EUROHEALTH

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Enhancing the health workforce
Figure 1: The Prudent Healthcare policy, Wales
wide range of resources that explores
the principles in the context of health
care delivery; as well as a number of
conferences and other events providing
fora of engagement at regular intervals.
All health service organizations are now
exploring and testing how these four
principles can be used to drive service
change and the remodelling of patient
pathways.
Source: Ref 1
system-wide policy is established that
prioritizes activities that add value,
contribute to improved patient outcomes
as well as sustainability.
The Prudent healthcare policy helps
implement aspirations outlined in existing
legislations and ensures these aspirations
are realised and synergised. For example,
the Well-being of Future Generations
Act (2015) 2 is cross sectoral legislation
focusing on sustainable development with
an emphasis on long term prevention,
collaboration, involvement and integration
of approaches that are needed to tackle
the generational challenges like climate
change, tackling poverty and health
inequalities. Consequently, ensuring
sustainable public services are responsive
to patient needs, both immediately and for
future generations, is a key government
strategic priority, as this is a powerful
driver to improve the health and wellbeing
of the population. Furthermore, by
focusing on working with individuals to
reach their desired outcome, the Prudent
healthcare policy also ensures that a more
integrated and coordinated approach
across services is delivered.
Part of an international movement
In recent years there has been a growing
international movement to reduce harm
and poor outcomes from the excessive
use of medical interventions. For
example, the Choose Wisely campaigns
in the US and Canada 3 provide simple
information which makes clear the
advantages and disadvantages of different
tests, treatments and medications, thus
enabling patients to make better informed
decisions with their clinicians. The British
Medical Journal campaign ‘Too much
medicine’ 4 highlights the threat to human
health posed by over-diagnosis and the
waste of resources on unnecessary care.
Scotland has also recently advocated the
concept of ‘Realistic Medicine’. There
is some evidence that suggests that
around 10% of all health care interventions
contribute to some harm to patients, 5
while an estimated 20% of health service
activity has no effect on patient
outcomes 6 – suggesting this ‘imprudent’
use of resources is endemic in current
health systems.
Principles and actions
The development of the Prudent
healthcare policy for health services
in Wales was initiated by the Bevan
Commission in 2013. 7 Following
nationwide discussion, four guiding
principles have been adopted (see left
side of Figure 1). A Prudent healthcare
website 1 has been developed with a
The action plan for national health
services in Wales, ‘Prudent healthcare –
Securing Health and Wellbeing for
Future Generations’, was published
in February 2016. This sets out three
priorities to focus collective national
action by professionals, the public and
public service leaders. The areas chosen
for action in this plan are:
• reducing unnecessary and inappropriate
tests, treatments and medication and
ensuring people are able to make
informed decisions about their care;
• changing the model of outpatients; and
• public services working together to
improve health care.
Info-graphics are used where possible to
help communicate the concept and help
with engagement (Figure 1).
production
focusses on
empowering
‘‘co-
individuals to
actively
participate
The specific actions within the plan were
selected because they touch the lives of
many people and because coordinated
action taken at both a national level
and by provider organizations will
have a significant impact on the way
health services are delivered in Wales.
For example, the number of outpatient
appointments held in acute secondary care
Eurohealth — Vol.22 | No.2 | 2016