Work is needed for older people’s services to keep becoming more personalised and preventative, say Kerry Allen and Jon Glasby

Demographic, social and technological changes have put health and social care services under increasing pressure. In England there is consensus that prevention focused reform is vital but there remains little clarity about how to achieve this.  

‘There is much scope for patient education about risks and benefits’

A policy paper from Birmingham University’s Health Services Management Centre has outlined 10 high-impact change areas for prevention in older people’s services. Drawn from a somewhat fragmented evidence base across health and social care (see box), these areas form a starting point for discussion.

Quality and inclusion

Healthy lifestyles activities have tended to focus on physical exercise, nutrition and social engagement. Programmes and events such as the government-supported “Full of Life” activities demonstrate the importance of local partnerships to ensure quality and inclusion. Local equal access policies to health services are fundamental.

Influenza and pneumococcal vaccines are seen as the most relevant and effective for prevention of illness among older people, a consideration for the ongoing review of cut-off points and optimal age for these interventions.

There is much scope for greater patient education about eligibility, risks and benefits.

Physical training, withdrawal of psychotropic medication, eyesight care, housing adaptations and use of hip protectors are all effective in falls prevention. Barriers to individual participation include denial of falling risk, the belief that no prevention measures are necessary, practical barriers to attending groups and a dislike of group activities. Strategies include direct invitations to activities and home based options.

Housing adaptations, repair services and telecare all have the potential to enable people to self-manage long-term conditions and remain in their own homes.

An important consideration for local commissioners and service designers is the context within which telecare products are made available, so that they are accessible alongside the right support services and do not substitute human contact, but complement it.

Emergent re-ablement services have perhaps been the most successful of the intermediate interventions, with most local authorities setting up and extending re-ablement schemes. While local evidence of these interventions seems extremely positive, both improving quality and reducing demand on acute and home care services, long-term evaluations raise several points of interest.

More services are developed and referrals taken in respect of hospital discharge, rather than preventing admissions. The independence-enhancing impact on individuals may be lost once they resume traditional home care services without the re-ablement focus.

Partnership working and personalisation show potential to underpin a preventative approach. Positive outcomes have been evident in some areas governed under partnership agreements and care trusts, as resources have been pooled and multidisciplinary services targeted towards specific groups. More work may be required to overcome a culture of lower expectations for older people’s services than in support for younger disabled people.

Kerry Allen is a research fellow at the Health Services Management Centre and Jon Glasby is professor of health and social care and director of the Health Services Management Centre, Birmingham University.


The approach

The report’s approach builds on the work of the NHS Institute, which has published guides on high-impact changes in a range of areas, including service improvement and delivery. Knowledge of what works in prevention appears more fragmented and underdeveloped in such a broad and complex area than it might be for a more focused and longer standing area of policy and practice.

10 High-Impact actions

  • Promoting healthy lifestyles
  • Vaccination
  • Screening
  • Falls prevention
  • Housing adaptations and practical support
  • Telecare and technology
  • Intermediate care
  • Reablement
  • Partnership working
  • Personalisation