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The prevention paradox

By guest blogger JEF SMITH

1.4 million older people – according to the pressure group Age UK and no-one has challenged their figure – are struggling to manage day-to-day tasks without support from the social care system which was theoretically designed to meet their needs.

Quite apart from relieving human misery, Age UK points out, decent care would ‘prevent even more strain on a system that is on the edge of collapse’. The financial case complements the moral justification.

It makes obvious sense to take preemptive action to stop something worse happening in the future, but the concept presents several difficulties. Can people who feel perfectly OK right now be persuaded to get (time-consuming) dental checks, take arduous physical and mental exercise, and stay off delicious but dangerous foods, on the grounds that such self-denial might save them from suffering x years in the future? Equally important, can public bodies legitimately redirect (inevitably scarce) funds away from pressing current needs for the sake of (uncertain) long term benefits?

As far as social care is concerned, prevention, and its near neighbour early intervention, have clearly lost out. Under the pressure of austerity, local authorities have all but dropped any services which do not respond to older people’s severe and immediate needs. Their priorities are reinforced by the fact that the independent organisations which provide most services are – by definition – largely interested in products which yields profits. By and large, for example, neither local councils nor self funders are sufficiently motivated to use day care, a perfect example of a preventative service, to make it commercially viable, so over recent years most day centres have closed.

I was musing on this perverse incentive the other day in my GP surgery’s waiting room when I spotted a poster with the admirably pro-prevention headline ‘Don’t wait until you feel worse’. What the message went on to say was – make more use of pharmacists.

Pharmacies, of course are businesses, so in this case commercial pressures are working to promote prevention rather than the other way round. Is there some way in which we could get a similar beneficial dynamic into social care?

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.

3 Replies to “The prevention paradox”

  1. Jef poses an interesting question. A related question is ‘Should we reward financially older people who are healthy and not costing the state money?’

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