This chapter was added to the APPP in July 2018.
It is essential that care and support systems actively promote wellbeing and independence, and do not just wait to respond when people reach crisis point. It is also vital that care and support systems intervene early to support individuals, help people retain or regain their skills and confidence, prevents need or delays deterioration in their condition wherever possible.
The local authority’s responsibilities for prevention, reducing and delaying needs apply to all adults, including:
- people who do not have any current needs for care and support;
- adults with needs for care and support, whether their needs are eligible and/ or met by the local authority or not;
- carers, including those who may be about to take on a caring role or who do not currently have any needs for support, and those with needs for support which may not be being met by the local authority or other organisation.
The term ‘prevention’ or ‘preventative’ measures can cover many different types of support, services, facilities or other resources. There is no single definition ; it can range from wide scale whole population measures aimed at promoting health, to more targeted, individual interventions aimed at improving skills or functioning for one person, a particular group or lessening the impact of caring on a carer’s health and wellbeing. In considering how to give effect to their responsibilities, local authorities should consider the range of options available, and how those different approaches could support the needs of their local communities.
Prevention is not a one off activity. Prevention can sometimes be seen as something that happens primarily at the time of a diagnosis or assessment (or soon after), or when there has been a subsequent change in the person’s condition. Prevention services are, however, something that should always be considered. For example, for carers caring for a family member at the end of their life, prevention services could include the provision of pre-bereavement support.
Strategies that support carers to continue to care should take carer resilience into account. Listening to local carer communities about the pressures they are face should be reflected in Joint Strategic Needs Assessments. Partnership working between, health, social care and carers groups is one way of working effectively to ensure that prevention strategies reduce the incidents of safeguarding and support carers to carry out their duties safely.
2. Prevent, Reduce, Delay
‘Prevention’ is often broken down into three general approaches – primary, secondary and tertiary prevention – which are described in more detail below. These terms illustrate what type of services, facilities and resources could be considered, arranged and provided as part of a prevention service, as well as to whom and when such services could be provided or arranged. However, services can cut across any or all of these three approaches and so the examples provided are not to be seen as limited to that particular approach. Prevention should be seen as ongoing and is not a single activity or intervention.
2.1 Prevent: primary prevention / promoting wellbeing
Prevention is aimed at individuals who have no current particular health or care and support needs. These are services, facilities or resources which are provided or arranged that may help an individual avoid developing needs for care and support. They may also help a carer avoid developing support needs by maintaining independence, good health and promoting wellbeing. They are generally universal services (that is, available to all), which may include – but are not limited to – interventions and advice that:
- provide universal access to good quality information;
- support safer neighbourhoods;
- promote healthy and active lifestyles (for example exercise classes);
- reduce loneliness or isolation (for example befriending schemes or community activities);
- encourage early discussions in families or groups about potential changes in the future (for example conversations about potential care arrangements or suitable accommodation should a family member become ill or disabled).
2.2 Reduce: secondary prevention / early intervention
These are more targeted interventions aimed at individuals who have an increased risk of developing needs. The provision of services, resources or facilities may help slow down or reduce any further deterioration, or prevent other needs from developing. Some early support can help stop a person’s life tip into crisis, for example a few hours support to help a family carer who is caring for their son or daughter with a learning disability and behaviour that challenges at home.
Targeted interventions should include approaches to identifying carers, including those who are taking on new caring responsibilities. Carers can also benefit from support to help them develop the knowledge and skills to care effectively and look after their own health and wellbeing.
2.3 Delay: tertiary prevention
These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible. Tertiary prevention could include, for example the rehabilitation of people who are severely sight impaired.
Tertiary prevention services could also include helping improve the lives of carers by enabling them to continue to have a life of their own alongside caring, for example through respite care, peer support groups like dementia cafés, or emotional support or stress management classes which can provide essential opportunities to share learning and coping tips with others. This can help carers develop mechanisms to cope with stress associated with caring and help them develop an awareness of their own physical and mental health needs.