#prudenthealthcare Prudent Healthcare - Welsh Government

1 # prudenthealthcare Prudent Healthcare Securing Health and Well-being for Future Generations Prudent Healthcare Securing Health and Well-being for Future Generations Contents APPROPRIATE. Focusing collective national action around 3 main areas Public services WORKING. What's this document about?.. 3. Where can Prudent Healthcare tests, treatments and medications ? TOGETHER to improve Healthcare have a big impact?.. 4. ACTION 1: Appropriate tests, treatments, and ACTION 2: Changing the Changing the Model model of of OUTPATIENTS. ACTION 3: Working together Reducing unnecessary and Radically changing the Developing strong public service to improve inappropriate, tests, treatments and outpatient model, making it partnerships and integration to prescriptions, and ensuring people easier to get specialist advice in provide the right care, in the Who can make Prudent are able to make informed decisions primary care settings. right place, at the right time. Healthcare happen?.. 11 about the care they receive.

2 12 Empowering & enabling 3 main groups of people 15. Public Service 17 PUBLIC PUBLIC SERVICE. LEADERS. Evolution of Prudent 19. Senior leadership 21. Minister for Health and Social Services 22. PROFESSIONALS. You can click on each image if you The public doing their bit to look Enpowering health & care Creating the necessary wish to go directly to that section after their health and wellbeing, professionals to support patients conditions to encourage a with services concentrating on and the public to make shared system-wide focus on value what matters to them. decisions about their health. and outcomes. Securing Health and Well-being for Future Generations 2. # prudenthealthcare What's this This is the latest phase of work to stimulate and progress debate, momentum and next year. The Prudent Healthcare principles can have a significant impact on the health document action around the concept of Prudent and well-being of people living in Wales by Healthcare in Wales. Prudent Healthcare reshaping health services and rebalancing about?

3 Describes the distinctive way of shaping the the relationship between individuals and Welsh NHS to ensure it is always adding health professionals. There are three groups value, contributes to improved outcomes of people the public, professionals and and is sustainable. public service leaders - who will be central to making these and other changes happen. The principles of Prudent Healthcare are: Achieve health and well-being with the This document is not the definitive how public, patients and professionals as to' guide for making Prudent Healthcare equal partners through co-production. happen because such a guide would miss the point. The Prudent Healthcare principles Care for those with the greatest health need to underpin everything that is done in need first, making the most effective use the Welsh NHS and challenge every board, of all skills and resources. clinician and patient to think daily about Do only what is needed, no more, no the things they can change and improve to less; and do no harm.

4 Secure better health and well-being. Reduce inappropriate variation using There will be many other examples evidence based practices consistently of Prudent Healthcare in practice and transparently. happening; the principles will underpin the development of services in every While the Prudent Healthcare principles are part of Wales and they will help shape applicable to all public services in Wales, conversations and consultations in every this action plan is aimed primarily at NHS. branch of practice between patient and organisations and describes work to be practitioner. carried out with partners at a national and organisational level over the course of the Securing Health and Well-being for Future Generations 3. # prudenthealthcare Where can Focusing collective national action around three main areas The debate and discussion around Prudent Healthcare in the last few months has Prudent identified three priority areas for action. These have been chosen because they touch the lives of many people and because coordinated action taken at both a national level Healthcare and by all organisations will have a significant impact on the way health services, in particular, are delivered and provided in Wales.

5 Focusing collective national action around 3 main areas have a big impact? APPROPRIATE Public services WORKING. tests, treatments and medications ? TOGETHER to improve Healthcare Changing the Model of OUTPATIENTS. ACTION 1 ACTION 2 ACTION 3. Securing Health and Well-being for Future Generations 4. # prudenthealthcare ACTION 1: Appropriate Focusing tests, collective treatments, national actionand medications around 3 main areas APPROPRIATE. a) Why? documenting evidence of over-medication, Public services WORKING. over-diagnosis and over-testing. Work being tests, treatments and medications ? When people come into contact TOGETHER. with the Welsh NHS, they want to know Healthcare are receiving the care and support which they to improve undertaken in Wales places the NHS at the forefront of an international movement to ensure every test, procedure and not only gives them the best immediate medication makes a positive contribution to outcomes but also contributes to their people's health and secures the principle of longer-term health and well-being.

