Delivering Prudent Healthcare in Wales

This week on Click on Wales   This week on Click on Wales we’ve been debating prudent healthcare in Wales.   Tuesday: Health Minister Mark Drakeford argued that we need to be more prudent about the way we provide healthcare.   Wednesday: Kate Macnamara outlined how prudent healthcare could be utilised in treating mental health conditions.   Yesterday: Dr Charlotte Jones explained to us how investment in GPs is critical to delivering prudent healthcare.   Today: Dr Ruth Hussey OBE describes some of the next steps for the Welsh NHS in delivering prudent healthcare in Wales.

What is meant by prudent healthcare and the principles are described in the Minister’s own IWA blog.

In my annual report last year, I outlined some of the key challenges we face in Wales and indicated some of the areas we need to address to tackle them together:

• poverty contributes to poor health;

• individuals and communities should be regarded as partners with NHS Wales to create improved healthcare services and improve health through co-production;

• physical activity is important for good physical and mental health.

I am confident that Prudent Healthcare is an approach that will help us to address these issues and we have been busy working on it. In April, colleagues in the NHS and Public Health Wales worked hard to deliver four successful workshops, involving patients and a range of practitioners, to test the draft principles of Prudent Healthcare that the Minister had outlined in his January speech. The workshops were run in four different treatment and geographical areas (orthopaedics, pain management, prescribing, and ear, nose, and throat services), as part of a period of engagement and debate to gather the views of people in the NHS and from people using the services also.

One clear finding from the early discussion is that Prudent Healthcare will not be delivered by the actions of NHS Wales alone. Continuing to secure value in healthcare will require a move from only treating diseases, to also adopting a preventative approach aimed at changing the circumstances that underpin poor health too. This will only be achieved by adopting a public service approach, with meaningful partnerships between all sectors and industry. We will need to embrace a wider social model of care, rather than purely a medical one. Other Welsh Government Departments and partner organisations, including the third sector, have vital roles to play and there many examples that follow the principles described in Prudent Healthcare, for example the team around the family approaches that have been developed are underpinned by evidence that prevention, through initiatives like Families First and Flying Start, and early (and often minimum) intervention can both improve the life chances of families and reduce the probability of more costly support being required at a later date.  Such initiatives will of course bring about considerable benefits through influencing the wider causes of poor health.

In June, I attended the UK NHS confederation conference with the Minister where he talked about a new bargain for the healthcare in Wales, which is about the Government and NHS creating the right conditions in which individuals can live full and active lives, but also that we all have a responsibility to look after ourselves and use the NHS wisely. The NHS is there to help us in our time of need, but with that comes a responsibility to use its resources prudently. In his words, the NHS is free from charge but not free from obligation.

The evidence that this can make a significant difference comes from a local study in Caerphilly, which was published recently. It revealed substantial reductions in serious health conditions linked to five healthy lifestyle behaviours: non smoking; a low BMI; regular exercise; a plant based diet; and alcohol consumption within guidelines. By adhering to 4 or 5 of these healthy behaviours, there was a: 73% reduction in type 2 diabetes, 67% reduction in vascular disease, 18% reduction in cancer and 64% reduction in dementia.

The Government has a responsibility to create the conditions for good health and wellbeing. The Active Travel Act has been welcomed in this regard and the recent consultation on the Public Health White Paper provides an opportunity to do more to help us enjoy healthier lives. For the long term, the Wellbeing and Future Generations Bill also provides the basis for policy making to be guided by overarching goals, with health a key part of that ambition.

This integrated approach also works at local level. The recent Tredegar Deep Place Study has demonstrated a strong correlation between poverty, place and public health and, by implication, the importance of effective partnerships to delivering Prudent Healthcare.

I was delighted to welcome Professor Sir Michael Marmot to Wales in July following the broadcast of his appearance on Desert Island Discs and it was fascinating to hear again his evidence about the links between poverty, health and  life chances and, in particular, the importance of children’s health. For me and many of the people I spoke to after the event, this absolutely reinforced the need for us all to work together towards this common goal.

Last week, I attended a meeting of influential leaders working in the field of health and wellbeing in Wales, where we discussed the next steps for translating the vision of Prudent Healthcare into reality. We will be developing a collection of short papers, in the form of an eBook, from a variety of perspectives, which will describe how Wales is at the forefront of an international movement and include practical steps from the different perspectives about how Prudent Healthcare can be implemented in Wales.

The next few months are going to be critical to achieving much in relation to prudent healthcare, but it will only be the start of the journey.