Definition
Any action that promotes good health and wellbeing and prevents illness, disease, injury or early death.
Prevention in relation to social care means the provision or arrangement of services, facilities or resources that prevent, delay or reduce a person’s needs for care and support. Under the Care Act 2014, local councils have a duty to promote wellbeing and to prevent, reduce and delay care and support needs.
Prevention can be broken down into 3 general approaches – primary, secondary and tertiary.
Primary prevention is aimed at people with no particular health or care and support needs. Things like providing access to information, supporting safer neighbourhoods and promoting healthy and active lifestyles are all examples of primary prevention.
Secondary prevention is more targeted action aimed at people who may be more likely to need care and support. Secondary prevention is sometimes called early intervention, and includes things like falls clinics and adaptations to people’s homes.
Tertiary prevention aims to support people to regain skills or to reduce care and support needs, for example rehabilitation or reablement support, or support for carers.
The bigger picture
‘Prevention is better than cure’ and while it is obviously better to prevent poor health, illness and injury, prevention in the context of social care is more of a tricky concept. What is it that is being ‘prevented’? The Care Act 2014 places a duty on local councils to prevent care and support needs, but this implies that needing care and support is a bad thing, and stigmatises people who require care and support to live their lives.
Often the ‘prevention agenda’ is linked to cost savings and reducing demand. It positions social care as a service to avoid, or that people have to resort to when they are ‘beyond prevention’, rather than social care being seen as a combination of connections, relationships, resources and support people can draw on to live the life they choose to lead.
Saying it differently
If you’re using the term prevention, be clear about what is being prevented. Ideally this should focus on people rather than on services – for example, preventing loss of choice and control, preventing the abuse of people’s human rights, preventing people from living in a place that doesn’t feel like home, or living with people they don’t want to live with, preventing loss of independence or participation in community life. Preventing people from being treated as if they are not human beings. Or ideally stop talking about prevention, and focus instead on what it is that should be promoted, and nurtured – like a sense of belonging, relationships, freedom, human rights, citizenship.
What people say
“What are we preventing? Are we preventing somebody having a miserable, disconnected life – result – or are we preventing them using expensive services?” – Angela Catley
“There’s kind of an assumption that hoards, that the system needs to keep back the hoards of people who are desperately going to push at its door -at serviceland door – if this isn’t prevented. And actually you know I don’t think I’ve ever met anybody that really was pushing at the serviceland door. Somebody once said to me that social services spend all their time trying to stop us having what we don’t want. And I think prevention for me has a loadedness to it as well, in addition to the code, that is saying ‘we know that you will overrun these services if we let you, and we need to prevent that happening. And actually you know, if you went and spoke to – nearly everyone I would think, would you be really desperately wanting this particular service or this particular support? Most people, many people really wouldn’t, you know. They’d want something else.” – Angela Catley