https://publichealthmatters.blog.gov.uk/2018/11/21/community-is-the-cornerstone-of-prevention/

Community is the cornerstone of prevention

If  I’ve learned one thing since becoming Minister for Care it’s that the traditional words and phrases we use to discuss health and care are not static terms, but ones ripe for reinvention and reinterpretation. Take prevention for example.

In a health context, we tend to think of it in purely medicinal or clinical terms – pills, potions and procedures to mitigate early symptoms and avoid or delay the development of more serious conditions further down the line.

There is so much more to it than that. Prevention is as much about the kind of communities we live in, the lifestyle choices we make, and the quality of care we receive, as it is the contents of our medicine cabinets.

It’s about detection, intervention and access to services and activities that can help maintain and sustain our good health.

As many of you will know, on assuming office, our Secretary of State Matt Hancock made prevention one his top three health and care priorities – and now he’s launched our department’s radical vision to promote its wider adoption: ‘Prevention is better than cure’.

The vision serves the broader mission, as set out in the Prime Minister’s Ageing Society Grand Challenge, to help people enjoy at least five extra, healthy, independent years of life by 2035, whilst narrowing the gap between the health outcomes of the richest and poorest in society.

It sets out goals to help people manage their physical and mental health needs closer to home. It also aims to leverage the benefits of an integrated health and social care system that delivers care in the right place, at the right time, and in ways that respect individual needs and wishes.

As part of a long-term funding settlement, the NHS budget will grow by over £20bn a year in real terms by 2023 to 24. It’s an incredible opportunity to dramatically shift the focus of health and social care away from reactive or remedial services and firmly towards prevention.

With the recent vision, the SoS has made it clear that prevention is integral to our long-term plan for the NHS: we need to target improvements in our health, not just improvements in our healthcare.

It’s not hard to see the logic, when the prize is more timely interventions, a healthier population and a workforce with enough time and resource to focus on care – and have more time for their own health and wellbeing outside work.

Community health services, already helping hundreds of thousands of patients to receive care in their own homes, will be critical to this endeavour. In fact, I’ll go further and say they are the cornerstone for prevention.

Health and care professionals in this space understand that truly joined up care means reaching beyond statutory health and care services into the communities they serve: the wider web of care. It is here where prevention must thrive as a goal and an outcome.

Community nursing provides a good example of this approach. For example, I was really impressed that Frimley Health in Surrey have partnered with their local fire service to help identify vulnerable people during fire safety visits.

Having a district nursing team collaborating and sharing information with the fire service is prevention in action - a combined effort to identify and mitigate health risks. Brilliant!

It’s not just about physical health of course. In my own constituency, the Gosport Shed has provided a supportive space for older men adjusting to retirement, experiencing bereavement, or coping with physical and mental illness, to come together on a range of community projects.

Since 2013, the shed’s existence has given them a renewed sense of purpose and belonging, helping them combat social isolation, depression and keeping them physically active and engaged in local life. It’s a win-win scenario – they are well loved for their great work in the community and one member told me that belonging to the group had literally saved his life.

Time and time again, I have seen fantastic examples of this approach: of statutory and informal services breaking down barriers and working innovatively to meet the needs of their communities. This is what prevention should mean in the modern era.

By doing this, we can help more people avoid GP appointments, encourage the independence of those needing care, and find alternatives to expensive residential placements. Attendant to this is the huge potential for community services to take some of the burden away from A&E.

Of course, there is a degree of personal responsibility attached to prevention and a responsibility to those who provide care free of charge – the unpaid carers looking after family and friends and without whom the rest of the care and support system would simply collapse. We must get better at caring for the carers. My Carers Action Plan, published earlier this year, sets out 64 ways to do just that.

So, when I talk about local health services, when I champion the contribution of paid and informal carers, I really mean it when I say community is the cornerstone of prevention. It’s where good health begins and where it must be nurtured and sustained if we are to deliver a health and care service fit for many generations to come.

Caroline Dinenage is Minister of State for Care at the Department of Health and Social Care.

Find out more about the government's vision for putting prevention at the heart of the nation's health.  Read the collection of case studies, showing examples of good practice in preventing health problems from happening.

5 comments

  1. Comment by Henry Muss posted on

    That's fantastic.
    I understood that "prevention" now sat with local authorities, who are delivering fantastic health and wellbeing programmes daily in communities across the country. (eg: http://www.hackney.gov,uk/one-yo).
    Yet The 2015 Health Survey for England found that 19% of men and 17 % of women were smokers, 31% of men drank over 14 units of alcohol per week, 27% of adults were obese and only 22% of children received enough physical activity. Even in a progressive inner city borough like Hackney Physical Activity/Obesity public health services receive only 3% of the public health budget. Mainly in part due to statutory service such as sexual health (around 20%) meanwhile in year savings have also had to be made, cutting front line services.
    How much of the £20bn will go towards councils, whose statutory duty is public health?

    Reply
    • Replies to Henry Muss>

      Comment by Dr P.N. Jarvis posted on

      Well said. When I retired, there were only two grossly obese people in our practice; now there are many.
      Proper regulation of food sales has been done before - there were few fat people during the late War, but we were all tolerably fed. In the face of so obvious an epidemic, it is the duty of HMG to stir its stumps.
      The additional costs to the NHS - from Type 2 diabetes for example - are both obvious and avoidable; the service will strain and may eventually collapse unless we fix it.
      My father worked in Public Health, which he said saved more lives than the rest of the entire medical profession, yet nowadays Public Health is a poor relation. This seems unwise.

      Reply
  2. Comment by Elcena Jeffers posted on

    All the right words are being used.
    We now need a National Full Employment Strategy.

    Reply
  3. Comment by Steven Carter posted on

    Here, here! More clarity around the role and support for local Public Health teams, please!

    Reply
  4. Comment by Susan J Capps-Jenner posted on

    Good in principle but can see problems in practice a look that has not been considered

    Reply

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