Can the NHS be saved by a ‘Prudent’ approach?

There’s a big, and growing, hole in the NHS budget. Is ‘Prudent healthcare’ the answer?

The Welsh NHS will have a 40% hole in its budget within 10 years.

The latest audit of the health service by the health think-tank The Nuffield Trust calculates that there’ll be an “unprecedented funding gap” of £2.5billion by 2025 because of rising pressures. The ageing population, rising hospital admissions for people with chronic disease and increases in the cost of providing health care mean that pressures on the Welsh NHS are growing.

“The NHS in Wales, which has become accustomed to increases in real-terms funding to meet demand pressures, must now meet the rising pressures of the population with a reduced budget” the report authors conclude.

Mark Drakeford, the Welsh Minister for Health and Social Services, has said since he took up post that the NHS faces a choice between unplanned change and planned change. He has set out the concept of prudent healthcare as the only way to meeting these profound challenges. He has defined it as “healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patients benefit”.

The IWA will be acting as a forum to debate this important concept over the coming months and last week held a major conference on the subject.  IWA members have received a summary of the event and can watch a Q&A with Mark Drakeford here, or listen below

5 thoughts on “Can the NHS be saved by a ‘Prudent’ approach?

  1. I noticed in the Bevan commission referring to co-pays and paper references to US studies – Aneurin Bevan would be turning in his grave. We have little to learn from the US, Ritz style healthcare system, where people can opt to pay extra for better treatments. The per capita spend on healthcare in the US is almost 2.5 times that in Wales or the UK and even stripping out the private healthcare contributions, the US taxpayer still pays more than we do in the UK. The quoted numbers of US citizens with no access to healthcare are hotly disputed, but even the most conservative estimates come in at 6%, with many often quoting the 40 million figure. If we seek to find solutions from a failed, non-inclusive system such as the US, which invented the term co-pay then this smacks of a route to the destruction of the NHS.

    As Aneurin Bevan eloquently stated – The collective principle asserts that… no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.
    The solution has to be maximising the utilisation of resources – not less diagnostics, but more efficient access to diagnostics – MRI scanners are designed to run 24/7 – large numbers of patients would take up the offer of a 2am scan, if it was offered. We don’t need less drugs, we need more efficient use of the best drugs – this links to rapid access to the best diagnostics, so patients have the correct treatments early and are not left on inappropriate regimes for years, leaving their conditions to degenerate.

    Rapid diagnosis will reduce costs. Lower costs will come from preventative things of course, but subsequent to that, speed of diagnosis and optimal rapid treatments should be the key to lower costs.
    No-one seems to be prepared to challenge the medical profession – the ones whose “mouths needed to be filled with gold” in order to get the NHS off the ground in the first place, perhaps laying the seed for future problems.

    On average a GP will spend only 14 years in employment – a phenomenal amount of money is invested in a few, who work in general practice for a very short period of time. We need more medical practitioners in the communities, with knowledge of the communities, who socialise within the communities. The general practice model we have does not work effectively – GPs aren’t satisfied and I would say the public aren’t satisfied, but it always amazes me , the number of surveys that report high levels of satisfaction with GPs – who do they survey? – If there is so much satisfaction why do so many go to A&E. General Practice was a weakness in the NHS from the start and it’s an issue that needs to be tackled.

    Citing more famous references from Aneurin Bevan in the context of housing:
    “We should try to introduce in our modern villages and towns what was always the lovely feature of English and Welsh villages, where the doctor, the grocer, the butcher and the farm labourer all lived in the same street. I believe that is essential for the full life of citizen… to see the living tapestry of a mixed community.

    In Cuba, which has the same life expectancy as the US and lower child mortality, all care delivery is organized at the local level, and the patients and their caregivers generally live in the same community. Can we genuinely say that is true in Wales?

  2. In Cuba doctors are state employees and do not or at least have not had free choice of employment or where they live. Nor can they easily emigrate, certainly not before doing some years of aproved ‘social’ work to repay the state for their education. Such levels of social control of the individual are impracticable in Britain so, while there is much in what Aled says, I am not clear what he is proposing.

  3. Agree with Aled. I find it remarkable that he says that doctors only do an average of 14 years employment! What do they do with the rest of their lives? Spend the gold that has been ‘ stuffed into their mouths’?
    The new ‘head’ of the NHS in England has stated that he wishes to see more local and smaller hospitals in their respective communities. This seems a highly desirable objective which we should emulate in Wales. Of course we need large hospitals (like the Heath, Morriston) with the latest high tech equipment, A&E and doctor training/research facilities but I imagine that a great deal of routine and long term treatment can be done locally without having to inflict transport and waiting time horrors on elderly or sick sufferers. This would also satisfy communities who are always up in arms at the closure of historic and much valued local facilities.
    As to doctors living near their patients, they seem to get paid sufficiently to afford not to live near them! They might catch something.

  4. More nurses needed in primary care. Seriously,many initial consultations could be done by specialist nurses, who could triage those patients who need to see a doctor. Long term conditions could be managed effectively by prescribing specialist nurses. There are already many examples of clinical teams being effectively led by ‘other’ health professionals, rather than seeking the unfindable (old style GPs who stay around and live locally),let’s look at more radical models of care.

  5. Cuts in the NHS are already resulting in higher costs!
    Two examples.
    Late last year I had appendicitis. It should have been a simple, brief operation, 24 hours on the ward, and home.
    Instead, because I was forced to wait 14 hours for surgery and a bed, my appendix exploded, the surgery was 5 times longer and more complex, and I blocked a hospital bed for a week in recovery. So the whole episode was 5 times more expensive for the NHS, and would have caused yet more expensive episodes for others kept waiting for treatment because of me.

    My best friend had a hip replacement – both sides needed one and the worst one was done first. The surgeon said he must have the other side done in 3 months because the new strong side would put strain on the other. My friend made an excellent recovery and for a short time was healthy and active.
    But he was kept waiting and waiting. Gradually the untreated hip deteriorated, just as predicted, until he was in constant agony ,on morphine. Bone damage set in. Mobility decreased so much it developed all kinds of other health conditions.
    This man, who should have been healthy and active today, is now dying. Slowly and painfully, and using up a large amount of health resources in that process which should not have been necessary.
    (I am grateful for the superlative care, when I finally got it. I’m unhappy that politics put my life at risk.)

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