Prevention in Social Care: A Public Health Perspective
Jim McManusJoint Director of Public Health
7th April 2011
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Key Messages• We’re in the middle of applying public health
to social care.• Social care is an equal factor in health care
use, cost advoidance and risk stratification• Public health methodology can bring strong
benefits– Evidence based best practice, and the silence of
evidence– Viable metrics /outcomes (qualitative,
quantitative)– Population perspective– Equity 2
The Outcomes
• A public health approach in social care should bring the following benefits:– Less people in residential care– More people independent– Less costs to NHS and Social Care– Fewer costs to GPs for those with long
term conditions and disabilities– A way of monitoring the new market and
micro-commissioning
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What is a social care public health perspective?
• Population approach to – projecting need– Identifying risks– Targeting interventions
• Intervention and outcome design• Emphasise Prevention (science & art)• Joining up (housing and social care,
primary care and social care)
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A new care model and public health
5Increasing Means
Increasing Needs
Citizen purchased care – state resources
Citizen purchased care – state resources
Citizen purchased care – own resources
Citizen purchased care – own resources
EnablementEnablement
PreventionPrevention
Universal offerUniversal offer
Health Improvement
Health Protection Service
Quality andImprovement
Commissioning priorities, Evidence, making it work, supporting implementation
Ensuring we have the right frameworks in place. Safeguarding too
Long term, medium term, short term, matrixPrevention, Enablement
Components of a Public Health social care model
Prediction and
Prevention
Prediction and
Prevention
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Prediction
forecast / target services
Secondary Prevention
Pri
ma
ry P
reve
ntio
n
Un
ive
rsal
& W
ell-
be
ing
LOWMODERATE
SUBSTANTIAL CRITICAL
Reduce numbers of people coming into high-cost services and
moving along FACS banding
Intensive Home Support
Residential Care
Community Equipment Services
Telecare Service
Tertiary Prevention
Risk Stratification
• A tool to support the model we have outlined above
• Help shift the balance of care from the acute to primary and community sectors and improve services locally.
• NHS commissioners should be as interested in this as social care
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Risk Prediction & Prevention
• Assessing risks of adverse outcomes and assigning people to these
• Multiple mathematical algorithms• Need to include BOTH health and
social risks• Identify interventions known to
succeed in mitigating risks• Implement
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From this
To this
From this
To this
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Falls Prevention• In Birmingham, over 40,000 older people have
falls every year.• 35% of over 65s experience one or more falls. • 45% of over 80 who live in the community fall
each year. • By reducing the common risk factors and by
providing appropriate equipment, falls can be reduced by between 10 -40%.
• A person’s home environment can also contribute to the risk of falling.
• Ageing demography means all this will increase 50% by 2020
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Prevent Falls – project approach
By providing a pathway for people who may be at risk of falling to get the help they need
• checklist to identify people at risk at falls and link to services and information
• Multi-agency: Birmingham City Council, Health Services, Third Sector
• Training for participants• Programme management –part of wider
prevention• Public health evidence based • Referral to a selection of agencies
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Prevention of Falls - Process• Target Population
• Persons over 50 years living in Birmingham
Complete Checklist and Questionnaire
Receives Checklist and Questionnaire
Record DataSend service
request to Service provider
Send Follow up letter to Client
Records Service delivery
Forwards checklist and questionnaire
Receives Follow up letter
Receives Service Request Forms
Visitor Agency
Citizen Receives Services
Service ProviderInitiates Services
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Results to date
• Over 500 people supported • All received information on preventing falls• Average number of services requested per
checklist – 2.6 requests per person• Number of people having a fall since – 14% (46%
before checklist)• Over 66% were very confident that the
information and services they received would help them prevent falls in the future
• There was a reported 3.7% improvement in quality of life
• One woman £11k • Service User evaluation commencing
The JSNA and Prevention
• Whether we like it or not, we have limited resource for JSNA and limited data capabilities
• Still a top down approach to data• How do we get past these
challenges?
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Two Approaches
Top Down• From hospital and
other data identify the key outcomes we need to prevent
• Identify
Bottom Up• Work from clinical
and other records, shared to assess, predict and communicate risk
• Feed outcomes from those folk into data warehouse to refine algorithm and monitor outcomes
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Challenges
• Political Will• Resources• Legal and Data Governance• Systems
• We have some way to go, but the work already underway demonstrates this is worth doing
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The Outcomes
• A public health approach in social care should bring the following benefits:– Less people in residential care– More people independent– Less costs to NHS and Social Care– Fewer costs to GPs for those with long
term conditions and disabilities– A way of monitoring the new market and
micro-commissioning
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