Prevention is better than bed-blocking

There were a few eyebrows raised last week when the Health Minister, Mark Drakeford AM, talked of problems of older people ‘bed blocking’ at A&E wards.

Setting aside the unhelpful pejorative language about older people, there is a serious point that we need to treat and care for more people (of all ages) at home or in the community rather than in formal and costly NHS or social care environments. This is an area where the Social Services & Wellbeing (Wales) Bill could prove influential, as it paves the way for a much greater emphasis on preventative services.

But what do we mean by the term preventative services?

The Bill talks of services which “contribute towards preventing or delaying the development of people’s needs for care and support”. The spectrum is wide and subjective, and rightly so – we need to allow people to decide what works for them, and what they feel helps them to retain their independence. For the older people with whom WRVS works, all they want is a little bit of help, which might take many forms – the Older People’s Commissioner has stressed the importance of companionship and support networks, Age Cymru have stressed the benefits of providing help with jobs around the house and garden, and the Institute for Welsh Affairs have praised services tackling loneliness and isolation. All are ‘preventative’ if they help older people to live happily in their own homes without the need for formal and costly residential care.

Research clearly tells us that only a more preventative agenda will be sufficient to respond to current and future pressures caused by changing demographics. We also know that older people themselves see a clear benefit in preventative services, with one recent study showing that older people prefer to receive domiciliary care than to be admitted into residential care. Elsewhere, the British Red Cross have said that their low-level support services alone can delivered savings of between £700 and £10,430 per person.

These supportive noises are not siren voices in the wilderness, or fringe groups with vested interests. Within Wales, the ever-growing consensus on prevention and early intervention includes the BMA Cymru, the SSIA, Public Health Wales and the CSSIW and Healthcare Inspectorate Wales.

So given the clear mandate, what needs to change?

The Social Services & Wellbeing Bill looks set to create a duty for councils to provide some sort of preventative care, and that should be thoroughly welcomed. Yet it is unclear whether these services will be free, and who will be entitled to receive them. These are fundamental questions which have to be answered before the Bill can be properly evaluated.

The charging issue is crucial. For older people to have ‘voice and control’ (in the current lexicon), they need access to information and advice at the earliest stage, prior to any formal assessments. They will obviously be deterred from doing so if they are charged simply for seeking advice. There needs to be a clear commitment in the Bill to ensure there is no charging for information and advice services.

An equally explicit statement is required on eligibility. For some time, local authorities have been gradually raising the threshold at which people become eligible for support – which means those falling below the threshold are less likely to get the help they need. The Bill talks of standardising the eligibility process, but is silent on where local authorities should set the bar. For prevention to become embedded in the system, any changes to eligibility must go hand-in-hand with a commitment that councils must not reduce the number of people receiving preventative support.

The Social Services & Wellbeing Bill is the biggest shakeup of social care in Wales for a generation. But it will only be truly successful if it delivers the shift in favour of preventative care which has repeatedly been shown to be necessary.

Dr. Ed Bridges is Public Affairs Manager for Wales, WRVS