Written Statement - Prudent healthcare: one year on

It has been a year since the concept of prudent healthcare was introduced at last year’s Welsh NHS Confederation conference. In just 12 short months, since the Bevan Commission initially defined a set of principles capturing the essence of prudent healthcare, we have moved from talking about what it means in theory to beginning to embed the principles into everyday practice in health and social care in Wales.

The debate surrounding prudent healthcare has surpassed expectations. It has moved from being a concept shared by only a few keenly-interested individuals to a topic widely discussed and disseminated by the NHS 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 featured in the pages of the British Medical Journal and The Lancet.

Last week, the latest set of chapters describing how prudent healthcare could work in Wales became available on the Making Prudent Healthcare Happen online resource www.prudenthealthcare.org.uk. The first set of chapters, videos and case studies, which have been available on the website since October, have been read thousands of times by people from around the world.

Wales is at the vanguard of a global movement to redesign health services according to prudent healthcare principles. In Italy, this work is known as slow medicine; in Canada, the Choosing Wisely campaign is leading the way. For health and social services in Wales, it is important that we continue to build on the momentum achieved over the last year.

The Bevan Commission has undertaken a further piece of work to finalise the prudent healthcare principles for Wales, to ensure that everyone involved in securing a healthier future for the population of Wales follows a common set of principles.

The Bevan Commission’s final 4 principles are:

• Achieve health and wellbeing with the public, patients and professionals as equal partners through co-production;
• Care for those with the greatest health need first, making the most effective use of all skills and resources;
• Do only what is needed, no more, no less; and do no harm.
• Reduce inappropriate variation using evidence based practices consistently and transparently.

However, the prudent healthcare concept of ‘only do what only you can do’ remains a powerful one, especially for a prudent health and social care workforce for the future. It will therefore be important to maintain the concept that no professional should routinely be providing a service, which does not require their level of clinical ability or expertise – only do what only you can do – as Wales continues its prudent healthcare journey.

The Welsh Government and NHS Wales will focus on 4 key areas where putting the prudent healthcare principles into practice will be especially important in the year ahead. Together we will:

1. Continue to put primary care in the driving seat of the NHS in Wales, implementing the commitments in the national primary care plan, and maximising the impact of the £10m primary care fund for 2015-16 and additional £30m for primary care from the autumn Budget statement;
2. Re-design the workforce for the future and redeploy our most precious resource - the people who work in healthcare. This will include launching a national primary care workforce strategy; publishing and responding to the Mel Evans review of healthcare education in Wales and commissioning an independent review of the workforce of the future;
3. Maintain the impetus in remodelling the relationship between the people who use health services in Wales and those who provide them, with continued support for the Academy of Royal Colleges of Wales in exploring the development of a Choosing Wisely Cymru campaign for Wales.
4.  Supported by the Bevan Commission, we will mobilise our thinking about the way we provide care for people, engaging in a debate initiated by the British Medical Journal about over-treatment and over-diagnosis, especially for people towards the end of their lives.

These areas alone will not make prudent healthcare happen, which is why I am keen to do everything possible to maintain the energy and debate of the last 12 months.

To support this, the Welsh Government will host its first prudent healthcare conference this summer, which will be opened by the First Minister. It will have an international reach and involve key partners who are furthering the prudent healthcare movement, including health boards and NHS trusts, the Royal Colleges, the National Institute for Health and Care Excellence and the British Medical Association.