Core NHS and social care investment has traditionally concentrated on commissioning treatments for people with ill health and the highest level of need, with intervention at the point of crises. Health and social care policy is trying to change this - trying to shift investment patterns to earlier interventions that promote health, independence and well being in order to prevent or delay the need for more costly intensive services. Commissioning a patient-led NHS, for example, sets out the government's vision for an NHS service which safeguards peoples health instead of waiting until they are sick, whilst Our health, our care, our say emphasises its commitment to shifting resources from hospitals in order to provide more preventative care in the community. This will enable people to be treated before their condition causes more serious problems and reduce the need for professionally provided care:

"A greater focus should be placed on preventative services through the wider well-being agenda and through better targeted early interventions that prevent or defer the need for more costly intensive support."

Much of the government's vision hinges on powerful, effective commissioning at PCT level and, particularly, at GP level. Commissioning can improve the effectiveness of prevention and early intervention services, so that users will be better served and demand for complex health and social care services reduced. Practice-based commissioning (PbC) is one means being introduced to deliver innovative locally based health care, giving GPs the freedom to tailor services to their patients' needs. It is hoped that this will lead to a wider range of services, including preventative care, being delivered close to where people live and work, and available at times that are convenient, so supporting people to manage and protect their own health and well-being and helping to avoid unnecessary admissions to hospital. Payment by Results (PbR) also provides incentives for the development of alternative primary and community services where these are more clinically effective and cost effective than hospitalisation.

Health and social care services are expected to work together to ensure that there is early support for prevention and health promotion, which means moving from a fragmented to a more integrated service provision, from an episodic focus to one of continuing relationships. For this to happen, PCTs and their local partners will need to ensure all investment is used to best effect, thereby reducing stays in hospital and supporting independent living at home, and allowing hospitals to devote themselves to meeting the clinical needs that only they are equipped to meet.

The term 'prevention' means many things to many people. The most common issues bundled up in this term include:

• Promoting health and well being with a view to preventing or delaying the need for more costly services at a later date.
• Providing low level services to maintain people's independence.
• Preventing the need for institutional care.
• Avoiding crises which might lead to hospital admission/re-admission.
• Reducing the adverse impact of long term conditions.

For commissioning to be effective in improving health and wellbeing and reducing health inequalities it needs to:

• Cover whole communities, not just current users of services.
• Take into account future demographic challenges.
• Be based on accurate, detailed assessment of local needs and characteristics, arrived at through partnership with local authorities, communities and other local partners.

North West Case Studies

• Lancashire's Directorate of Adult and Community Services has co-ordinated a cross-directorate, multi-agency project to develop a strategic approach to preventative services for adults and older people with lower level needs. Find out more about Lancashire's analysis of low level needs and services.

Sources of further help - external link

‘The billion dollar question’: embedding prevention in older people’s services—10 ‘high impact’ changes.  Health Services Management Centre, University of Birmingham Policy discussion paper (August 2010)  This paper looks at the very real challenges of implementing preventative services in the context of increasing demographic and social pressures.  While acknowledging that prevention is difficult to prove the report suggests some interesting ways to further improve older people’s health and wellbeing and suggest arrangements to better preventative approaches. 

Adult social care information & advice services review: summary outcomes. Social Care National Skills Academy (August 2010)  Effective information and advice are central to the success of the personalisation agenda.  As part of the Transformation of Adult Social Care all local authorities are expected to have accessible, universal information and advice services in place by April 2011.  This review looked at how local authorities are progressing towards this goal.

Regional factsheets on Carers (March 2010) The Centre for International Research on Care, Labour and Equalities (CIRCLE) at Leeds University, commissioned by DH, has produced a set of 9 regional factsheets on carers.  These factsheets include information on carers in each region and provides useful data for commissioning, contracting and service development.

State of Care CQC (Care Quality Commission) annual report looking at the state of care in England.  It provides details on how well health and social care services have performed in 2009, and highlights improvements.  There is a useful webpage with videos and service user's personal stories.

Commissioning for Carers and Commissioning for Carers: an Action Guide for Decision Makers. These guides are funded by the Department of Health and serve as blueprint for better commissioning to achieve high quality outcomes and targets in respect of carers. September 2009

The first ever DH National Dementia Strategy is a landmark document that will transform the quality of dementia care. It sets out initiatives designed to make the lives of people with dementia, their carers and families better and more fulfilled.  It will increase awareness of dementia, ensure early diagnosis and intervention and radically improve the quality of care that people with the condition receive. Proposals include the introduction of a dementia specialist into every general hospital and care home and for mental health teams to assess people with dementia (February 2009).

