Almost two years to the day since the Care Act came into force, its vision of a truly preventative care system still seems a long way off. So why is it so hard to realise this shared vision, asks British Red Cross chief executive Mike Adamson
On 1 April 2015 the Care Act became law in England. It promised to create a truly preventative social care system that would catch people before they fell into crisis, extend their independent lives and keep them out of acute medical and social care.
Today, two years later, it’s obvious to everyone that many social care users still reach crisis point before they get care and support. Age UK estimates 1.2 million older people have unmet needs. And cash-strapped local authorities confessed they spend less now on preventative services than they did before the Care Act was enacted, according to the Association of Directors of Adult Social Services (ADASS).
Enabling people to live as independently as possible
We in the British Red Cross have worked with people between home and hospital since the NHS was founded. Supporting people through what is often a transition in their lives, we are well placed to see when change tips into crisis for lack of sometimes quite simple practical or emotional support.
Every day we see the positive impact of small interventions, such as checking the fridge for food, or collecting somebody’s prescriptions. Apparently small acts, but without them people run the risk of going hungry or without their medication.
We also see the transformative effects of small home adaptations or assistive technology, such as bracelet trackers for people with dementia or home sensors. These sorts of interventions keep people at home when they would otherwise be in hospital or care homes. They allow people not just to live, but to live well.
Shaping the Care Act’s prevention duty
The relative simplicity of these interventions is reassuring. So it is frustrating to me that people still all too often reach crisis point before receiving such support. Without it, they are at risk of losing their independence, and, too often, needing greater levels of care.
“Preventative care” is much more than public health campaigns, although it has sometimes been misunderstood as such. And it’s important we have a shared language on this. So we helped shape the Care Bill which recognised this; defining “prevention” as something that continues through a person’s illness or condition.
Three equally important forms of prevention are written into the statutory guidance:
- Primary prevention/ prevent: is aimed at people who have no particular health or care and support needs and is intended to prevent a condition or illness in the first place. For example, health promotion, universal vaccination and community activities to counter isolation.
- Secondary prevention/ reduce: is aimed at people who have an increased risk of developing health or care and support needs and is intended to slow down or reduce any further deterioration. For example, short term wheelchair loans, connecting and supporting people where life events might leave them lonely, handyperson services.
- Tertiary prevention/ delay: is aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, to help them regain confidence and skills, and prevent the recurrence of crisis if it has already occurred. For example, reablement, support at home after hospital discharge, and assistive technology.
The Care Act also obliged local authorities to assess whether people would benefit from preventative services before determining their eligibility, extending access to these service beyond those with “severe” and “critical” needs.
The Care Act’s prevention duty is yet to be fully implemented
With more than 15 million people already living with a long term condition in England, it’s imperative that we start to invest in preventative interventions aimed at minimising the effect of disability or deterioration.
‘By last year, 37 per cent of joint health and wellbeing strategies still did not incorporate a full understanding of prevention’
We seem unable to act on the mounting evidence that investment in prevention supports both well-being and efficiency, the two gaps which the NHS Five Year Forward View seeks to close.
Our own research shows that, by last year, 37 per cent of joint health and wellbeing strategies still did not incorporate a full understanding of prevention. All too often, the gap was tertiary prevention.
As we know, local authorities are struggling to divert funds from statutory, more acute social care services to innovative preventative care and support. Yet the ADASS Budget Survey 2016 respondents cite increased prevention and early intervention as the top area to generate savings.
The government’s upcoming green paper provides a critical opportunity for reform, to ensure we finally create a system centred on keeping people well and independent. We must learn from previous mistakes by meeting new initiatives with new resources and most importantly, a real plan of action.