More than a year ago, the discussion about prudent healthcare began in Wales with a piece of work led by the Bevan Commission. During this period, there has been a lively debate, which has exceeded expectations in both shape and scale. Prudent healthcare has gone from being a concept shared by only a few keenly-interested individuals to a topic widely discussed and disseminated by the health service and beyond. It appears in health board papers; features in the work of our Royal Colleges; whole conferences have been devoted to it and it has been mentioned in the British Medical Journal.
This period has been devoted to the refinement and implementation of the idea itself – what exactly do we mean by prudent healthcare – and by an effort to agree and codify a set of core principles.
My own view has been that we have to be patient during this process. The debate is a necessary and worthwhile investment in the long-term viability of the vision. To an outsider – such as me – the world of health and healthcare can appear dominated by the search for an elusive and, in some important ways, spurious appearance of certainty. While the need for the practice of healthcare to be evidence-based is essential, this has to be accompanied by a more nuanced understanding of the nature of evidence: its contestability, the iterative relationship between evidence and application and so on.
However, we have to be watchful in the way any pre-existing system responds to new thinking by discovering it was doing this all along. Just applying the label of prudent healthcare in a post-hoc fashion to the world as it has always been – the practice of retrofitting – would be a very disappointing outcome.
Prudent healthcare will not happen by the Welsh Government or just one sector acting alone. For the NHS and social services to embrace prudent healthcare and for people across Wales to fully realise its benefits, leaders, managers and clinicians, but also the wider public, need to think about what the principles mean for them and their interactions with the health service and act accordingly.
Prudent healthcare has to be more than an idea and more than a set of principles. It has to change the way health services are used and provided. It has to make a real and 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.
My own advocacy of the prudent healthcare approach begins and ends with that ambition.
The health service remains a modern miracle. It is the greatest achievement of practical socialism – an organisation we pay into in the hope we will be fortunate not to need its services; an organisation in which we pool our risks and share the results on the basis that those with the greatest need and not the fattest wallets will be the first to receive attention.
But it is also a system under continual stress and strain as demands rise and the resource from which to meet them stands still.
In October 2014, I had the privilege of launching the Making Prudent Healthcare Happen website – www.prudenthealthcare.wales – which demonstrates how health and social services in Wales are moving from discussing and debating the principles of prudent healthcare towards applying them to services and to patient care.