennis A Atkin says:

    Elder abuse in the community as identified by a commissioned report by Action Against Elder Abuse (undertaken by Kings College, London in 2006) and in particular in terms of domestic abuse inititiated by recognised carers in the community, is a core issue yet to be addressed. A number of voluntary sector agencies at national, regional and local level are regarded to have the competency to address this issue and should be encouraged to do so through Government initiatives.

  2. Kevin Harrison says:

    a. What do good outcomes look like? Where is there practice-based evidence of interventions that support/enable these outcomes?

    Investing in prevention doesn’t come easy in a world where every investment needs to be evidenced that it will bring a return. The nature of prevention is that you’re stopping something from happening, and therefore your evidence base is constantly trying to demonstrate something didn’t happen – trying to prove a negative. This can be done in broad terms using scenario analysis, but for payments by results to work then evidence is needed at client level.

    Care are support outcomes can be measured at client level. Not in overly simple binary terms (i.e. was the outcome achieved – Y/N ?) and not using meaningless anecdotal case studies, but with measures of the distance travelled towards tangible outcomes that are identified by the client. This works best however where the care/support package is delivered on a structured basis against a support plan and, better still, within a common outcomes set that is understood across local commissioners and strategic planners, and benchmarked across types of service provision.

    As a starting point, look at the [short-term] outcomes framework developed under Supporting People. Better still, look at the innovative work some local authorities have been doing to replace it with local outcomes frameworks following CLG’s decision to cease using CHR (St Andrews). Building on this good practice, it wouldn’t take much to develop a common web-based outcomes system that captures the distance travelled towards clients’ agreed outcomes, but still allows end users and local partners to determine what those outcomes should be. Payment by results would then be linked to the distance travelled towards individually agreed outcomes.

    c. How could we change cultures and behaviour so that investment in prevention and early intervention is mainstream practice rather than relying on intervention at the point of crisis?

    Agencies need to think beyond their statutory duties. Many such agencies still see prevention in terms of how to stop those on the cusp of a statutory duty from crossing it, or how to stop those already within the statutory duty from needing more acute services. Real prevention happens much further upstream, amongst a bigger audience of citizens who are largely not yet known to statutory agencies. We need to focus on the events in peoples lives that subsequently increase the propensity to need care and support in later life – unemployment, homelessness, domestic violence, family breakdown, substance misuse, mental health problems, etc.. Prevention needs to be understood in terms of minimizing these life events and the impact they have, particularly through promoting settled housing and helping stabilize peoples lives. That requires agencies to consider a more universal audience of citizens, to look beyond statutory duties and adopt a much broader view of who is potentially vulnerable.

  3. Tom Cooper says:

    With reference to prevention of health problems, short of advising people how to live (e.g. to stop smoking, drinking, overeating, speeding, having unprotected sex, ASBOs etc.), introducing health and safety laws such as COSHH and anti-pollution legislation covering unleaded petrol and recycling which the government has over the years tackled quite well, it is hard to know what else can realistically be done without overstepping the mark into unwarranted intrusion. Having observed the recent riots I cannot help thinking that some effort needs to be put into restoring a sense of personal responsibility, even morality, in people’s minds as the breakdown of self-restraint and respect evident amongst a sizeable proportion of young people in our society is alarming. However that falls outside the remit of health and social care.

    With reference to early intervention, there is little that agencies can do as they do not initiate contact but have to wait for people in need either to come forward themselves or to be referred to them for assistance by a third party. Of course if a GP were to alert the local social services team about a patient potentially in need of help, say somebody in the early stages of dementia who retained mental capacity, that would be a breach of confidentiality and unethical behaviour, no matter how practically sensible, unless the patient were to give permission.

    • Dennis Atkin says:

      Whilst acknowledging what your saying and agreeing to the principle around confidentiality, there are qualified exceptions to the rule supported in statute; where a persons life may be placed at risk or there is an identified child protection issue then a breach of confidentiality may be necessary to safeguard that person or another person from significant harm. Not to do so may make yourself subject to an enquiryand possible prosecution under recent legislation such as the Domestic Violence Crime and Victims Act 2004?

      • Tom Cooper says:

        You may be right in respect of particularly acute situations however the general principle still applies in the context of the question posed, namely how to promote prevention and early (as opposed to crisis) intervention to help people maintain independence and improve their health and well being. My point is that agencies will always tend to be reactive rather than proactive.

        • Jeremy Labram says:

          In some work we did with ‘customers’ who were in their fifties and willing to think about retirement planning (which I suppose is a nice thing), but revealed that they were very unwilling to consider what they would do with some sort of life crisis. Such a service would not be valued.

