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.
