Just 10 mention the NHS Five Year Forward View. While none of these strategies was rated weak or very weak, there was no obvious correlation between doing so and a high-rating label. Perhaps this is because the Forward View fails to emphasise the importance of tertiary preventative interventions in the same way it emphasises primary and secondary. Thirty-seven strategies mention the Better Care Fund (or Transformation Fund, as it used to be called) in comparison to just six out of 138 last year. This could be because Better Care Fund plans have further developed over the course of the year. Recommendation: > Health and Wellbeing Boards should update their joint health and wellbeing strategies regularly so that they include key policy and practice developments. The triple definition of prevention While many more strategies are emphasising the using the triple definition of prevention is a useful importance of preventative interventions being way to ensure preventative interventions are being adopted across the life course and the pathology adopted across the life course and the pathology of of a condition or illness, only 12 joint health and a condition or illness. wellbeing strategies use the full triple definition of prevention (either primary, secondary, Some Health and Wellbeing Boards have used tertiary / prevent, reduce, delay / both their own terminology. In some cases the terms terminologies). applied cover all three types of prevention, but in many cases do not. For example, sometimes tertiary A further 46 use this terminology in part. For prevention is captured solely as ‘reablement’ or ‘long example, only talking about ‘delaying and reducing term care’. However, tertiary prevention is more than the need for care and support’ (often when referring just reablement and applies to more than those with to the Adult Social Care Outcomes Framework that long term needs. 31 includes this as its second of four key ‘domains’). In other cases, only the terms ‘primary’ or Various strategies also include a definition or ‘secondary prevention’ are mentioned. explanation as to what is meant by ‘wellbeing’. These definitions vary despite ‘wellbeing’ being Confusion as to what constitutes primary, defined under Section 1(2) of the Care Act. secondary or tertiary prevention was evident in some of the strategies. Some strategies appear to conflate ‘secondary’ and ‘tertiary’ prevention into Recommendation: ‘secondary prevention’. > Health and Wellbeing Boards should The British Red Cross does not want the sector to incorporate the Care Act’s triple definition of be diverted by discussions about which interventions prevention into their joint health and wellbeing sit where, so long as preventative interventions are strategies. being adopted before, during and after a crisis. > Health and Wellbeing Boards are Indeed, there is no hard and fast rule as to where encouraged to look to define ‘wellbeing’ using each preventative intervention sits. As the statutory the Care Act’s definition set out in Section 1 of guidance explains, ‘services can cut across any or 33 the Care Act. 32 all of these three general approaches’ . However, British Red Cross Prevention in action [email protected] 14 l l