Richard Humphries

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Our health, our care our say a new direction
for community services White Paper
Older Peoples Wellbeing making the shift
towards prevention, ICN conference, London 9th
March 2006
- the preventative agenda

• Richard Humphries
• Chief Executive
• Care Services Improvement Partnership

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Although we are convinced that an effective
health service, sufficient decent housing, full
employment, adequate incomes, and an imaginative
and well-developed education system are
cornerstones to any general preventive policy,
there is comparatively little evidence upon which
specific programmes could be confidently built.
Report of the Committee on Local Authority and
Allied Personal Social Services, 1968 (The
Seebohm Report)
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It will be important to continue to develop the
evidence base for this (preventative) approach to
identify cost-effective solutions.
ndependence, Well-being Choice Our vision for
the future of social care for adults in England
Green Paper, 2005
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If you help a person at the beginning, its
better.
Social care user

• Green Paper consultation
• 80 supported shift to prevention
• almost 75 supported role of universal services
  in assisting preventative agenda
• Your Health, Your Care, Your Say consultation
• strong support for earlier intervention
  prevention
• ditto care closer to home staying independent
  for as long as possible
• 59 said they could do more
• to be healthy

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The UK lags internationally in spending on well
being and prevention(1)
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• Notes
• OECD Data. Prevention and public health services
  comprise of services designed to enhance the
  health status of the population as distinct from
  the curative services which repair health
  dysfunction. Typical services are vaccination
  campaigns and programmes (Function HC.6 in the
  ICHA).

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We appear to spend a lot on the reactive
treatment of intensive users and older people
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many of whom are older
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and most NHS money is spent on hospitals
Administration and management - 14.2b
. Twenty seven of health spend is devoted to
primary care contrasted to an OECD average of
around one-third

• Primary care - 18.6b
• Community health (6.5b)
• GPs (4.4b)
• Dental/ ophthalmic (2.3b)

Pharmaceuticals 7.8b
Hospitals 27.6b
Source DH Analysis (CAT)
Source OHE compendium (2005) based on 2002-03
figures
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The system fails to adequately integrate services
from other sectors and is viewed from an internal
focus
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The fragmentation of services is particularly
marked at the boundary between health and social
care. It adversely affects people with complex
needs and long term conditions who require access
to integrated services and support.
Community health care
Social care
Other support services
Nursing care
Residential care
Benefits advice
Personal care
Rehabilitation
Respite care
Leisure
Equipment
Housing adaptations (major)
Housing adaptations (minor)
Intermediate care
Chiropody
Physiotherapy
Domiciliary care
Access to work
Acute care
free at the point of use
means-tested service
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A single White Paper
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A new direction shifts towards
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A new direction shifts towards
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Our longer term aim is to bring about a
sustained realignment of the whole health and
social care system. Far more services will be
delivered safely and effectively in settings
closer to home people will have real choices in
both primary care and social care and services
will be integrated and built around the needs of
individuals and not service providers. Year on
year, as NHS budgets rise, we will see higher
growth in prevention, primary and community care
than in secondary care, and also resources will
shift from the latter to former (para 1.28)
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Wellbeing Prevention unpicking what the White
Paper says

• aims for promoting health and wellbeing in old
  age are
• to promote higher levels of physical activity in
  older population
• to reduce barriers to increased levels of
  physical activity, mental wellbeing and social
  engagement among excluded groups of older people
• to continue to increase uptake of evidence-based
  disease prevention programmes among older people
• wider context of Choosing Health cross
  government policy
• Opportunity Health
• A Sure Start to Later Life (incl. Link-Age
  plus)

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Wellbeing PreventionLeadership strategic
framework

• Statutory role of DASS (2.57)
• strengthened role of DPH (2.58)
• Strategic needs assessment (2.60)
• develop joint outcomes for NHS and social
  (2.64)
• care
• Joint commissioning framework for health (7.53)
  
• wellbeing
• role of Local Strategic Partnerships (2.68,2.79)
  
• Local Area Agreements (2.73)

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Wellbeing Preventionspecific measures

• DH/DWP/HSE Health, Work Wellbeing
  strategy (2.17)
• NHS Life Check (2.30)
• Mental health emotional wellbeing 2.39
  2.42)
• Psychological therapies (2.46)
• National Reference Group for (2.87)
• Health and Well-being
• New QOF measures for outcomes (2.91)
• Evidence from POPPS pilots (2.84)
• Shifting NHS resources
• redesign of care pathways (6.14)
• intermediate care (6.18)
• PCT Delivery plans (6.35)
• Unbundling Tariffs (6.77)

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Prevention wellbeing part of a broader agenda
for change

• Independence, Wellbeing Choice Green Paper on
  Adult Social Care
• Our Health, Our Care, Our Say White Paper
• Every Child Matters children's agenda
• NHS system reform
• payment by results
• practice-based commissioning
• reconfiguration of PCTs SHAs
• Local Government White Paper
• Financial balance
• Comprehensive Spending Review 2008

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Making it work key issues

• resources
• decommissioning disinvestment
• mismatch of budgets benefits
• evidence base
• capacity for change management

If you do what you always did, youll get what
you always got
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richard.humphries_at_dh.gsi.gov.uk
www.csip.org.uk
(www.integratedcarenetwork.gov.uk)
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