Prevention is the best care: the potential of prevention

In almost every strategy on health and social care in Scotland which you come across these days the two concepts of ‘prevention’ and ‘self-management’ are likely to appear somewhere. They are the aspirational essence of the modern health and care economy. Yet in reality for all the talk there has been little substance added to their mention.

In public health the mantra of prevention has been assiduously articulated. We know the success of preventative approaches in terms of smoking and the significant decline in diseases of the lung as a consequence. We also consciously recognise the benefits of anti-obesity campaigns and attempts to limit sugar intake even if we don’t always follow them. But in the realm of social care ‘prevention’ is often a political and policy mantra which carries little meaning and certainly not one which is currently deserving of resource commitment.

Last year Becca Gatherum in her report for Scottish Care, Bringing Home Care,articulated a vision of care at home which was firmly grounded in the principle of preventative approaches, was rooted in robust research including that of the LifeCurve and which evidenced real individual and societal benefit.

So what do we mean by prevention in social care? Put simply they are those models and approaches which prevent an individual from either early or unnecessary access to enhanced care, hospitalisation or sharper personal physical decline and deterioration. They are approaches which enable independent living for a longer period of time and are focussed on maintaining a higher quality of life and wellbeing. They are about maximising autonomy and control. And yes, significantly they are not only about personal benefit but providing an economic and societal benefit through the avoidance of expensive clinical and especially surgical intervention. Falls prevention is perhaps the best exemplar of the promise and potential of preventative social care.

Yet nearly a year on from the Scottish Care report I see no evidence of any Integrated Joint Board robustly taking up the vision of preventative care. Well strictly speaking that might not be true. There is ‘talk’ of prevention and there are some attempts to use technology enabled care to initiate some developments. Such approaches which use technology to map and monitor decline and physical change in a person have real benefit but without being part of a bigger prevention strategy they can only go part of the way.

In fact it might even be that we are causing damage to truly effective preventative models by some of our proposals and plans. I have seen in recent weeks some horrendous proposals appearing before IJBs which predicate savings based on reducing care home provision on the basis of using technology and assuming a non-existent robust and coherent homecare system which is enabled to undertake even more advanced clinical support in the community. This is dangerous thinking not deserving even of the mirage of planning and threatens not only individual harm but also any serious attempt to systematically reform the health and social care system.

A holistic model of preventative social care maximises the benefits of technology rather than uses it to replace human presence, professional judgement and instinctive experience.

Yet maybe it is not surprising that we have failed to see the adequate resourcing of preventative approaches – because they are initially costly and because you cannot remove advanced homecare at the same time.

Surely the time has come for us to not only to talk the talk around prevention but to be brave and start to walk the talk? It is time for someone somewhere to invest substantially in a model of preventative homecare AT THE SAME TIME as maintaining and building enhanced homecare. They are reciprocal and inter-dependent processes. The one cannot exist without the other. Prevention cannot be used as a replacement for person-led, rights-based, dignified care. You cannot achieve the beneficial outcomes of preventative approaches without initial investment – just ask any public health specialist!

Social care in Scotland urgently needs a sense of political vision which goes beyond bandaging the present system and dares to heed its own mantras and invests in real preventative social care.

Dr Donald Macaskill
@DrDMacskill