1. Prudent healthcare in NHS Wales
Paul Gimson, National Programme Manager for Primary Care
1000 Lives Improvement
Achieving prudent healthcare in NHS Wales

2. WHY?
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4. Increasing and complex demand on healthcare
Our population is increasing and getting older
More people are being diagnosed with one or more long-term health conditions like diabetes and dementia
Frail and older people increasingly have more complex needs
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5. Prudent healthcare
“Healthcare which is conceived, managed and delivered in a cautious and wise way characterised by forethought, vigilance and careful budgeting which achieves tangible benefits and quality outcomes for patients.”
Achieving prudent healthcare in NHS Wales

6. Prudent healthcare
“Healthcare which is conceived, managed and delivered in a cautious and wise way characterised by forethought, vigilance and careful budgeting which achieves tangible benefits and quality outcomes for patients.”
Achieving prudent healthcare in NHS Wales

7. Establishing the principles
Dec 2013: ‘Simply Prudent Healthcare’ Bevan Commission
Jan 2014: Prudent healthcare in a time of austerity – the Minister’s speech
Achieving prudent healthcare in NHS Wales

8. Four workshops 30 delegates Patients, managers and clinicians
10 guests
Identify opportunities
Indicate methods
Comment on principles
Achieving prudent healthcare in NHS Wales

9. Four workshops Adult pain management Medicine prescribing
Cardiff & Vale University Health Board
Medicine prescribing
Cwm Taf University Health Board
Adult hearing loss, dizziness and tinnitus
ABMU Health Board
Knee and hip problems
Aneurin Bevan University Health Board
Achieving prudent healthcare in NHS Wales

10. Review of the workshop
Achieving prudent healthcare in NHS Wales

11. Principles revised Do no harm.
Carry out the minimum appropriate intervention.
Organise the workforce around the “only do, what only you can do” principle.
Promote equity.
Remodel the relationship between user and provider on the basis of co-production.
Revised principles in Ministerial statement, July 2014
Achieving prudent healthcare in NHS Wales

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13. Prudent healthcare – a definition
“Prudent healthcare is defined by a set of organising principles designed to put the delivery of clinical value centre stage and captures the important contribution that individuals have in creating and sustaining their own health and well being. The principles aim to increase the involvement of patients to make wiser decisions at all stages of life, cut down waste and overtreatment to reduce harm, enable the most urgent patients to be seen more quickly and put prevention and early intervention centre stage.”
Achieving prudent healthcare in NHS Wales

14. Some further Thoughts on Prudent Healthcare
It directly involves patients in designing their own care and participating in co-creating services
It focuses on obtaining the best outcomes for patients, discarding practices which are of marginal or no benefit, or may even cause harm
It is allied with a global movement seeking to reduce harmful overmedicalisation

15. Prudent healthcare – a wider perspective
Choosing Wisely Canada
Targeting unnecessary tests, treatments and procedures
Better Value Healthcare
Achieving prudent healthcare in NHS Wales

16. Implementing prudent healthcare
Greater focus on prevention, promoting wellness and healthy behaviours, improving community cohesion
Prudent Prescribing
Shared goal setting and shared decision making (better outcomes & use of evidence)
Working together across primary and secondary care – alternatives to referral, improving access to specialists & patient experience
Refraining from interventions with low clinical value and no robust evidence base
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17. Prudent HealthCare – Next steps?
SDM – Opportunity, resource and capacity
Using evidence effectively to reflect co-morbidities, elderly population and polypharmacy
Co-production – information and resource to support collaboration and integration
Prudent prescribing and tackling polypharmacy
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18. How? Leadership Organisational development Clinical Engagement
Values driven working and recruitment culture
A greater emphasis on patient-set goals and priorities
Exploring lifestyle interventions rather than medical responses
Understanding (and delivering) what matters most to people who use the service
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19. So what does Prudent Healthcare mean to you?
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