"It's time to make prevention across public services a reality"

The idea of prevention, is highly regarded by many as an essential enabler of a sustainable health and social care system. Prevention or preventing means acting early to avoid or delay someone’s need for formal, intensive health and social care support.

The key issue is that both the definition and application are broad; from public health programmes; to focussed interventions with identified ‘high risk’ groups; to more traditional deployment of equipment and technology. What works, and how can we implement prevention effectively across local communities?

Despite good intentions, delivering prevention at scale locally has remained elusive."

The wide range of applications and interpretations has meant that very few programmes have successfully demonstrated that prevention is an investable and scalable proposition. Implementation is also complex, as recognised through both the Fuller Stocktake and the Hewitt Review.

However, the emerging capability of technology, and in particular artificial intelligence and machine learning, presents an opportunity to change the narrative. With technology, and artificial intelligence a mainstream part of many of our lives, applications like ChatGPT have brought to life the possibilities of implementing prevention, and made this feel more familiar, improving trust and understanding.

These exciting developments have now given health care specialists the capability to use vast amounts of data to identify who would benefit from a specific type of intervention, and this is becoming more and more mainstream. This adds a new level of possibility and energy to the field, and makes targeted, proactive prevention deliverable, scalable, and sustainable.

For example, a falls model developed by one county council can predict the likelihood of a fall in the next 12 months to an accuracy of 70 per cent. The same technology uses natural language processing to read case notes, and draw out and highlight key risk factors, supporting professional judgement rather than replacing it, building collaboration and trust. Not just relevant to falls, the technology provides a single view of a resident providing a platform to identify risks as diverse as social isolation, homelessness, and involvement in youth violence.

Taking a proactive approach to prevention, underpinned by technology, challenges the notion that significant investment is needed to make substantial progress."

Proactive prevention can support the challenges of the here and now, and the long-term future. Whilst the long-term direction absolutely needs to be about redeploying resources to communities and prevention, a focus on proactive prevention enables existing resources to be better focussed on the cohorts of people who need them the most right now, releasing pressure in the short-term.

The same county council who implemented the falls model is delivering interventions to individuals most at risk of a fall using existing services, such as the reablement service, assistive technology, housing and handyman services, and the voluntary sector. This approach enables the building of evidence and confidence in interventions that work, which can then be scaled up, without the requirement of significant investment.

In another city, this approach resulted in health and social care services targeting preventative support at the five per cent of residents driving over half of all demand. Specific, tailored approaches were taken which targeted cohorts within this small minority, such as men in their 60’s, who are over five times more likely to need to engage with cancer services.

Proactive prevention is not as simple as deploying technology."

Organisations and systems moving to a model of ‘prevention first’ are having to deliver an entirely new operating model. With data and technology sitting at the heart of this and people, processes, systems, and commissioned services fully aligned. The operating model is structured around key resident cohorts rather than services delivered, to enable and support a deep understanding of the people living in a particular place. Governance, KPIs and culture embrace targeted prevention and encourage innovation. Achieving this consistently, nationwide, represents a major programme of change for public services.

Local systems also need national support."

Data sharing and information governance need to enable and promote effective data sharing across health and social care at both a local and national level, to build a deep understanding of the cohorts to target. As it stands, information governance is more often a blocker than an enabler. In addition, there are also significant ethical considerations, including how to communicate sensitively with residents around the risk of a future health event, which need to be dealt with through a careful process of co-production and engagement. There are local solutions to these challenges, but national action, support, and frameworks could support faster and more effective implementation at scale.

The leadership role required in local systems should not be underestimated."

Leading a complex programme of change and innovation, whilst dealing with the significant operational and financial challenges in the here and now, requires a sophisticated approach. Developing an organisation that fosters innovation, building strong partnerships across a system, and having literacy and confidence in data and technology are all key components of successful leadership of prevention approaches, which require concerted effort and investment to develop.

Public services cannot continue as they are, with rising demand for support, spiralling unit prices, and a challenged workforce. Major transformation is needed to shift to a new and more sustainable operating model, where the focus is on a targeted approach to prevention. Whilst there are significant challenges in taking this step, many of the solutions now exist, and with the right leadership these can be adopted at scale. The time is now to be optimistic for the future of public services, and to make targeted, proactive prevention a reality.