By Paul Goulden

The case for prevention in health and social care is one that governments across the world acknowledge, and yet often prevention services are the first to be cut when budgets are tight. Is this sensible?

To explore how prevention is more cost effective that crisis treatment, we need to look at what prevention looks like on the ground.

So . . . if you are of a sensitive nature or have an issue with feet, then you may want to stop reading now.

The fact is that toenails are a big issue. If they are not cut regularly, there are a variety of problems that occur.

Anyone who has worked on the front line in the health and social care space will be able to tell you horror stories of poor footcare; toenails curling under feet, or in some cases people not being able to take slippers off because they are toe-nailed to their feet. And from this, it naturally follows that there is a massively increased falls risk due to poor footcare.

Other poor foot care and untreated issues like ulcers and fungal infections can lead to complications and wider impacts on general health, and this is without the impact on wellbeing and dignity brought on by the shame of not being able to look after yourself.

There are many reasons why older people become unable to look after their own feet. When mobility reduces, there can be clear difficulties in people being able to reach down to their feet, especially if you add in conditions like arthritis of the hands or Parkinson’s Disease. And as with so many conditions, there is this “it’s alright, I’m coping attitude” that, while being a noble sentiment, is also completely misplaced and prevents them getting help.

Yet, the benefits of basic footcare interventions massively outweigh the actual costs. I did some work a few years ago on this and found that

• The cost of a neck of femur break caused by a fall, including ambulance, A&E, in-patient stay, home care package and physio was in the region of £30,000.
• A foot care assistant role seeing 5 clients per day, five days a week over 50 weeks, with clients seen quarterly can look after 300 clients per year.
• Salary, on-costs and overhead costs for the staff member(s) were around £30,000.

So, using those figures, an investment of £30,000 would pay for itself by preventing just one neck of femur break due to poor footcare. Every further outcome would be a saving to local health care provision. So why isn’t basic footcare provided to all those who need it? Even on a subsidised basis?

One of the issues is that the NHS generally wants to see savings in current revenue rather than deferred savings (i.e. stopping things that would have happened in the future), and this has been a constant problem for preventative services – how do you prove something has not happened?

In ILC’s report: Money talks: Investing in proactive health measures to support healthy ageing, we established a direct link between increasing spending on prevention measures and improvements to a decrease in avoidable mortality, an increase in life expectancy, and higher survivability rates of lung and breast cancers.

As the above example shows, small scale and relatively inexpensive interventions can have a big impact. If governments acknowledge the importance of prevention, then these simple solutions can deliver huge savings to the NHS and great wellbeing benefits for our ageing population. Time to put our best foot forward.