Issue - meetings

23.1     The Chair invited the committee to engage in an exploratory discussion on the topic of prevention, based around issues outlined in the report. The following key points were raised in the discussion:

·         The importance of an evidence-based approach to identifying where best to invest to get a return in terms of outcomes and cost. This approach involves: a good understanding of need via sources like the Joint Strategic Needs Assessment (JSNA); understanding current performance e.g. through benchmarking with other areas; and awareness of best practice such as targeted NHS initiatives. Much of this work is supported by Public Health. This range of information enables decisions to be made about priorities, particularly in relation to health inequalities, areas of poor performance, or the needs of our type of population. From this, service specifications are developed which are now more outcomes focused, and services commissioned from the NHS, or from the third sector via the Commissioning Grants Prospectus. Services are then monitored and evaluated with this information feeding back into the loop.

·         The challenge of investing in prevention in a climate of financial constraint and increasing demand for reactive services. A particular challenge is the long-term nature of some preventative work which will not provide a payback for many years. However, the risk of focusing spending on current demand rather than prevention is that longer term demand will increase even further, storing up additional problems for the future. The payback period for prevention has always been an issue for the NHS which has predominantly remained a reactive, demand-led service. It is difficult to double-run services and there is a lack of money to invest in longer term prevention.

·         The importance of partnership working across agencies on prevention and the role of specialist vs mainstream services. Thresholds are in place for referral to certain specialist services, such as support to families, so that resources are focused where need is highest. At a lower level preventative work is built into mainstream services via the ‘Making Every Contact Count’ approach which prompts staff in frontline services to use contacts with patients/clients to provide information or advice on other services or lifestyle issues. If a case becomes more complex or there is a lack of engagement staff have the option to refer to Health and Social Care Connect.

·         Risks related to the ringfencing of the Public Health grant to local authorities. If the current ringfence (which runs to 2018/19) is not extended there is a risk to Councils’ ability to maintain investment in preventative services due to pressures on other parts of the Council to meet statutory duties. The grant includes allocations for drug and alcohol misuse and for smoking cessation. The Public Health grant has seen reductions in recent years but these have been smaller than the overall reductions to the County Council budget and have been managed by recommissioning or re-specifying services.

·         Whether prevention can be viewed as an ‘invest to save’ approach or whether, by  extending life expectancy and quality  ...  view the full minutes text for item 23