England & Wales Health and social care

Viewpoint: Prevention in Action – moving towards a truly preventative system


Most of us agree that prevention is better than cure, writes Olivia Field, so why are we yet to shift towards a truly preventative health and social care system?

 In 2013 the British Red Cross reviewed more than 110 joint health and wellbeing strategies and found that the term ‘prevention’ was understood differently across the country.

While many recognised public health campaigns as preventative, only around a third clearly incorporated lower-level preventative services, such as reablement.

As the draft Care Bill made its way through parliament, the Red Cross and LGiU warned that unless the Bill defined prevention, local authorities might interpret their new duties too broadly to affect real change. We successfully called for the Care Act’s statutory guidance to define prevention using a proposed triple definition (primary, secondary and tertiary).

The Care Act’s triple definition of prevention:

  • Primary prevention is about minimising the risk of people developing needs.
  • Secondary prevention is about targeting people at high risk of developing needs and intervening early.
  • Tertiary prevention is about minimising deterioration and the loss of independence for people with established needs or preventing the reoccurrence of a health and social care crisis.

For the first time the ambition to shift towards a truly preventative system was enshrined in law. Unfortunately, a recent Red Cross study found the full ambition of the Act’s prevention duty has yet to be realised.

While prevention is increasingly a key consideration in local plans and strategies, responses to 149 out of 152 Freedom of Information requests have revealed that too many local authorities still don’t recognise all three forms of prevention. And while 38 per cent of joint health and wellbeing strategies now recognise and prioritise all three types of prevention, only 12 of 151 use the Care Act’s full triple definition of prevention.

In fact, in the face of local authority budget cuts, preventative budgets have actually reduced since the Care Act 2014 came into force almost a year ago. The focus is still on reacting to crises rather than preventing them.

This year, however, another opportunity to properly invest in prevention presents itself: the devolution of integrated health and social care budgets.

Integration and co-creation provide the opportunity to eradicate the false distinction between ‘clinical’ and ‘social’ needs that all too often results in no statutory agency taking responsibility for the person or service in question.

It also incentivises both local authorities and the NHS to invest in prevention. A single budget means savings return to the same pot and both benefit from cost-efficiencies.

But, while both health and social sectors have an ambition to shift towards prevention, our research suggests that they may be talking about different things.

The NHS Five Year Forward View and Care Act statutory guidance, released on the same day last year, both prioritise prevention – but only the latter defines it. The Forward View also fails to emphasise the importance of tertiary prevention.

We know there is a risk of health dominating social care in integration plans and are concerned that this could push tertiary preventative interventions even more to the sidelines. As areas move towards increased integration, sharing the same language – including the same definition of ‘prevention’ – will keep the ambition of both sectors aligned.

So far the triple definition has been largely overlooked by the rest of the health sector, but it should be just as useful to the NHS as adult social care and public health. Using this definition as the basis of preventative planning helps ensure prevention is recognised as a continuum, with an ambition to prevent people’s needs escalating at any stage of their condition, whatever that condition may be.

Decision makers across the country recognise the need for radical transformation. They also recognise the part prevention must play in this transformation. But for this to mean anything, the importance of preventing, reducing and delaying the need for care and support (and its associated costs) must be recognised. Unless we share the same understanding, we do not share the same ambition.

 The Red Cross sets out a series of recommendations for devolved areas: from seizing the opportunity to eradicate the false distinction between people’s clinical and social needs to ensuring strategic plans for integration fully incorporate and prioritise prevention.

 The full report can be read here: www.redcross.org.uk/prevention


 Olivia Field is a Policy and Advocacy Officer at the British Red Cross. @oliviamayafield