Public Health Prevention And Social Care Mcmanus 7 April 2011

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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