There is consensus on the need to shift from reaction to prevention but unless we share the same definition, we do not share the same ambition. Language is one of the biggest threats to progress, writes Mike Adamson
The NHS has rarely been out of the headlines of late. Accident and emergency departments are especially struggling to cope with demand while, at the same time, people are unsure which part of this straining system is right for them.
Just last week I passed a London bus with an advert seeking to remind us that “A&E is for serious emergencies only”, and listing the alternatives.
In the run up to the general election, the parties are setting out their plans for this uniquely British institution. One thing they all agree on is the need to shift the health and social care focus from repair to prevention.
- Prevention is a better investment than cure
- New care models explained: How the NHS can successfully integrate care
- The latest coverage and analysis of the general election
The truth of the matter is it pays to spend on prevention. It’s common sense that investing in preventing minor situations from escalating into crises is more cost effective than picking up the pieces.
‘We are yet to achieve consensus on what “prevention” actually means’
This principle applies across health and social care and it should span our lifetimes.
It should be enshrined in universal public health campaigns, right up to the management of chronic illnesses and long term conditions.
But while politicians and policy makers profess to support the theory, it seems we are yet to achieve consensus on what “prevention” actually means.
And while public health initiatives are getting airtime in the run up to the election, little focus has been given to preventing people’s needs for social care, reducing the impact of those needs and delaying – ideally, preventing entirely – the loss of independence.
The Red Cross advocated strongly for prevention to not only be included in the Care Act, but also to be defined. And we were successful, with three equally important forms of prevention being written into the statutory guidance.
‘The left hand doesn’t know what the right is doing’
But the definition of “triple prevention” that has been enshrined in the act is yet to be adopted by the NHS or make an appearance in the NHS Five Year Forward View.
The omission comes despite the two documents having been launched on the same day last year. It simply implies that the left hand doesn’t know what the right is doing.
So while there appears to be consensus on the vision, unless we use a common language and can be confident we are all talking about the same things, we’re not going to be able to effectively work together to make that prevention vision a reality.
The Care Act definition of ‘triple prevention’
PREVENT: primary prevention/promoting wellbeing
Primary prevention is aimed at people who have no particular health or care and support needs. The intention is to help a person avoid developing needs for care and support, or help a carer avoid developing support needs.
It includes universal policies like health promotion, first aid learning and universal services like community activities that prevent social isolation.
REDUCE: secondary prevention/early intervention
Secondary prevention is more targeted. Interventions are aimed at people who have an increased risk of developing health or care and support needs, or at carers with an increased risk of developing support needs.
The goal is to help slow down or reduce any further deterioration, to prevent further needs from developing, and to prevent a crisis occurring.
Secondary prevention includes short term provision of wheelchairs, handyman services, “social prescribing” services and telecare.
DELAY: tertiary prevention
Tertiary prevention is aimed at minimising the effect of disability or deterioration for people with established or complex health conditions.
The goal is to support people to regain confidence and skills, and to manage or reduce need where possible. For people who have already reached the point of crisis, the goal is also to prevent this reoccurring.
Tertiary prevention includes reablement, rehabilitation and bed based intermediate care.
New Models of Care – vanguard sites
It is proposed that the 29 “vanguard sites” for the forward view’s new models of care - something of a mouthful in itself - will set the benchmark for delivering the forward view’s vision of integrated and improved working.
The vision’s initial preventative focus will be on the introduction of a nation-wide diabetes prevention programme.
‘The vanguard sites are a concrete opportunity to make prevention real’
A clear focus can certainly drive change, but isn’t there a danger that we lose sight of the continuum of prevention that the triple prevention definition gives us?
Prevention is a continuum: across the life course; across the pathology of a long term condition; and across physical health, mental health and emotional wellbeing.
The vanguards offer a tangible opportunity to change health and social care; not just to change systems, redesign processes and shift money around, but to actually change people’s experiences and lives at the end of it.
They are a concrete opportunity to make prevention real, but it’s one we’re at risk of squandering if we can’t all describe the same opportunity with the same words meaning the same thing.
Speaking the same language
We’re witnessing the largest, most comprehensive transformation of adult social care since 1948; the forward view presents a compelling vision of reform; and yet – almost 70 years on from the inception of the NHS – one of the biggest threats to progress seems to be language.
‘One of the biggest threats to progress seems to be language’
There is consensus, even politically, on the need to shift from reaction to prevention. But unless we share the same definition, we do not share the same ambition.
With the vanguard sites selected, now is the time for the NHS to adopt the “triple prevention” definition of the Care Act.
Together, using the same language, we can make prevention real.
Mike Adamson is chief executive of the British Red Cross
Age UK, British Red Cross and the Royal Voluntary Service have teamed up to put on a free series of debates at Tavis House, tackling the big issues for older people across health and care in the lead up to the general election in 2015.
- How do we make prevention real?, the fourth debate in the series, is being held today. Follow its progress using hashtag #TSQDebates