6 Doing no harm. However, there is growing evidence that Changing too many the Modelundergo tests and receive people of OUTPATIENTS. treatments and medications, which have b) Actions to be taken over the little clinical benefit and, by doing little next 12 months good, can lead to physical or psychological The Academy of Medical Royal Colleges harm. In the US, an estimated $5bn of in Wales, together with Public Health medicines are thrown away unused every Wales and the Board of Community year and 30% of all medical spending is Health Councils, will develop the unnecessary and does not add value in care. Choosing Wisely campaign for Wales. This will help clinicians and the public Quite certainly, investing time, energy and to make effective choices about tests, money in activity of little value restricts treatments and procedures based on the health service's ability to invest in best evidence. The campaign forms new, cutting-edge and evidence-based part of a global initiative and builds practices.

7 Wales is not alone in facing this on the success of the Choosing Wisely challenge; the British Medical Journal's movement in the US and Canada. The Too Much Medicine' campaign has cast first clinical and public guides will be an international spotlight on these issues, published in summer 2016;. Securing Health and Well-being for Future Generations 5. # prudenthealthcare ACTION 1: Appropriate tests, treatments, and medications The NHS as we all know is b) Actions to be taken over the now in enormous difficulty, in a next 12 months state of huge challenge with great A clinician and patient-led programme The 1000 Lives Improvement programme financial constraints as are health will be developed to reduce the rate will develop a Wales-wide quality systems around the world, and we of inappropriate antibiotic prescribing improvement approach to reduce need clear thinking, courage and in Wales. In the majority of Wales, the inappropriate variation in clinical leadership. And I think if anywhere rates of prescribing are significantly practice across Wales, for example higher than the UK average.

8 This rates of routine surgical procedures can get things right, Wales the programme will be overseen by the or patterns of prescribing where the cradle of the NHS - can do it. It's Prudent Prescribing Implementation variation cannot be explained by important to feel that [ Prudent Group and adopted throughout Wales. clinical need. Healthcare ] is part of a movement It will ensure the NHS and the public are around the world, and genuinely contributing to the global fight against it is. The BMJ's Too Much Medicine antimicrobial resistance;. campaign is one journal working The Prudent Prescribing Implementation on that; in America, Jama Internal Group will lead a review looking at what Medicine has the Less Is More changes can be made to the repeat campaign; and of course there prescription system across Wales to is Choosing Wisely and it's reduce unnecessary and inappropriate wonderful that Wales is signing prescriptions. The group will also up to this. This has to be a whole develop ways of helping people make system approach, and with the better and informed choices about strength of Wales behind it, it's how and when they request repeat sure to succeed.

9 Prescriptions, which will improve the take-up of prescription medicines and Dr Fiona Godlee, British Medical Journal reduce waste;. speaking at the Prudent Healthcare conference July 2015. Securing Health and Well-being for Future Generations 6. # prudenthealthcare ACTION. collective 2: Changing national the model action around of outpatients 3 main areas a) Why? Public services WORKING. b) Action to be taken over the next 12 months ? TOGETHER to improve Approximately Healthcare million outpatient appointments were provided by the NHS in Wales last year more than the population A national project will be set up to radically change the outpatient model, of Wales. A third related to just three ensuring it is easier to access specialist specialties -trauma and orthopaedics, advice to support decision-making in ophthalmology and general surgery. primary care. The early priorities will However, not all outpatient appointments be to: Changing the Model had a useful clinical purpose and many Support the rapid implementation of OUTPATIENTS could have been carried out in other of the national planned care Healthcare settings, closer to people's implementation plans in all NHS.

10 Having endured eczema all of my homes. Outpatient departments also face organisations for orthopaedics, life I was referred last September to a number of other issues. Unwell people ENT, urology and eye care. In eye Glangwili for Phototherapy treatment. who have to attend multiple clinics report care, for example, new community- I was unable to finish the treatment that to be a difficult experience to manage. based assessment and treatment due solely to the fact that I live in the Staff find that working in a high volume service for wet age-related macular Northern extremities of Ceredigion. low clinical value setting promotes little job degeneration (AMD) will be piloted My treatment required two 2 minute satisfaction. The sheer number of routine in four areas of Wales, making it sessions per week. I was expected contacts make it difficult for secondary more convenient for people to access to travel 125 miles on each visit, care to respond promptly to requests from the right care, in the right place, taking several hours.