Determining Best Preventative Social Care Practice in the Contexts of Older People Receiving Care and Support at Home and Those Living with Dementia

End of project summary

Main Messages

The Determining Best Preventative Social Care Practice (DBPSCP) study undertook qualitative research in four of the seven Welsh regions exploring how, and in what ways, they have enacted the call for ‘prevention’ in Welsh laws such as the Social Services and Well-being Act (Wales) 2014. Over the first two phases of research, 64 professionals (e.g., local authority, health board, or community organisation workers) were interviewed to establish how they understood prevention, what strategies were guiding it, and what actions were being taken particularly in the context of older people and those living with dementia. We also analysed regional documents to see how prevention was talked about. These research phases identified 11 case studies of good practice to take forward and investigate further. The third phase of research talked to and observed front line practitioners (69), older people (40), and their carers (17) to gain knowledge of how the case studies worked for older people, and in what ways they made their lives better.

• Case studies covered community connector services, front doors of social care, integrated hospital discharge teams, community agent services, age friendly initiatives, micro-enterprise provision, unpaid carer organisations, and bottom-up community development.
• Resilient communities were a core focal point for all regions, as was how individuals accessed health and care systems, and were referred to other parts of the ‘whole system’. Underlying this were concerns around demand management, decreasing budgets, and workforce recruitment and retention.
• There were no bespoke prevention strategies in the regions. Instead, prevention was often seen as implicit in the work of all statutory systems. Case studies, therefore, highlighted responsive and pro-active, episodic and long-term forms of prevention.
• Case studies also highlighted the exceptional work of professionals, with this sometimes operating alongside well-organised, interconnected systems. The buy-in of all key stakeholders was important in developing the latter.
• Measuring prevention remains difficult, particularly over the long-term. Greater in-depth work on the theory of change behind specific initiatives and their contributions to the ‘whole’ system and individual or community well-being will help to evaluate what is working, how long we think it might take for tangible change, and for what reasons.

Complexity theory and life course theory may contribute ideas that help to navigate these tensions and guide future practice in evaluating and understanding prevention.