Is the concept of prudent healthcare becoming a reality? by Mark Smith [article on Wales Online, 7 April 2015

Health Correspondent Mark Smith looks at how the Welsh NHS is looking to change the way it looks after patients

Faced with ever-increasing demands and rising costs, the Welsh NHS must find ways of doing things differently to ensure it not only survives but thrives.

Almost exactly a year ago, the phrase ‘prudent healthcare’ started to be discussed in Wales as a possible way of meeting these challenges.

Health Correspondent Mark Smith looks at whether the concept is becoming a reality.

Prudent healthcare started life in Wales with a piece of work led by the Bevan Commission, and in the space of just a few months it has moved from being a much-debated topic to actually being applied to services and patient care.

In essence, prudent healthcare is about using the finite resources of NHS Wales wisely and doing “everything appropriate” rather than “everything possible”.

It is about ensuring people with the greatest need are treated first, ensuring all decisions about care and treatment are based on clear evidence and avoiding the unnecessary harm caused by over-treatment.

At its heart is a partnership between healthcare professionals and the public with patients playing an integral part in designing services which meet their needs as well as taking more responsibility for their own health and wellbeing.

Ultimately, it’s about ensuring that wherever you are in Wales you receive the same quality of service.

‘Prudent healthcare can change the way health services are used and provided’
Health and Social Services Minister Mark Drakeford has laid down a challenge to the NHS to change the way it provides care by using the prudent healthcare principles.

He said: “Prudent healthcare has to be more than an idea and a set of principles. It has to change the way health services are used and provided.

“It has to make a real, practical difference to the broad sweep of those millions of encounters, which take place every year between Welsh people and their health service.

“The strongest case for making such a difference is that, if we get it right, it offers a way of allowing the founding principles of the NHS to be sustained into the future.”

Prudent healthcare is based on four key principles:

• Achieving health and wellbeing with the public, patients and professionals as equal partners;
• Caring for those with the greatest health need first, making the most effective use of all skills and resources;
• Doing only what is needed, no more, no less – and do no harm;
• Reducing inappropriate variation using evidence-based practices consistently and transparently

Alongside these four principles is the associated prudent healthcare idea that all healthcare staff providing care in the NHS should be working at the top of their clinical competency.

No consultant should be seeing patients who could be seen by a nurse practitioner, and no GP should be seeing people who could be treated by a clinical pharmacist, for example.

This is known as “only do what only you can do” and will help to shape the NHS workforce of the future.

Where is there examples of this work?
There are many examples of where these prudent healthcare principles are being applied to improve patient care and services across NHS Wales.

At Wrexham Maelor Hospital in Betsi Cadwaladr University Health Board, staff have created a virtual cardiology clinic where people with the greatest health needs are seen as a priority by the consultant and those with less critical and less complicated cases are treated by a local GP.

And in Abertawe Bro Morgannwg University Health Board, the creation of a home nocturnal haemodialysis service highlights how a more efficient use of NHS resources can improve the wellbeing and quality-of-life for people who need kidney dialysis.

Professor Drakeford said: “It is clinical need that is most important when deciding when we should receive treatment and not how long we have been on a waiting list.

“All decisions to treat a patient should be made using the best evidence.

“If all hospitals and health boards stick to this principle, people all over Wales could expect the same level of treatment and we would see less variation in outcomes between the health and care we receive.”

The 1000 Lives Improvement service, which is part of Public Health Wales, has supported four health boards in Wales to use prudent healthcare in a variety of different clinical areas.

In Abertawe Bro Morgannwg University Health Board, staff held a workshop with patients to see how their experiences could be used to improve ear, nose and throat (ENT) services.

They found that around 20% to 25% of patients either didn’t need any treatment or may need treatment that wasn’t best delivered by an ENT surgeon.

‘It is about negotiating a different way of working with patients’ Paul Roberts, chief executive of the health board said: “Prudent healthcare is about negotiating a different way of working with patients and looking at what they want, really need and what will give them a better quality of life. We need to design services around outcomes valued by the patient and the only way we can do this is by asking them what they expect.”

In Cardiff and Vale University Health Board, a workshop held with chronic pain patients revealed that the time people waited for a scan was a concern for many and in neighbouring Cwm Taf University Health Board, wasted medication and how this could be reduced was discussed.

Professor Drakeford said: “Patients, doctors, nurses – everyone needs to make decisions about health together.

“Doctors are experts in medicine and should explain the different available options clearly and openly to their patients but patients are the experts in their own lives and what is important to them.

“They should be able to discuss these things openly and reach a mutual decision about the best course of action.

“Prudent healthcare will not happen by the Welsh Government or just one part of the health service acting alone.

“Everyone involved will need to embrace its values and ideas in their day-to-day lives as the focus point for keeping Wales healthy.”

For further information, please visit www.prudenthealthcare.org.uk