Building community capacity for multi-level prevention

Clive Miller
Clive Miller , Office of Public Management (OPM)
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The Care Act 2014 makes it a duty to ensure the provision of preventative services across three levels of care and support: primary (i.e., to prevent), secondary (to reduce) and tertiary (to delay). The new TLAP framework Developing the power of strong, inclusive communities shows how community capacity building and the redesign of services to support more effective coproduction of outcomes can contribute to all three levels of prevention.

It is a common misconception that the use of, and contributing to, community activities is really only of use at the primary level of prevention. Above that level health and social care services kick in and take over. However when individual patient journeys are tracked they reveal that, at different points in their lives, people draw on community support at all three levels of prevention.

At the secondary level of prevention, people requiring support will typically continue to live in their own homes and local communities which if strong and inclusive are important potential sources of support. The evidence on savings also indicates that the quickest return from investment is found at this level of prevention. It is here that long term conditions begin to undermine people's independence leading to increased frequencies of GP consultations, A and E attendances and hospital stays.

Sheffield, one of the Health and Wellbeing Boards that trialled the TLAP framework, used the framework to review its approach to secondary level prevention. Looking at both how to incorporate community self-help and redesign services to boost the effectiveness of coproduction it identified a series of actions. Some of these required modifications and extensions to existing services and community activities, others needed gaps to be filled:

Action to support co-production in Sheffield

  • Risk Stratification - so that people at real risk of declining independence and wellbeing are identified before they increase their call on the formal health and care system.
  • Community Asset development - so that activities and support services are available locally that are attuned to the needs of people at risk.
  • Inform and Advise - so that people can self-help and find the support they need to stay independent and well.
  • See and Sort - so that people identified as being at risk are actively (and assertively) sup­ported to access community support activi­ties and services.
  • Self Care, Wellness Plan - so that people with longer-term needs are supported to maintain or regain their independence and wellbeing.
  • Life Navigator - so that people who struggle to navigate the system and stay in control of their care and support are helped to do so.

Community capacity building also has an important role to play at the tertiary level of prevention. Whilst some people may remain in their own or relatives' homes, many people are supported in sheltered housing, care or nursing homes. Drawing on the evidence that "giving" benefits the health and wellbeing of the giver as well as the receiver care settings might consider:

  • Changing care regimes to enable people to self-care and support one another;
  • Opening up care homes to local community participation and use; and
  • Enabling care home residents to contribute to their local communities.

Everyone has something to give, even at the end of life, the trick is finding out what and how and enabling them to do so.

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Posted on by Old Site User

Our organisation (Wirral Older People's Parliament) has tried to support these ideas for years. The manifesto below was a recent production for our prespective parliamentary candidates and others

The Peoples’ Manifesto for Health and Care Services.
The following points are a summary of two months work by many members of Wirral older People’s Parliament..
1.We want a National Health Service, with local CCGs meeting the needs of their communities. We are not in favour of localities (such as Greater Manchester) taking complete control. In fact, we strongly oppose any more big reorganisations for the next five to ten years, since they are costly and unsettling to staff and the public. We are opposed to privatisation.
2.Overall funding must increase significantly, because of population increase, and medical advances. This must include training of more doctors, nurses and allied health professionals, as well as better training for care workers.
3.Beware of over-empowering administrators and bureaucrats. They should facilitate – not dictate. Listen to the hands-on medics, nurses, care workers and the patients. Reduce management to the necessary minimum.
4.The fragmentation of health and care services must be addressed by the current integration drive. There is a real need amongst older people in particular to be treated as a person – not as a collection of medical conditions. It can be a problem that some GPs will only see a patient about one condition at a time.
5.Should more services be available 24/7?
6.We are strongly in favour of integrated, locally provided care for all people with complex needs (the majority of whom are old) in their own home or nearby if it is possible. Far more NHS resources need moving from hospital to community. More resources must go into social care.
7.Make sure good practice is identified and learnt from, rather than simply exposing bad practice. Most staff in health and social care are very caring – often defeated by bureaucracy, targets and over-work.
8.Good receptionists and telephonists in all health and care services are vital, and must have training in people-skills.
9.Keep paperwork and records to a necessary minimum for all staff across the services, We want our records available to necessary health and care workers, but NOT sold elsewhere.
10.Mental Health services need more investment, including better provision for crises. This includes the need for better services for some hard-to-manage dementia patients.
11.Make much better use of voluntary and community groups, by commissioning more from them. This should include supports for disease groups, carers, advocacy services, general advice and guidance, activities to reduce isolation and encourage better life-styles etc.
12.Finally, we (the population in general) must learn that we have a part to play. We must not abuse NHS facilities as happens so often. We need to recognise that each one of us can be a good neighbour and part of a caring society.


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