The active and independent living programme 2016-2020

Prevention and Early Intervention

Background

The Minister for Public Health and Sport announced in May 2015 the need to build on the successes of the AHP National Delivery Plan 2012-2015 and provide an ongoing focus for AHPs' contributions to supporting the population's health and wellbeing. A new national programme - the Active and Independent Living Programme ( AILP) - was agreed, closely aligned to the 2020 Vision and the broader policy context across health and social care. An extensive engagement process identified the vision and priorities (for further information on the engagement process, visit the AILP community of practice).

The case for prevention and early intervention

AILP is underpinned by an acknowledgement of the importance of prevention and early intervention to people's lives. Prevention and early intervention are key themes throughout Scotland's health and social care policy agenda, and are central to the ambitions of the Health and Social Care Delivery Plan.

A significant percentage of the NHS Scotland's annual spend is on preventable conditions, and 2% of the population use 50% of hospital prescribing resources. ^[2] Services must be transformed to focus on how best to manage wellness, rather than waiting for a crisis to occur, and preventative approaches in the community need to be addressed to support the Health and Social Care Delivery Plan's target of reducing by 400,000 the number of unscheduled hospital bed days and doubling the provision of end-of-life and palliative care in communities.

The evidence base for preventative strategies, including many AHP-led interventions, is now growing in key areas such as communication in children and young people, mental wellbeing, physical activity, nutrition, and work and health. AILP aims to make a significant contribution to supporting AHPs through specific wellbeing programmes - Move & Improve, Eat Well and Making Every Communication Count (for more details on these programmes, see Appendix 1 and visit the AILP community of practice).

In addition, a national survey of AHPs in May 2017, in which every AHP working in adult services in Scotland was asked to undertake a 'Lifecurve' survey with two people, will provide for the first time a baseline of the stages in people's lives at which AHPs intervene. The expectation is that this will too often be revealed to be after the early intervention/prevention stage, and the survey will provide evidence to identify what work is required to shift the focus. Information on the Lifecurve can be accessed from the AILP community of practice.

Policy context in relation to prevention and early intervention

AILP is not a standalone programme and is part of a wider policy agenda supporting prevention and early intervention. It aligns to A Plan for Scotland and its four underpinning priorities for long-term improvements to the health of the population:

• empowering a truly community health service
• enhancing mental health
• improving population health
• supporting clinical leadership of transformation.

The overall aim of health and social care in Scotland is that people can be supported to live longer, healthier lives at home or in a homely setting. The focus is on prevention, early intervention and supported self-management. Where people need hospital care, the aim is for day surgery to be the norm, and when stays must be longer, for people to be discharged as swiftly as it is safe to do so with the right community support where appropriate. These aims are supported by Scotland's National Wellbeing Outcomes, which focus on improving the experiences and quality of services for people and their families.

The vision for primary care is that by 2030, primary and community care will be at the heart of the healthcare system. Highly skilled multidisciplinary teams will be delivering care within locality clusters, with GPs involved in strategic planning. The public will be more informed and empowered, and will be able to access directly the right professional care at the right time, while remaining at or near home wherever possible.

This vision is supported by the concepts outlined in Realising Realistic Medicine, which put the person receiving health and care at the centre of decision-making and create a personalised approach. It aims to reduce harm, waste and unwarranted variation, while managing risks and innovating to improve.

The needs of people with long-term conditions, dementia or mental health problems, or who are socially excluded or otherwise vulnerable, are also central to policy drivers. The National Performance Framework, to which all public services in Scotland are aligned, provides a clear vision with broad measures of national wellbeing covering a range of economic, health, social and environmental indicators and targets. In addition, Scotland's new Mental Health Strategy 2017-2027 sets out priorities to deliver significant improvements in the mental health of the population at key life stages.

AILP and prevention and early intervention

AILP emerged as a key action of the Health and Social Care Delivery Plan. Its aim is to support people of all ages and abilities to live well, be physically active, manage their own health conditions, remain in or return to employment, and live independently at home or in a homely setting. Relevant AILP work streams are fully embedded in national health and social care policy programmes, including Transforming Primary Care, the Modern Outpatient, access and flow programmes, the Mental Health Strategy, the Dementia Strategy and a range of programmes to support the outcomes of integration, including the 400,000 bed-day reduction.

Realising the AILP vision will require a concerted and sustained focus on prevention, early intervention and enablement. Key to this will be effective partnership working, driving the inherent culture change required, alongside strengthening workforce development requirements, as set out in the National Workforce Plan.