Coming out of this lockdown, prevention most be our priority 

‘Prevention is better than the cure’ is possibly one of the most overused cliches in public policy. But it also happens to be true. The population is ageing, and demand for health and social care is rising to unsustainable levels. If we want fewer people to spend more of their adult lives in institutional forms of care – forms of care that can deliver poor outcomes at great expense – then we need a better strategy for preventing this from happening.  

COVID-19, which has exacerbated many people’s bad physical and mental health and placed new demands on health services, only makes the situation more urgent. 

In both health and social care, the stars have aligned on the need for prevention. In the NHS, reforms are all about ‘out of hospital care’. In social care, the mantra of supporting people’s independence has been the driving goal for some time. But progress has been slow. 

In social care, it has been hard to make the switch from funding an old model of traditional residential and home care – based on paying providers by the hour or for bed days in return for certain tasks and outputs – to one that seeks to deliver outcomes that people want and that are more likely to keep them independent in their own homes or communities. 

We know from the evidence that reablement – an intervention aimed at rebuilding a person’s skills and confidence after a crisis – works, but we hugely underinvest in this. Likewise, we know that social isolation harms people’s health and can eventually lead to hospital admissions, but we rarely fund care on the basis of it reducing isolation.  

Different forms of strategic commissioning are required. In Lancashire this has meant changing the way home care is provided. Over a period of two years (2016-18), the council trialled and rolled-out new ways of working in the service, underpinned by a newly commissioned reablement service with an innovative, outcomes-based contract. The new contract incentivises providers to support people to achieve their maximum level of independence as soon as possible, so that they spend less time receiving formal services.

But we also need to encourage new kinds of organisations to enter the local ‘market’ – those rooted in their communities and dedicated to keeping people connected, happy and independent. At SCIE – along with our colleagues Think Local Act Personal and Shared Lives Plus – we have called for investment in community-led innovations, those with proven track records in prevention, but which are not adequately invested in through traditional forms of funding and commissioning. We’ve set out some ideas about how we could achieve this on our Social Care Innovation Network site.  

Finally, we need a different approach nationally. We need to avoid making blanket calls for more money to ‘fix social care’ (although we do need much more money!). Instead we need to ask that any more money is used for lasting radical change, based on a positive vision for social care; like this from the Local Government Association:

“Any additional funding that is made available to social care, whether in the short- or medium-term, should not simply be used for ‘more of the same’ and the pre-COVID-19 status quo. Rather, it should be used to help us move to a more person-centred and preventative model of social care that is rooted in supporting people’s wellbeing in line with the Care Act and building resilience in our local public services and communities.”  

So prevention, as the mantra goes, is far, far better than the cure. But making it happen requires bravery and a new approach.  

SCIE: Prevention and wellbeing resources  
https://www.scie.org.uk/prevention  

Ewan King is a panellist at our Healthy Ageing webinar: Preventing the preventable, on Thursday 25 February 2021. Find out more about the event