By Dr Simon Read
Prevention, acting early to stop unwanted things happening, is entrenched into our daily lives. Everyday tasks like tooth-brushing and maxims such as ‘a stitch in time saves nine’ are underpinned by the premise of prevention. It seems so commonsensical, driven by a logic that is hard to deny.
Anna Coote summarises prevention across three areas: upstream, midstream, and downstream. Taking action downstream arguably plasters over a problem that is happening farther up the river. In healthcare, this has led to preventative monitoring in a range of conditions, and public health efforts towards smoking cessation, healthy eating, regular exercise, and improving environmental conditions.
Prevention in social care
But how does this work in social care? In a highly complex landscape, often requiring a historical imagination to understand the root causes of individual and community issues, can we apply these same approaches?
I’ve been researching preventative social care and support in Wales for five years, initially working with a team evaluating the Social Services and Well-being (Wales) Act 2014. We found a contested terrain where multiple interpretations of prevention are fused together. For some, it is up to communities and individuals to help themselves. For others, decreased budgets, a diminishing workforce, and increased demand have resulted in prevention being seen as a way of reducing state expenditure or avoiding system collapse.
Necessity and complexity of prevention
This position is born from concerns around state provision of care, particularly for older people. Demographic shifts now point us towards an ageing population, with the active workforce lessening yearly. It is tempting to see prevention as a ‘golden goose’, a means of softening these impacts, or at least delaying them.
But the history of prevention demonstrates that it is an ongoing process, and one that gets abandoned when economic times get tough. And that’s because, by its nature, preventative social care and support is complex and emergent and requires attentiveness and investment. It is also inherently difficult to measure the impacts of its labour, because these can be long-term, tangential and non-linear.
Demystifying prevention in social care
The intention of my project is to demystify some of these processes. This will involve thinking through what preventative services are truly trying to achieve. Is it enhanced well-being for the individuals using them? Greater connection to one’s community? Growth of community assets and resilience? Or the avoidance of state expenditure?
A lot hinges on how we negotiate these dilemmas. It will need a multi-faceted, considered approach with views on how best to develop integrated ‘whole systems’, and how they best accommodate the complex lives of those they serve.
Acknowledgements
This post was driven by findings from the IMPACT Study, and my ongoing Health and Care Research Wales Social Care Research Fellowship. I’d like to acknowledge the incredible teams who have worked on and supported these projects, including Professor Fiona Verity (Brunel University), Dr Gideon Calder (Swansea University), Professor Mark Llewellyn, and Professor Jonathan Richards (both University of South Wales).
