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Prevention and self-care – Activities to achieve integrated care

What is prevention and how does it work?

The positive impact of assistive products goes far beyond improving the health, well-being, participation and inclusion of individual users – families and societies also benefit. In addition to policy requirements, economic and social benefits make the case for health and welfare systems to invest in assistive products and related services.

WHO 2022

If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat.

Chief Medical Officers, quoted in Public Health England 2020

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.

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How does prevention support integrated care?

Support for self-management is part of the shift in relationship between health and care professionals and people represented by personalised care. This means a person not being seen as a patient with symptoms or different conditions that need treating, but rather as a whole person with skills, strengths, and attributes, as well as needs that need to be met.

NHS England and NHS Improvement 2020

Loneliness can often be associated with older people who live on their own, but it is not just about social isolation or older people; we recognise that being lonely can have an impact irrespective of age and circumstance. Frequent loneliness can also ramp up pressure on public services, increase referrals to adult social care and trigger multiple attendances at GP surgeries.

Local Government Association 2019

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.

Who are prevention interventions aimed at?

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.

What does prevention need to succeed?

Reablement is generally well-received by older people and their informal carers. However, poor engagement from older people did occur when they had a poor understanding of their role in reablement and when they had not been fully consulted regarding their reablement goals.

Health & Social Care in the Community 2022

Collaborative design involving technology entrepreneurs, health care professionals and patients from the start is an important component of an innovation process.

King’s Fund 2020

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.

What is the evidence for outcomes and impact?

While improvements of functional performance and safety as the primary focus of adaptations studies have been documented in greater depth following RCT studies, health gains and economic benefits were relatively weakly evidenced.

UK Collaborative Centre for Housing Evidence 2022

Older people who participate in year-long exercise programmes fall less and are less likely to be injured if they do fall. Exercise does not increase or decrease their risk of hospitalisation.

National Institute for Health Research 2019

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

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