1. Prevention in Social Care: A Public Health Perspective Jim McManus Joint Director of Public Health 7 th April 2011 1

2. 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

3. 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 3

4. 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) 4

5. A new care model and public health 5 Increasing Means Increasing Needs Citizen purchased care – state resources Citizen purchased care – own resources Enablement Prevention Universal offer

6. Health Improvement Health Protection Service Quality and Improvement Commissioning priorities, Evidence, making it work, supporting implementation Ensuring we have the right frameworks in place. Safeguarding too Long term, medium term, short term, matrix Prevention, Enablement Components of a Public Health social care model Prediction and Prevention

7. 7 Prediction forecast / target services Secondary Prevention Primary Prevention Universal & Well-being LOW MODERATE SUBSTANTIALCRITICAL 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

8. 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 8

9. 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 9

10. From this To this

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12. 12 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

13. 13 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

14. 14 Prevention of Falls - Process Target Population Persons over 50 years living in Birmingham

15. 15 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

16. 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? 16

17. 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 17

18. 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 18

19. 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 19