Viewpoint: What does ‘prevention’ mean?

Olivia Field, Advocacy Assistant at the British Red Cross, explains why confusion over the term ‘prevention’ means health and wellbeing boards are failing to include low-level preventative services in their care strategies. The draft care bill offers an opportunity for clarity. This blog was originally posted on The Guardian.

Health and social care has become something of a hot topic this year and, among those in charge of driving reform, there is general agreement that “prevention is better than cure”. The sector recognises that investing in preventative support increases a person’s wellbeing and saves on costs in the long term.

But while the decision-makers may have got this general message – it is yet to be seen in practice.

The draft care bill places a duty on local authorities to “provide or arrange for the provision of services, facilities or resources” that will prevent or delay the need for care and support. The British Red Cross is concerned that these terms are too broad to effect real change. Without a clear and consistent definition of ‘prevention’ it is all too easy for councils to “fulfil” their duty through public health campaigns alone.

A British Red Cross review of more than 110 health and wellbeing board* strategies exposes the range of differing opinions on what exactly “prevention” means. While many strategies include public health campaign initiatives, only around one-third clearly incorporate low-level preventative services, such as reablement. As the strategies are intended to guide local planning, decision-making and commissioning, it is crucial that they should recognise prevention in all its forms.

Drawing on the National Audit Office’s definitions and our own work with the Local Government Information Unit (LGiU), the British Red Cross suggests three equally-important bands of prevention:

Primary prevention seeks to prevent or minimise problems arising in the first place. Examples may include campaigns addressing lifestyle behaviours, such as smoking or excessive alcohol consumption.
Secondary prevention targets people at high risk or showing early signs of an illness, condition or need. Examples may include prostrate examinations and screenings for breast cancer.
Tertiary prevention encompasses intervention after the onset of an illness, or condition and the need to stop or delay them getting worse. Low-level care and support – such as time-limited reablement – would be included within this band.

The British Red Cross study found that health and wellbeing boardsgenerally fail to distinguish between these bands, with “prevention” meaning universal public health initiatives to some, and targeted reablement services to others. Rarely did a single strategy embrace, or even acknowledge, all three bands of prevention. As a result, very few strategies aim for a preventative approach across all stages of developing need.

Worryingly, forms of tertiary prevention are often left out entirely, with the focus instead placed squarely on stopping something from happening or arising. Yet in the health and social care sector “prevention” has, for some time now, also meant preventing or delaying the increase of need – even at an advanced stage – in order to maximise independence and control.

We hope the provision of tertiary prevention can be explicitly included within the local authorities’ duty so it will become more prominent in health and wellbeing strategies. Without this commitment, we fear that councils – especially given their new responsibility for public health – will be able to “fulfil” their duty through provision of primary and secondary prevention alone.

While the British Red Cross is advocating for a shift towards low-level preventative support services, we want to see prevention in all its forms at the core of our health and social care system.

Until we can clarify what the draft care bill’s duty of prevention is, we can’t be sure that other forms of prevention won’t be ruled out.

Health and wellbeing boards were introduced in the Health and Social Care Act 2012 to improve the general health and wellbeing of local populations. They are made up of leaders from different parts of the health and care system in order to better integrate health and social care. Currently, there are about 138 and a further 14 are being developed.