Two weeks ago, despite it being one of the first warm evenings of the year, a sizeable crowd gathered for the most recent in our series of Tavistock Square Debates tackling the big issues across health and care for older people. And this debate posed one of the toughest questions yet: “How do we make prevention real?”
Whether we are talking about preventing ill health in the first place or helping people stay well and manage a condition, we all agree prevention is better than cure. Likewise there is little argument that we should aim to prevent a crisis wherever possible.
However, in practice the case for investment and shifting resources ‘upstream’ is not always easy to make. In the light of the renewed emphasis on preventive approaches set out in the NHS Forward View and the Care Act, we asked our expert panel their views on what it would really take to break the cycle of short term targets and siloed budgets; to move from words to action.
Our panel kicked off on an optimistic note, highlighting successes in public health like the progress made in containing communicable disease through mass immunisation programmes.
Yet optimism was short lived. All our panellists agreed there is a long way to go to tackle long term health conditions, especially within the older population, and reduce health inequalities. This, the panel agreed, could only be achieved by a comprehensive shift towards preventative activity across the health and care services and by harnessing resources and assets in and outside of the conventional health and care system.
Having agreed the scope of the issue, three themes emerged out of our panel’s discussion: workforce, intelligence and ambition.
Shirley Cramer, CEO of the Royal Society for Public Health, presented a compelling case for investment in the workforce. Work by the Royal Society has identified a potential ‘hidden workforce’ of millions of people from 170 different occupations that could be mobilised to take an active role in public health and prevention. And this is before getting serious about engaging millions of informal carers and volunteers.
Our GP on the panel, Dr Steve Laitner, argued for a more intelligent approach to segmenting and understanding the health needs of the population. He outlined more targeted support, including proper care planning for people living with long-term conditions or frailty, and rapid access to appropriate care for those at risk of a crisis (eg. by stationing GPs in A&E departments).
Yet our panellists also recognised this as one of the most challenging areas for the health system as a whole. Even when the case for preventive services is underpinned by robust evidence, engrained cultures, targets and funding flows too often pull services and professionals in the opposite direction.
The solution, according to Mike Adamson, CEO of the Red Cross, is to recalibrate goals and targets onto what really matters to people, starting by setting the goal of ‘no older person should spend one day longer in hospital than strictly necessary’. Judging a local health and care system against this milestone would focus minds and incentives.
The final theme to emerge revolved around ambition and the capacity of the sector to demand bold, coordinated action. Has the health sector been too timid to advocate for approaches than might be seen to ‘nanny’ rather than ‘nudge’ people towards healthier lifestyles? I’m not sure our panel or audience for that matter were unanimous on this one – more of a 50/50 split. Perhaps a topic for another day?
Please visit ageuk.org.uk/professional-resources-home/conferences/tavistock-square-debates to find out more information about our series of Tavistock Square Debates.