Alice Hobbs

Alice.Hobbs@wales.nhs.uk'

Jul 152014
 

Helen Birtwhistle

I was privileged to once again be a judge at the recent NHS Wales Awards and what struck me was just how much of the innovative work being honoured had co-production and prudent healthcare at its core.

We know financial pressures mean working in healthcare is often a tough place to be but this is a time to work smarter and make the best use of resources to deliver quality, safe patient care across Wales.

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Jul 152014
 
GrantRobinson

Grant Robinson

Cwm Taf Health Board was a worthy winner of the Improving Patient Safety category at this year’s NHS Wales Awards for its project on patient flow.

By coordinating actions to make sure patients don’t wait unnecessarily for the care they need, health board staff have significantly reduced the time people spend waiting in ambulances and in the accident and emergency departments.

They’ve been able to demonstrate improved patient outcomes and experience, sometimes in areas they didn’t expect, and the changes have been sustained.

The Unscheduled Care Improvement Programme in Wales is designed to make it easy for people to get the right emergency and urgent care when it is needed, and to make sure that no-one has to wait unnecessarily for the care they need, or to go back to their home.

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Jul 012014
 

PeteStraw Image1A beautiful, sunny Llandudno greeted us on our arrival at the highly-anticipated 1000 Lives Improvement National Learning Event, a fantastic opportunity for healthcare practitioners and students to meet and discuss the notion of prudent healthcare and quality improvement within the NHS in Wales.

Welcome coffee and pastries lined the stomach for the launch session delivered by Professor Matthew Makin (Medical Director, BCUHB) and Dr Alan Wilson (Director, 1000 Lives Improvement), who introduced the concept of prudent healthcare – built on the three pillars of reducing avoidable harm, appropriately minimising intervention, and promoting co-production of health between service users and providers.

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Jun 092014
 
Marcus Longley

Marcus Longley

Prudent healthcare is a big idea, or it is nothing.

But big ideas are not always welcome in public policy – they tend to disrupt ‘business as usual’. While we are spending our precious, finite thinking time on what the big idea really means, we might just neglect all those other equally vital, but more pressing, objectives, like safer care and balancing the books… And anyway, big ideas come and go, don’t they?

Public services know how to deal with latest Ministerial big ideas. The time-honoured approach is to thank the Minister profusely for providing vital new direction and insight, talk about it a lot in conferences organised for that purpose, include the new catch-phrases in every possible document… then re-badge all the things you were doing already using the new label, and get back to the day job.

But before health boards and trusts kill off prudent healthcare in this way, let’s just recognise that its three key planks cannot just be swallowed up into business as usual.

First, a prudent healthcare system will really empower people to maximise their own wellbeing, often recognising that that there are no clinical fixes. Chronic conditions are often, by definition, incurable, and good healthcare is about helping people to minimise their impact on what matters most to them in their lives. So people with chronic conditions – most of our patients – should routinely be offered a wide menu of support, from information and skills training, to individual and peer group support, often provided by the third sector, so that they can find things which work for them. Choice and diversity here are vital – one size will not fit all.

Second, when it comes to clinical intervention, prudent healthcare depends on patients really choosing what’s best for them. That means finding new ways of supporting patients really to think through what would be best for them, and creating the expectation that they will often say “No”.  And if they say “No”, we have to have alternatives to offer them (see above).

Third, it means re-defining what good care means. Under prudent healthcare, the key issue is what patients think about their care, not as they leave the hospital, but months down the line. A perfect operation which the patient wishes they hadn’t had two years later, is a huge waste of time and effort, on so many counts.

So … All we need, then, is a whole new swathe of non-clinical service provision, supported but not provided by the NHS; a re-thinking of the clinical encounter, with new systems to support that; and a new way of measuring our performance, with patient-defined and reported outcome measures routinely collected and compared on thousands of clinical interventions.

That’s not ‘business as usual’.

We need to hear the managerial squealing of brakes across NHS Wales, as our leaders realise that this is big change, fit for a big idea, requiring a new direction.

For further information, read Achieving prudent healthcare in NHS Wales or visit the prudent healthcare section of the 1000 Lives Improvement  website.

Marcus Longley is Director of the Welsh Institute for Health and Social Care and Professor of Applied Health Policy

Jun 092014
 

 

Professor Peter Bradley

Professor Peter Bradley

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:

  1. What happens now that does harm or little good?
  2. What happens now in an expensive way, which could be done in a more cost effective way?
  3. 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.

For further information, read Achieving prudent healthcare in NHS Wales or visit the prudent healthcare section of the 1000 Lives Improvement website.

Dr Peter Bradley is the director of Public Health Development in Public Health Wales. Follow Peter on Twitter @pbradley1965