Climbing ladders: From treatment to prevention (2025)

After a stroke two years ago, Sue often feels wobbly on her feet. She fell in the street last year and broke her wrist, which has left her feeling afraid to go out. She used to enjoy bingo with friends but no longer feels able to manage it and is becoming isolated. She now relies heavily on her daughter, Carol, for getting out to appointments and having regular hot meals.

Sue lives in a privately rented home that has become damp, with mould starting to show in several rooms. She often has a bad chest and struggles to move around. She needs a handrail on the stairs to feel safe, but her landlord has not been helpful with repairs or adaptations.

Despite these issues, Sue doesn't want to move - she has happy memories of living there with her late husband, Bill, and worries how a move would affect her beloved cat and best pal, Ivy.

After asking Carol to help her find out who she can complain to, Sue contacted Private Sector Housing at the council to report that her landlord had not carried out her repairs.

An officer for the team inspected Sue's home to check what repairs or improvements were needed and the landlord received a formal notice covering all the necessary repairs. With their help, the landlord finally carried out repairs that fixed the damp and mould.

The council also referred her to Adult Social Care Direct, which led to a banister rail being fitted in her home.

Since then, Sue's health has improved and she is visiting the GP less regularly, but her latest visit really helped her continue improving on her own.

At her last appointment, Sue's GP referred her to a programme to help improve her strength and balance. Each week for the 14-week programme, she is picked up by a taxi , because of her mobility issues, and taken to the local leisure centre for an exercise class designed to prevent falls for people who are over 65 and are mild or moderately frail. Sue now does her exercises at home every day and has made a new friend from the course. They plan to go to a local community exercise class together once the programme ends.

The snakes and ladders in Sue's story

Snakes

Factors such as poor housing design and inadequate neighbourhood lighting are linked to a higher risk of falls among older adults.

It costs the NHS around £1.4bn per year to treat people who are affected by poor housing. The most common extreme hazards likely to be found in the home are those relating to cold and home accidents, particularly falls on stairs.¹¹

35% of the retirement age population in Gateshead and Newcastle feel lonely at least once a day. 12 Loneliness and social isolation increase the risk of stroke, heart disease, diabetes, cognitive decline, and premature death. It also affects mental health, with people who are lonely twice as likely to get depressed.¹³

Ladders

The Council's Private Sector Housing Team helped fix a key building block of health for Sue, by making her home a safer and more comfortable place to live, and helping to prevent further illness, accidents and healthcare.

A key factor, in enabling Sue to participate in the Strength and Balance (Otago programme) was the transport provided to get her there due to her mobility issues. The whole programme increased her strength, mobility and reduced her fear of falling so improving her quality of life and reducing her future needs for support from health, social care and her family.

Upping prevention

Falls have significant impacts on older people, families, communities, and health services, but they are preventable and not an inevitable part of ageing. There is a strong moral, social, and economic case for investing in falls prevention. In Gateshead, falls admissions cost around £4.73 million annually (based on £5,200 per admission and a 12-day hospital stay), and this doesn't include wider system costs. Increasing focus on community-based falls prevention and creating safer environments is essential to reduce risks and support older people, in an ageing population.¹⁴

Partnership

Addressing the health and wellbeing challenges we face in Gateshead requires collaboration because the ability to take preventative action on issues such as the building blocks of health lies across society and not within the control of any one organisation. Collaboration and place-based system working needs to become business as usual and there is a real opportunity to make this a reality at present, to create a system where preventative action becomes second nature rather than an optional addition.

Done properly, all stakeholders (including residents) could be included in decisions and service design to make sure that people's needs are met not just within an organisational context, but through a lens that takes account of their views and where they live and work. This makes collaboration crucial and the Health and Wellbeing Board, with its statutory responsibilities for the Joint Strategic Needs Assessment and the Health & Wellbeing Strategy, has a central leadership role in steering this work and ensuring its alignment to local priorities.

The recent NHS 10-year plan can be a defining moment of opportunity for the health and care system. It sets the strategic direction for the NHS and provides a timely opportunity to focus on prevention and collaboration. It identifies that three strategic pivots are required:

• Hospital to community: more care available on people's doorsteps and from the comfort of their own home.
• Analogue to digital: new technology to liberate staff from time wasting admin and to make booking appointments and managing people's care easier.
• Sickness to prevention: reaching people earlier, to catch illness before it spreads and prevent it in the first place, by making the healthy choice the easy choice. 

Each of these speak to the need to intervene earlier to prevent the health and wellbeing problems society faces and where that is not possible, to mitigate the impacts of the illness that ensues. 

For example, the pivot from hospital to community provides a real opportunity for collaboration. As systems are increasingly required to deliver more preventative, joined up care within constrained resources, neighbourhood based approaches offer a practical and effective route to improving outcomes while reducing health inequalities. Neighbourhoods provide a scale at which partners can work collectively with communities, align services around local need, and take early, preventative action.

The NHS as a whole is a critical partner in this work and has a crucial role in delivering prevention from health creation to tertiary efforts as its role goes beyond treatment to actively shaping population health through its anchor institution status, clinical interventions, digital innovation, and community partnerships. Local authorities have a role through public health responsibilities and through building block services such as planning, housing, education, social care, and economic development. Likewise, VCSE organisations and their role in mobilising community assets, co-producing interventions, and reach into vulnerable groups.

Agreement of a clear framework to drive the required system working on the three pivots would provide a shared foundation to help Gateshead translate national ambition into consistent, locally led prevention-based action. Following the evidence base to create guiding principles would be a logical step to support the development of governance and infrastructure to allow development and delivery of the the three pivots that are person-centred, preventative, and grounded in local data, community assets and lived experience.

This would create the environment for a collaborative approach that could:

• provide system-wide leadership and collective accountability
• enable shared governance, shared risk and shared decision-making
• create the infrastructure for delegated budgets and integrated commissioning
• lead development of the place-based Neighbourhood Health Plan

Viewing this opportunity through a treatment to prevention lens, there is a once in a generation chance for joint planning including all stakeholders to embed prevention, reduce unfair inequalities, develop co-produced services, and build this into community infrastructure.

Challenges

There are persistent barriers to achieving the collaboration needed. These include:

• suspicion, lack of trust and inconsistent collaboration between sectors
• siloed decision-making driven by organisational pressures
• fragmented and inconsistent information sharing and digital systems
• workforce capacity
• historical practices that incentivise protectionism and prioritise short-term transactional approach

These have always been there and affect all organisations but will need to be overcome and there are some enablers that will help with this:

Enablers

• explore joint commissioning of evidence-based prevention programmes
• collaborative action on wider determinants of health, including housing, employment, and transport
• shared and compatible digital systems for information sharing
• place-based population health dashboards
• workforce and prevention activity mapping across all partners and joint workforce planning
• clear leadership capacity for programme delivery