Agenda item

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 of life, it can actually  increase social care and health costs.  It is clear that prevention is aiming to improve life outcomes, as well as make better use of resources. This may create additional costs in some areas, but these are likely to be offset by preventing more serious conditions which require acute interventions that are particularly expensive e.g. heart attacks, strokes. In addition, improvements in quality of life can create a virtuous circle where one improvement makes people more likely to make other positive changes such as exercising more.

·         The role of NHS health checks and evidence of their effectiveness. These are now more targeted on certain groups and conditions e.g. diabetes and heart disease and are a relatively inexpensive approach. There is evidence of direct savings to the NHS, for example through use of statins preventing heart attacks which are very expensive to treat.

23.2     The committee drew the following conclusions and recommendations from the discussion:

·         The importance of not losing sight of prevention in the context of the financial challenge, but a recognition that choices are becoming harder in the context of increasing demand for statutory services and reducing finances.

·         An understanding that ESCC spending and investment decisions will be made through the Council’s Reconciling, Policy, Performance and Resources (RPPR) process. More broadly, resourcing of prevention will be influenced by Public Health England and NHS England.

·         Support for the Council’s ongoing prevention campaigns and a recommendation that the department looks at ways to use existing communication resources such as the Your County magazine to support this work at low cost.

·         The importance of co-ordinating work on prevention across agencies and across the county to make best use of resources.

23.3     RESOLVED to scope a table-top review of how preventative work is co-ordinated by Adult Social Care and for all Members to be involved in a one-off meeting with relevant officers in the New Year to explore this subject.