As a pharmacist, a lot of what is said about prudent healthcare instantly makes a lot of sense to me – of course we want to reduce unnecessary interventions; particularly if they are costly and ineffective. This makes sense on a number of levels – the NHS is, as we all know, on a restricted budget. In addition to this, it is important not to forget that the majority of patients would rather not be subjected to procedures, tests and the potential side effects of medication if there were unlikely to be any benefit.
This week on Click on Wales
This week on Click on Wales we’ll be debating prudent healthcare in Wales.
Yesterday: Health Minister Mark Drakeford argued that we need to be more prudent about the way we provide healthcare.
Today: Kate Macnamara profiles how prudent healthcare could be utilised in treating mental health conditions.
Tomorrow: Dr Charlotte Jones will explain to us how investment in GPs is critical to delivering prudent healthcare.
Friday: Dr Ruth Hussey OBE will describe some of the next steps for the Welsh NHS in delivering prudent healthcare in Wales.
On this occasion I am writing not in the capacity of a healthcare professional but of a patient. I have suffered from problems with my mental health since the age of 14, and was formally diagnosed with bipolar disorder around three and a half years ago. I am a campaigner for raised awareness and reduced stigma surrounding mental health, and as such have tried to take into account the varying opinions of mental health service users as a whole.
A major barrier to accessing appropriate treatment as a mental health patient is stigma, and unfortunately this is still widely prevalent within our society. Many service users, myself included, have felt that at some point the symptoms they have been presenting with have been “played down” or dismissed as a result of their underlying mental health condition. This can discourage patients from seeking help in the future, and has implications for the ongoing care of psychiatric illnesses alongside physical complaints. Patients with serious mental health conditions have a life expectancy that may be up to 17 years shorter than the rest of the population. It is vital that the prudent healthcare approach safeguards against any worsening of these physical health inequalities.
One of the key ways in which this can be done is by raising awareness of mental health conditions. Within the healthcare system the subsequent improvement in understanding and reduction in stigma could help to ensure patients always receive the most appropriate care. This itself would become a more prudent approach, preventing problems from worsening and requiring more costly intervention further down the line (inpatient stays, more expensive drug treatment, etc.)
A raised awareness in society could also help a prudent healthcare system. Greater acceptance and less fear of discrimination would help to encourage people to talk about their problems earlier on. Early intervention is a recognised means to prevent problems from worsening and to help recovery. However, early intervention is of no benefit if patients who think they might be having problems with their mental health are too afraid or unwilling to come forward and seek help. This needs to be tackled, so that prudent approaches can be fully utilised.
All patients are individuals and therefore, whatever their illness, their treatment may be different to that of others with the same condition. However, within mental health, treatments often need to be highly tailored – a number of different types of medication may be tried before symptoms are adequately managed, for example. This is very different to the approaches in some other areas of healthcare – for example, with a particular infection, we have a good idea which antibiotic is most likely to treat it, or we can send a sample to a lab and have it tested to tell us what to use. A prudent approach could be very useful in guiding treatment in that situation. Responses like this cannot be tested for in most mental health conditions, so it is important that the need for tailored treatment is not underestimated.
Another area that is particular to mental health is the use of talking therapies. This is a difficult area in which to take a prudent approach, as there is a high demand, which services may not always be able to meet. A number of discussions about prudent healthcare have mentioned the use of technology. The use of online video links to group sessions as well as one to one discussions could be very useful, particularly in rural areas. It can save on time spent by healthcare professionals who would otherwise be travelling between locations, and importantly can make access easier for patients.
Many mental health patients have problems funding transport; some may be unable to drive, so using technology like this may in fact allow them greater access to services, under a prudent approach, than before. Apps are increasingly popular and accessible and could be an excellent way to engage service users in communicating with healthcare providers. They even have the potential to allow remote monitoring of things like blood pressure and pulse rate. It is important to remember with both of these examples that technology is not always accessible to everyone, particularly in older patient groups who may be less familiar with computers and smartphones.
Prudent healthcare certainly has excellent potential to prevent unnecessary spending and interventions. Care is needed in all patient groups, to make sure the issues specific to them are identified and to stop existing problems being inadvertently worsened. Providing patients with the care they need as early as possible has obvious benefits to the individual, as well as preventing costly treatment further down the line, and this may well be a good starting point.
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