From crisis intervention to prevention?

Helena Herklots, is right to stress in her Guardian article the absolute importance of day-to-day services to many older people’s quality of life – services that are often low cost and straightforward can help people to stay independent and to enjoy life – services like befriending and handypersons.

All of us, but maybe especially health professionals, need to remind ourselves that the vast majority of services that are essential to delaying or preventing frail elderly people being hospitalised or having to go into residential care, are not NHS services. As Helena stresses, services such as falls prevention ones can be extremely effective, and mainstream council services, such as housing support, accessible transport provision and community development, are the crucial elements of a robust preventative agenda.

Prevention is fundamental for older people, but also for general health and wellbeing. Investing now is critical if we are going to be able to continue to afford one of the best health systems in the world.

Yet we know these services are under threat. It can be hard to continue to invest in preventative services that have an impact down the line when critical services are under enormous pressure now.

What needs to be done?

We need to make the business case for investment – building on the qualitative evidence from projects such as Partnerships for Older People (POPs) with more robust models that identify what is being spent now, that measure outcomes across sectors, and understands who benefits. We may need incentives across the public sector – extending the health premium concept in the health reforms.

What else? A more strategic approach within councils to prevention and early intervention is necessary – some councils have this, but not all. There are many great initiatives out there, for example, in tackling health inequalities and in health improvement, but often they are one-offs, because of how funding has worked and because some councils do not take a whole council approach to health improvement.

Will the health reforms help to shift the healthcare system from crisis intervention to pro-active prevention? Partnership working and collaboration must be the key here. Whatever the continuing concerns about the health and social care bill (around the role of Monitor for example and the place of competition), there is room for optimism.

The reforms should establish a more rational and coherent framework for integration to take place. How? Firstly, the transfer of responsibilities for public health to local authorities. Then the explicit acknowledgement, underlined by the Future Forum report, of the crucial role local authorities play in health and wellbeing and preventing ill health. We have the vehicles to carry through the principles – the new health and wellbeing boards specifically. And other tools, such as a strengthened joint strategic needs assessment (JSNA) which is instrumental to informed commissioning and to designing effective preventative strategies.

Stronger collaboration between health and local government and the integration of public health within local authorities, could see much greater investment in prevention, compared to the miniscule amount the NHS has traditionally spent.

Of course none of this is going to be easy: the financial pressures may require closer collaboration, but they can easily undermine existing partnerships; the government talks about the need for integration, but the Prime Minister in speaking on the response to the Future Forum report, talked about integration being needed within elements of the NHS but didn’t mention integration beyond the NHS. The challenges are immense – who will be responsible for integrating care for people with long-term conditions; how can we tackle health inequalities at a time of austerity and cuts?

I spoke at a conference recently on the changing role of local government in the preventative health agenda. The audience was primarily health professionals, I ended by saying that all of this isn’t primarily about changes to the role of local government – local government has always been central to improving the health and wellbeing of its population, but it is more about changes to the NHS and its relationship to local government – as much about cultural change as structural change.

If we want to move to a more rational system that is focused on prevention and on wellbeing, the critical role of local government has to be embraced by local government itself, and. crucially by all its partners in health.

Janet Sillett is the LGiU’s briefings manager

Councils in charge of healthy lifestyle drive. The Government's White Paper has, as expected, put councils in charge of public health. Local public health directors will be moved out of the NHS and into local government. The LGiU has found broad support for the move in our recent DoH-commissioned paper. But the report has also identified significant risks. Councils are concerned that the speed and scale of reform could result in a loss of focus on preventative action, the fragmentation of local health services and non-alignment of council services with the new GP consortia. Report author Janet Sillett will be providing a full briefing for LGiU members on the implications of the White Paper once its published. It’s going to be tough. LGiU Chief Executive Andy Sawford has contributed to an LGC briefing on council spending cuts. Andy argues that the government is going to have to be more supportive of innovation and more tolerant of failure that inevitably goes with that. Managing risk will be hard in this new world . Some areas, such as child safety, might be protected forever but in others more risks will have to be taken. Lewisham town hall protest broken up by riot police. This surely won't be the last rumpus that councils and the police will have to contend with as the cuts begin to bite. Cumbria's libraries help people have their say on council priorities and budget options. An interesting example of good-old-fashioned and high-tech council services working together. The council's libraries will be offering free internet access specifically for people wanting to fill in its online consultation on spending cuts. The site's had 2,229 visits in its first week alone. Councils are spending £314 million per year on CCTV. A new report has found that 10 councils are spending over £3 million per year. I can't really comment on whether that represents value or not. It does, however, sound like an awful lot of money.