The Audit Commission published Living well in later life (March 2006) which reviews the state of services for older people, including care services and services that contribute towards the wellbeing and quality of life of older people, and Local quality of life indicators - supporting local communities to become sustainable (August 2005). The Audit Commission also investigated Older People - Independence and Well-being: the challenge for public services (February 2004). This report explores the nature of change required from public services in relation to the independence and wellbeing of older people. It covers both the majority who have no need of care services and the minority of frail older people who may need support and care. The report considers what independence means for older people, looks at the support and services provided to carers of older people; and describes the models that exist to support frail older people in the community e.g. chronic disease management, intensive case management and assistive technology.

The Department of Health provides various information and resources to support health and social care organisation's implementation of the National Dementia Strategy.

The Centre for Policy on Ageing www.cpa.org.uk is a research and policy influencing organisation with a remit to focus on the wide-ranging needs of older people. The Centre has a policy and research department, a library and information service, and publications including downloadable research briefings on a variety of topics e.g. social inclusion and living arrangements for older people. The Centre has links to the journals Ageing and Society and the British Society of Gerontology.

 Community Care makes articles available at http://www.communitycare.co.uk/SiteMap/Articles/182/Page1.htm. These include 'Independent Living Fund is past its prime' (Bob Hudson and Melanie Henwood, March 2007) and 'Taking the accent off the acute' (S Mithran, June 2006), which argues that the shift from acute to community services must overcome conflicts between some of the policy strands currently operating and change fatigue among GPs and within PCTs.

Care Quality Commission's (CQC) First major statement on the quality of Adult Social Care.

The Department of Health website has a section on Long Term Conditions where recent publications include self care for people with long term conditions and high impact changes for practice teams.  There is also a link to Supporting people with long term conditions: An NHS and social care model to support local innovation and integration.  The DH also supports the Partnerships for Older People Projects (POPPS)

Department of Health has also published a useful report bringing together findings of a joint working group to improve community information.  Improving Information for Stakeholders: A report of a primary care trust and strategic health authority working group to improve community information. December 2009.

The Health Services Management Centre at Birmingham University www.hsmc.bham.ac.uk specialises in development, education and research in health and social care services. Recent research publications include: Making the Shift from Secondary to Primary Care Helen Parker (July 2006) which explores how to achieve the government's vision of community-based care; Reducing unplanned hospital admissions: what does the literature tell us? (March 2006); and Improving care for people with long-term conditions (May 2006).

The Improvement and Development Agency (IDeA) has a Healthy Communities and an Adults Social Care section with briefings, articles, case studies, and a discussions database.

The Housing Learning & Improvement Network (LIN) is the national network for promoting new ideas, good practice and supporting change in the delivery of housing, care and support services for older and vulnerable adults, including people with disabilities and long term conditions.

The Joseph Rowntree Foundation at www.jrf.org.uk is a social policy research and development charity. Relevant projects include Older people's views and experiences of resources in later life (April 2007), Building a good life for older people in local communities (October 2004), and the Older people shaping policy and practice programme.

The King's Fund offers papers and research on health policy related issues, some of which are downloadable, these include an anatomy of GP referral decisions (January 2007).

The National Institute for Health Research has a number of research programmes including the Service Delivery and Organisation programme at www.sdo.lshtm.ac.uk/ where downloadable research summaries include Peter Griffiths, Roz Ullman and Ruth Harris (March 2007) 'Self-assessment of health and social care needs by older people'.

The Personal Social Services Research Unit at the University of Kent (www.pssru.ac.uk) undertakes social and health care research. Accessible papers include Ann-Marie Towers and Ann Netten (2006) Control, Well-Being and the Meaning of Home in Extra Care Housing and Care Homes, PSSRU Discussion Paper No. 2342.

Research in Practice for Adults aims to help front-line practitioners and managers in adult social care make best use of research knowledge. Its website at www.ripfa.org.uk offers news and policy updates, details of learning events and of a number of 'change projects', plus a resource bank. Its evidence clusters are updated from recent articles and policy documents and provide a good overview of the issues. Cluster One is about prevention (click here)

The Social Policy Research Unit (SPRU) at the University of York offers downloadable research at www.york.ac.uk/inst/spru, including outcomes-focused social care services for older people - progress and possibilities by Caroline Glendinning, Sue Clarke, Philippa Hare et al (November 2006).

Well-being and Choice is a website for social care and health care that promotes service users' own priorities and quality of life. Downloadable publications include:

• An outcome-based approach to domiciliary care (June 2005) by Lucianne Sawyer.
• Caring for the whole person: home care for older people which promotes well-being and choice.
• Reducing depression among older people receiving care briefing on a North Yorkshire PCT project that takes a holistic, person-centred approach by care staff.

The Wanless Report - available at http://www.hm-treasury.gov.uk/consult_wanless_final.htm - highlights the economic argument for refocusing investment on preventive approaches to care, reducing the future financial burden of longevity and population change.

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