          Maybe a better approach, which came up in discussion today, is to talk about taking measures today to sustain your current lifestyle – ‘keep myself active’; ‘keep in good shape’; ‘read the paper every day’; eat well and look after myself’. This seems much more in tune with what many people actually do, and is much more optimistic.

  4. Howard Osborne says:

    No-one so far has mentioned the substantial indirect benefit to the wider client population of commissioners realising large sustainable economic cost savings as a result of effective preventative and early interventions. These (subject to budget insularity that can block attribution of savings made to the source of the intervention) can, apart from a contribution to a net decrease in expenditure in suppoort of budget cuts, still offer considerable options for re-investment in services for the wider good. These can be yet more prevention/early interventions or downstream ongoing care. Although in its early stages, Social Return on Investment can finally offer a technique to quantify benefit and inform wiser commisisoning of services, whether tradiitonal or micro-commisioning via personalisation.

  5. Hilary Vick says:

    Sroke wards must not virtually shut down between 24 Dec and 2 Jan. Stroke victiims can not afford to lose this amount of time for physiotherapy and all the interventions needed to get them back to maximum independence.

  6. Varsha Dodhia says:

    The whole system is about outcome measurement. There are few direct measures but we have a number of proxy.

    People with long-term conditions need empowerment to manage their condition and “live as well as possible” with the condition. The whole society benefits from this because the greater the need for intervention, the greater the cost and less good the outcomes.

    Admission to hospital is a good one where we can measure how many days spent for the condition. A person with advanced diabetes needs support both medical and lifestyle change so that the condition is controlled and does not escalate towards kidney failure.

    The medical model of treatment works so far but lifestyle change needs different measures. If the wellbeing is desired, a subsidised exercise classes and subsidised telephone/motivational support to stay on course. This is applicable across a range of conditions including mental health. Today we spend large amounts on medical model who have invested huge amounts to show evidence of how treatments work but we have very few research studies which show alternative support from the voluntary sector making a significant contribution.

    Can we nudge commissioners to look at case studies and expert patient feedback to understand what works and how the support network can be upscaled to be able to deliver better outcomes. A lot of Social Enterprises being setup actually now work towards creating better outcomes and how social return on investment can be measured.

    • Jeremy Labram says:

      Nudging commissioners as you say is a good thing, but they do need to be able to look at case studies which prove something. Maybe the designers of case studies need to make use of control groups and proper sampling.

      I have just been corresponding with an advisor to the select committee on this subject of early intervention. I think a fundamental problem is proving the efficacy of any such measures. I spent a long time puzzling over many case studies of reablement – none of which could compare doing something versus doing nothing.

      When I was studying biology I learned the value of running a control group, members of which do not get early intervention, in parallel with an equal group who do. Social Care research does not seem to do this. I’ve heard professionals say that it is not fair to those who don’t get it. But unless you test objectively you don’t know whether it is efficacious and so how can you know whether it is fair or unfair.

  7. Natasha Muirhead says:

    4) Prevention
    How can we stop people’s health from getting worse and help them to look after themselves for longer?
    This can be achieved by:
    • making sure that individuals such as myself get the most appropriate support when they first need it to minimise the risk of them having any health problems and or to stop any existing health problems from getting any worse.
    • Their needs need to be identified early
    • there needs to be good communication from all the local services at all levels as to what is available to them so that this information can then be provided to potential and existing service users.
    • All local services need to understand what autism is
    • They need to work with local autism specific organisations such as Autism West Midlands to produce information for their service users with autism in the most accessible way to them and to help the individual service users themselves weigh up their options and make informed decisions about who they can go to, for what sort of health problems and under what circumstances.
    In my opinion then and only then can individuals such as myself really make choices so that they can be more independent, take more control over their own lives and have more responsibility for themelves. This can also be achieved by providing individuals with Autism such as myself with the most appropriate help and support to meet their wants and needs. When I was receiving support from Autism West Midlands to live indepently in my own home it gave me a great deal of peace of mind and it helped to greatly reduce my levels of anxiety about how I would cope with life when my family, in particular my parents who I still feel that I am very dependent on, are no longer around.

  8. Guildford Soroptimists says:

    This is a very difficult area. Individuals can be reluctant to seek help at an early stage of any impairment, but this is the time to research options and be aware of the options.

    Many people are reluctant to admit problems. Perhaps we need a ‘Health Visitor’ system for those who need care?

Leave a Reply

Leave a comment