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Investing in prevention for older people at the health and social care interface

Paper | September 2011

This paper describes a new investment model designed to stimulate improved and more cost-effective outcomes for older people at the interface of health and social care. Its emphasis is on reducing demand by providing targeted preventative services as a mainstream intervention - rather than as add-on or pilot-based service - and integrating provision so that it straddles health and social care.

Based on a presentation by Professor Andrew Kerslake of IPC to the Eastern Region group of the Association of Directors of Adult Social Care (ADASS), the paper begins with an assessment of the demographic and other drivers of rising demand on services, before assessing the shortcomings of demand-reduction strategies to date. Among these, it identifies primarily a lack of clarity on the relationship between funding and outcomes, noting the potential failure of coordination between multiple separate funders and the danger that prevention strategies run alongside the mainstream interventions they are supposed to replace, and show up as an additional cost.

Drawing on earlier interview and case file audit research conducted by IPC among care home populations, the paper then identifies key characteristics and conditions found among those admitted, including continence problems, dementia, stroke and falls. The limitations of existing care approaches to these conditions are outlined and a new investment-based model described, based on: assessment of resources available, outcomes desired, evidence base available, likelihood of benefits occurring, the extent of savings they would offer, and the timescale over which those benefits would accrue. The merits of this framework are then demonstrated by applying it to falls to illustrate the potential savings from reduced demand and the better outcomes for users.

The paper concludes with implications for local commissioning strategies.

For further information please contact Keith Moultrie at IPC

Tel: 01225 484088