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Prevention in action: How prevention and integration are being understood and prioritised locally in England

The British Red Cross has been working in the space between home and hospital since before the NHS was established. Our UK health and social care services today include: lower-level support enabling people to continue living independently at home; A&E discharge support; helping people home from hospital; transport to and from hospital; short term mobility aids, like a wheelchair; first aid education; new services to tackle loneliness and social isolation; and more.

All of these services help prevent a situation escalate and enable people to regain their confidence and independence. It is this unique position, working within both the community and in hospitals that enables us to understand where people are falling through the gaps. Through this work we see firsthand what works and what does not, and use this insight and evidence to shape our advocacy and policy development.

We see too many people having to reach the point of health and social care crisis before they receive support. As such, we have long been calling for a shift towards prevention. Seemingly small interventions, such as the provision of a short-term wheelchair, a simple home adaptation or even help with the shopping, can be the difference between living independently at home, and being admitted to a care home or hospital.

We are delighted, therefore, that the ambition to shift towards a truly preventative system has been enshrined in both social care and in health: in law via the Care Act (2014) and emphasised in the NHS Five Year Forward View and its Next Steps document, respectively. Since April 2015, the Care Act has placed a duty on local authorities to ensure a range of services that prevent, reduce and delay the need for care and support are available in their area. Local authorities also have to consider whether people could benefit from preventative services, before they determine if they are eligible for statutory support. In practice, this means people with lower level needs should be able to access services that would help prevent them falling into crisis. A system that ensures people with lower-level needs can access services that prevent, reduce and delay the need for further care is good for the individual and the public purse.

Yet our system still largely focuses on reacting to, rather than preventing, crises. Research carried out by the Red Cross in 2015, a year after the Care Act’s prevention duty came into force, found that Parliament’s vision for prevention was not being fully realised. While the majority of local authorities reported making changes to the structures and processes that framed their provision of preventative services, such as the creation of new boards, roles, strategies and guidance, this had rarely translated into enhanced provision. We also found that some  local authorities were conflating their duty to provide information and advice with their duty to prevent needs for care and support. There also seemed to be no consistent understanding of exactly what prevention’ is and how to put it into action. This is
despite the Care Act’s statutory guidance defining the term, using the triple definition of prevention.

To us, a truly preventative system would prioritise prevention at every stage of a condition (before, during and after). So, over two years since both the NHS Five Year Forward View and the Care Act came into force, we wanted to see whether the prioritisation and understanding of prevention has improved at a local level.

Since our last report, there have also been some significant changes to the way health and social care services are planned. Every locality in England now has a sustainability and transformation partnership (STP) and plan, which are critical to transforming health and social care at a local level. For this year’s report, we have taken the new opportunity to assess prevention in STPs as well as repeating a review of joint health and wellbeing strategies and local authority Freedom of Information (FOI) responses.

We have also looked beyond prevention to health and social care integration, which we believe to be critical to ensuring the funding and provision of preventative interventions in local health and social care systems. Single budgets, for example, mean savings would return to the same pot and benefit both the NHS and local authorities from costefficiencies. Integration also has the potential to eradicate the often false distinction between people’s ‘health’ and ‘social care’ needs. This distinction all too often results in people falling through the gaps. As with prevention, we wanted to gain a better understanding of how integration is being prioritised and actioned locally.