Achieving prudent healthcare in NHS Wales is a new paper published by Public Health Wales which outlines the findings of four workshops set up to test ‘prudent healthcare’ in the real world.
What is prudent healthcare? The Minister has defined it as, “Healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patient’s benefit.” In practice this looks like safe, effective care delivered without delays. I think we’d all agree we would like to be guaranteed healthcare like that.
In the paper, we have summarised the principles of prudent healthcare as:
- Minimise avoidable harm.
- Carry out the minimum appropriate intervention.
- Promote equity between the people who provide and use services.
The workshops raised several points of interest, but there was general agreement form the staff and service users present that the current system’s faults and occasional failings could be fixed by applying these principles.
The third one is key to successfully applying these principles. We know that when people are involved in their healthcare, and are given complete information and genuine choice, they often choose the less risky options, which usually are the least expensive. For example, if we advise people about pharmaceutical side-effects, they are more likely to want to try changing their lifestyle rather than being prescribed medicines.
The workshops also looked at some specific questions:
- What happens now that does harm or little good?
- What happens now in an expensive way, which could be done in a more cost effective way?
- What would the pathway look like if organised around the minimum intervention principle?
There are huge gains to be made in quality, improved patient outcomes and cost-effectiveness from reducing delays in the system. We sometimes automatically put people through the system because we are set up to deliver certain treatments or interventions rather than offering people a lower level of intervention that would be of equal benefit to them, and possibly more!
The perspective of the people who use our services is vital. They can alert us to delays and wastage in the system and have an equal role to play in ensuring they receive the treatment that is right for them. We have to learn to listen and involve them more. The future of our health service depends on it.
Dr Peter Bradley is the director of Public Health Development in Public Health Wales. Follow Peter on Twitter @pbradley1965