Implementing the NHS Long Term plan provides an opportunity to reframe how we think about prevention and prevention is now everyone’s business, writes Phil McCarvill, chief advisor at the NHS Confederation, as part of our NHS Voices blog series about the long-term plan.
The NHS Long Term Plan puts community services centre stage – we now need to make this vision a reality.
Traditionally, within the health and care system, prevention has been used to describe efforts to reduce excessive use or exposure to alcohol, drugs, tobacco, fatty foods, sugar or risky sexual behaviours.
It has been associated with preventing the development of conditions such as diabetes, obesity, mental ill health, cancer, dementia, heart disease, COPD and sexually transmitted infections. The public health approach has delivered many positive things for both individuals and for society.
At the heart of the prevention agenda has been the goal of keeping people well and preventing problems from arising in the first place.
The findings of Securing the future: Funding health and social care up to the 2030s by the Institute for Fiscal Studies and the Health Foundation, commissioned by the NHS Confederation, show that we need to shift the emphasis towards what happens in people’s homes and local communities.
The alternative is that we face having to increase acute care provision by 40 per cent by 2033.
Assuming that the latter is unthinkable - whether fiscally or from a service perspective - the increasing importance and impact of demographic pressures means that we need to do something radically different and this surely means that the moment for strengthening and funding ‘prevention’ activity has arrived.
I would suggest that we need to reframe what we mean by prevention and to adopt a much broader more inclusive definition of it.
So much of what is delivered by NHS community services, primary care, ambulance services, social care and what charities and communities do locally is about delivering in different ways on the prevention ambition of keeping people well for longer.
This is particularly true for older people with multiple conditions. Every day teams of people are preventing people from falling. They are keeping people warm by fitting insulation and new windows and doors. They are ensuring people remain connected within their communities by visiting those living alone and through befriending services and social activities, preventing them becoming socially isolated or mentally unwell. They are making sure people keep vital medical appointments or, even better still, are taking services out into their own homes and communities. They are delivering care in people’s homes which previously would have taken place in local hospitals or resulted in A&E visits and potentially acute care admissions.
In doing so they are playing their part in avoiding increased pressure on already stretched acute hospital services, but more importantly they are providing great care and support and preventing people from becoming ill and/or enabling them to remain well and living at home for as long as possible.
Prioritising care and support at home
It is in all of our interests to prioritise care and support within people’s homes and local communities. That is true today, but it is arguably one of the ways that we will be able to deliver a sustainable NHS over the next decade and beyond.
In addition to a broader definition, we also need a better way of describing such a broad range of services and interventions. Should we be talking about ‘keeping people well for longer’, ‘enabling to live the lives they want to live’ or ‘supporting health communities’? Somehow talking about prevention in the traditional sense feels too narrow and only encapsulates one part of the bigger picture.
The publication of the NHS Long Term Plan has given fresh impetus to this agenda, with its renewed emphasis of what happens in people’s homes and local communities and to lift the pressure on local hospitals.
The plan puts community services, social care, primary care, ambulance services and the work of the third sector at the heart of the blueprint for the next decade. Prevention in the broadest sense is now everyone’s business.
If we do not grasp this opportunity and prioritise this approach to prevention then we will need to come up with a much more radical plan outlining how we are going to fund, staff, house and deliver 40 per cent more acute care.
Phil McCarvill (@phil_mccarvill) is chief advisor at the NHS Confederation which, alongside NHS Providers, has established the Community Network bringing together and representing NHS and not-for-profit organisations providing NHS community health services. This blog is part of a series of responses by the NHS Confederation group on the NHS Long Term Plan. Read more in this series.