When philosopher Desiderius Erasmus said Prevention is better than cure, I doubt he thought we would still be stating the obvious over 500 years later.
Chapter two of the NHS Five Year Forward View is dedicated to ‘Getting serious about prevention’ and creating a ‘new relationship with patients and communities’. It references Derek Wanless’ health review of twelve years ago, which ‘warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded – and the NHS is on the hook for the consequences.’ At least Erasmus and Wanless agree.
The scale of the challenge is huge and emerging from this is the growing debate about the future of community care. In order to prevent ‘avoidable illness’ we all can assume there needs to be a whole community approach to prevention. The future of the NHS surely depends on people, young and old, being able to manage their health in a way that doesn’t lean so much on the wonderful, but costly health system we all applaud. But they can’t and won’t be able to do it alone.
Community intervention in public health is essential and thankfully is already happening. This is something we at the Community Development Foundation looked at for our 2014 research report Tailor-made, that can be found here on the SCIE website. We reviewed over 130 sources of literature bringing together evidence and stories of the community sector’s contribution to people’s lives and society as a whole. The title of the research perfectly describes what is special about these groups. They evolve out of community needs, are led by local people and serve the people on their doorsteps. As a result, they provide services and activities that are a perfect fit for their communities.
Some of the striking findings of the research are the eight distinctive characteristics of these small groups: volunteers and staff are needs-based and expert often with first-hand experience of the issues facing their beneficiaries. Because of this and their local nature they are trusted. They are also holistic – individual needs are not segmented into social policy categories, such as health or housing – and they are connected to their community, support the whole person and co-ordinate care across different providers. As a result of all of this they are committed and value for money. Our dedicated microsite brings this to life with health and wellbeing case studies.
But how many public or private sector providers could claim these characteristics for their own organisation? How can we deepen community-based care and increase collaboration between healthcare professionals and these embedded local resource and, through them, shift from reactive to preventative responses? We have a good idea of the scale of the problem, from tackling obesity to caring for an aging population, so what is the scale of the opportunity for community-led interventions?
In 2010 the Third Sector Resource Centre’s review of the UK’s ‘under the radar groups’ it was estimated there were 600,000 – 900,000 micro and small volunteer-led groups. Ninety-five per cent of these community-based organisations had an annual income of less than £2,000; 51% of registered charities were described as micros with an annual income of less than £10,000. These income-light groups form the largest proportion of the wider voluntary and community sector and are incredibly resourceful. And in 2011 The Kings Fund identified just under a quarter (39,340) of England’s £171,000 voluntary and community sector organisations were involved in the provision of adult health and/or social care and support services. Taking all of this data into account, I would say that the opportunity is huge.
This blog was first published on the SCIE Prevention Library Forum