1. PREVENTION : Role of Housing & Housing related support Rosanne Sodzi Dept of Health (South West)

2. What is health? A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO definition)

3. Living and working conditions Work environment Unemployment Education Water & sanitation Agriculture & food production Health care services Housing Age, sex and constitutional factors Source: Dahlgren C and Whitehead M (1991) What Determines Health?

4. Prevention What are we trying to prevent? When are we “doing” prevention? Where do we do this work? How do we “do” prevention? Who do we need to tell? How do we do more?

5. What do we want to prevent? For individuals: physical ill health poor quality of life/isolation poor mental health having to move house when they don’t want to.

6. What do we want to prevent? For Health & Social Care Organisations: Unnecessary hospital admission Expensive treatment for preventable conditions Delayed hospital discharge High levels of intensive social care Admission to nursing homes Moving from own home to supported housing, including sheltered, extra care etc.

7. Should we focus on what to prevent? Or should we focus on what we want to ACHIEVE? A healthy population Supported to Live independently where they want to be In a active, safe and vibrant community & A FOCUS ON THE MOST VULNERABLE

8. What are preventative services? Services which delay or reduce the need for more costly intensive services Strategies and approaches which promote quality of life and engagement with the community (Source : ADSS)

9. Three types of prevention Primary prevention : to prevent the occurrence of disease/injury (Decent housing, healthy lifestyles, falls prevention, good neighbourhood support) Secondary prevention : identification and treatment of disease/illness at an early stage (low-level services to enable people to manage at home, early detection of illness)

10. Three types of prevention Tertiary prevention : reducing disabilities & promoting independence Maintenance of independence and slowing down of processes of deterioration Reducing levels of home care Reducing Length of stay in residential care or hospital

11. When do we “do” prevention? For housing and housing related support Where is your prevention work? Do we focus on providing a framework of prevention for the people in our local authority, in our housing scheme etc?

12. A Checklist of Preventative Care strategies : Where are they? Environment : location of home, quality of home Medication: of preventative drugs, compliance Lifestyle : physical activity, maintain mental activity & social activity

13. Example : What does Sheltered Housing offer? Primary prevention : a decent home, availability of care and support, health promotion activity, a community of residents, sense of security Secondary prevention : early detection of illness, provision of low-level care Tertiary prevention: Availability of social care and support, telecare, adaptions.

14. Low to moderate needs Citizenship Information Lifestyle Practical support Early intervention Enablement Community support for Long Term Care Institutional avoidance Timely discharge ‘Preventative’ interventions General population Complex needs Substantial needs

15. How do we “do” prevention? Do we know what works? Have we looked at the evidence of what works? Have we used this evidence to shape what we do? Do we stop doing things which don’t work? Do we tell others, when it does work?!

16. Who needs to know? Commissioners of health and social care (Feed into Joint Strategic Needs Assessment) Directors of Public Health Local Area Agreement teams

17. Lots of National Indicators! Do you know what’s in your LAA? Can you become part of the delivery plan? All 198 indicators have to be reported on.

18. Examples of some NIs 139 Satisfaction of over 65s with home & neighbourhood 140 Fair treatment by local services 187 Tackling fuel poverty 119 Overall health & wellbeing 136 Supported to live independently 125 Achieving independence though rehab 129 End of life care 131 Delayed transfers of care

19. Summing up Think about how your services contribute to the prevention agenda : primary, secondary and tertiary Are you using the evidence base available to shape services (look at the Housing LIN website!) What can you do differently, within existing resources, and with more resources Know your local areas priorities

20. Why prevention? Is it better to invest in a fence at the top of a cliff or An ambulance at the bottom?

21. The Best Fences Housing and Housing Related Support Need to demonstrate that their services are often the best fences available for some of our most vulnerable groups.