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Preventative approaches seek to promote people’s independence, delay, or avoid people’s wellbeing deteriorating due to illness, disability and / or ageing, and reduce the likelihood of people from experiencing crises in their health and / or social situation. Along with improving people’s wellbeing, preventative support has the potential to reduce demands on health and care services including hospital admissions and long-term residential care. Prevention can apply to people’s mental health as well as their physical health. Self-care refers to individuals, families and communities having the skills and capacity to promote their own wellbeing and to manage aspects of a long-term illness or disability.
Prevention services can potentially incorporate a wide range of both targeted and generic activities. These include: facilitating access to information, skills, and self-care resources; creating safe and enabling living environments through adapted housing and physical aids; using digital technologies to support self-management of conditions and maintain independence; and developing a physical and social environment through which people can access community-based resources and support and engage in wider society.
Prevention helps individuals and families to maintain as much control as possible over their lives through avoiding or delaying deterioration in their abilities and recovering from a crisis in their health or social situation. It encourages health and social care professionals to support people to take as much responsibility as possible for their own and family’s wellbeing and to feel confident in making decisions over their lives and care. Embedding prevention within a health and social care system facilitates collaboration with broader public services and the voluntary and community sector including those relating to transport, housing, money and finance, and the physical environment.
Preventive interventions and the promotion of self-care are suitable for anyone receiving integrated care, based on personal needs, skills and preferences. Anyone who is at risk of deteriorating health or greater dependency on health and care services would benefit from having access to services that augment or complement more traditional health and social care.
In the past, prevention orientated services have often struggled to compete for investment with direct health and care services. Integrated care systems must build upon their understanding of the needs of local populations and co-production with people with lived experience and communities to identify and invest sufficiently in the most promising local opportunities for prevention and self-care. Commissioners should take an outcomes-based approach which provides an opportunity for providers to work flexibly within an overall model of support and, in which, monitoring is not based solely on activity levels. Collaboration with wider partners, including private business and the voluntary sector, helps to lever new opportunities and technologies. Alongside commissioning of specific services, the practice of wider health and social care professionals must also seek to promote independence, choice, and wellbeing in their interactions with individuals and families.
Prevention is a difficult aspect of health and social care practice to research as it is challenging to accurately predict what would have happened if a support had not been provided and to quantify the contribution of an intervention alongside other factors which could have improved or deteriorated someone’s wellbeing. There is though growing evidence that a range of preventative measures, if well designed and implemented, can result in people reporting better health and wellbeing, being less prone to risks such as falls, being able to manage their long-term conditions, and to remain connected with informal networks and community resources. The impact of preventative approaches on a population’s overall use of health and care services, including admissions to hospital, has not yet been formally established through research.
Findings from the economic evaluation presented in this case summary showed positive changes in social care-related quality of life measured with the Adult Social Care Outcomes Toolkit. This included improvements in home cleanliness, dignity, occupation, and usual activities. However, changes were small and not statistically significant.
London School of Economics and Political Science 2019
