Prevention includes proactively monitoring possible ill health risks just as much as preventing admission in the hospital, writes Samantha Jones

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Nhs england col

Nhs england col

samantha jones

Samantha Jones

Samantha Jones

The Five Year Forward View is clear that “the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all depend on a radical upgrade in prevention and public health”.

Prevention of ill health is at the heart of the new care model vanguards with a range of approaches being tested. For some it is about the needs of a city-wide population whilst for others it is the population of a care home.  

In some cases, “prevention” means preventing an unnecessary admission to hospital, while in others it involves proactively monitoring the health of the whole population and identifying the groups most at risk of ill health.

In Sunderland, evidence shows that 3 per cent of patients account for 50 per cent of NHS costs, with the next 12 per cent accounting for 36 per cent of costs.

All Together Better Sunderland vanguard – a multispecialty community provider – is using this kind of information to shape their work on prevention. This includes the creation of a recovery at home service which focuses care on the people who need it most.  

The service, which is supported by a range of health and social care professionals, operates 24 hours a day, seven days a week, offering people quick access to short-term urgent care at home during times of illness or if someone experiences an unexpected change in their condition that could develop into a crisis.

The recovery at home service is proving very popular and the vanguard has seen a significant reduction in delayed transfers of care

They have also launched five “community integrated teams” who deliver support for the most vulnerable people across the city. The teams, which include district nurses, community matrons, GPs, practice nurses and social care professionals, provide a coordinated response for those with complex needs.

All Together Better Sunderland has seen early signs of a reduction in emergency admissions to hospital for people over 65. The recovery at home service is proving very popular and the vanguard has seen a significant reduction in delayed transfers of care.

Earlier this year, the NHS Confederation, NHS Providers, NHS Clinical Commissioners and the Local Government Association jointly hosted two conferences where clinicians and other staff from the vanguards shared their work on prevention with colleagues from the wider NHS and care services.  

The four organisations have summarised the findings of the events in a report. I would encourage people to read the document, which can be downloaded via the NHS Confederation website:

For more information about the work of the vanguards, visit

Samantha Jones is director, New Care Models Programme, part of the Five Year Forward View