Health Minister Mark Drakeford has described Prudent Healthcare as “healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patients benefit.”
The Bevan Commission, which advises the Health Minister, has defined Prudent Healthcare as “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.”
What this means in practice is to pursue the best courses of treatment and only perform procedures that have a good track record of successful outcomes. In particular the Bevan Commission has recommended pursuing the following ‘principles for prudent healthcare’:
- Healthcare should fit the needs and circumstances of the citizen.
- Healthcare should actively avoid waste and harm.
- Healthcare that brings little or no benefit should be abandoned.
- Healthcare must make the best possible use of the limited financial resources available.
As NHS Wales develops its Prudent Healthcare approach, it will begin by focusing on:
- Making sure the most effective drugs are prescribed.
- Ensuring evidence-based best practice is followed in operations.
- Stopping doing clinical procedures that are said to have no effect. (For example, NICE have identified
- 867 procedures that should no longer be carried out as they have little or no positive effect.)
The Health Minister has said clinicians should focus on doing the minimum necessary to benefit the patient, pointing to the over-prescribing of antibiotics as an example of treatment which in many cases makes little difference to the patient and has contributed to a build up of resistance to the drugs.
Mark Drakeford said: "There is no choice but change in the Welsh NHS. The only choice is between planned change, in which we attempt to take our destiny into our own hands and shape our collective futures, or change that will happen to us in an unplanned, unpredictable, ungovernable way. The choice is not between change and no change, it’s about the sort of change we want to have and how we go about it.
"I am keen that the NHS in Wales embarks on shaping our future on the basis of the principles associated with prudent medicine and prudent health care.
"The Prudent Healthcare approach is already well established in some aspects of contemporary clinical practice in our own country, as well as being widely rehearsed in other jurisdictions such as Canada. We need to work to a principle of what is often called minimum appropriate intervention. Who actually in practice would wish to undergo a greater level of treatment than that necessary for addressing their condition?
"Let me be absolutely clear, the prudent approach to medicine is not about rationing; instead it aims to deliver healthcare that fits the needs and circumstances of patients and that actively avoids wasteful care that is not to patient’s benefit. It is an ethical approach to treating patients in which clinical need and clinical prioritisation determine how services are provided.
"We cannot simply stand back and watch the unfolding film of the NHS in Wales. We will now work on a set of guidelines of prudent health care for use on the ground.
"NHS staff provide the key to success in the future. Every single day, right across Wales, huge efforts are made to provide the services people rely on. Together, we are capable of facing the future, of solving the problems and the challenges the NHS faces.”
To watch the Heath Minister’s interview on Prudent Healthcare visit: www.prudenthealthcare.org.uk
Read more about The Bevan Commission.