Prudent Healthcare and the Prudent Approach

1. Prudent Healthcare and the Prudent Approach Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission Welsh Public Health Conference, Millennium Centre, 7 October 2014 Insert name of presentation on Master Slide

2. Closing the Funding Gap: • Bevan Commission Reports (2012, 2013) • Nuffield Report (2014) • Welcome announcement: additional funding for NHS Wales (30September, 2014) • A continuing formidable challenge Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

3. Bevan Commission ReportFinancial Challenge - Wales • Progressive underfunding gap, relative to other three UK countries • Barnett Formula • Additional demands and inflationary pressures to bring increasing funding gap • Annual cost savings of 5% to bridge the gap Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

4. Financial Challenge - Wales • Challenge is manageable for two years • Current approach will not release necessary savings for the foreseeable future • Current situation is unsustainable • NHS Wales at risk Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

5. To close the gap without additional funding, NHS Wales will have to improve efficacy and productivity at a record rate and sustain this for a period not seen either in the history of the NHS or other countries’ health systems. Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

6. A Viable Way Forward? What is Prudent Healthcare and Why Now? Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

7. Prudent Healthcare ‘Healthcare which is conceived, managed and delivered in a cautious, safe and wise way characterised by forethought, vigilance and careful budgeting which achieves tangible benefits and quality outcomes for patients’ Bevan Commission, 2013 Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

8. Provisional Principles • Treating greatest clinical need first • Do no harm – achieve measurable good • Do the minimum appropriate intervention to achieve the desired outcomes • Choose the most Prudent Care, openly together with the patient • Consistently and appropriately apply evidence based medicine in practice • Co-produce health with the public, patients & partners Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

9. Prudent Healthcare principles • Agreement between clinician and patient that the intervention is likely to effect a tangible beneficial outcome compared with other possible interventions • beyond the ‘do no harm’ approach • intervention must do more measurable good than doing nothing Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

10. Prudent Healthcare principles • The objective of achieving optimum health which the circumstances permit should the intervention be agreed and adopted • If intervention is justified, it should always be that which is the least necessarily required to bring about, or to seek to bring about, the agreed change Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

11. Minister’s Statements: • Healthcare fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patient’s benefit. • Rebalance the NHS in Wales to create a patient centred system – remodel user/provide relationship on co-production. Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

12. Prudent Healthcare - Action • Stop doing things where there’s evidence they don’t work • Invest only in what gives tangible benefits • Investigate areas where evidence is not clear • Improve quality and clinical outcomes • Involve patients and citizens in co-production Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

13. How do we do this in Wales? • Big bang, not glacial change • Nationwide, at once • Gain ownership across the system • Cultural change – everyone’s business Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

14. Fashioning the principles Dec 2013: ‘Simply Prudent Healthcare’ Bevan Commission Jan 2014: Prudent healthcare in a time of austerity – the Minister’s speech April 2014: Prudent healthcare workshops (to test principles) Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

15. Four workshops • 30 delegates • Patients, managers and clinicians • 10 guests • Identify opportunities • Indicate methods • Comment on principles Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

16. Four workshops • Adult pain management • 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 Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

17. Review of the workshop Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

18. Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

19. The latest five... • 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. Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

20. The Prudent Approach: The approach is not and should not be confined solely to the provision and management of healthcare, it must also be applied to social care, health improvement, achieving a step change in the health of the people in Wales and remodelling the relationship between citizens and NHS Wales based on Co-production Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

21. Turn talk into reality • Huge, real financial challenge • Develop and adopt Prudent Healthcare and the Prudent Approach • Everyone’s business • Develop and encourage a ‘Social Movement’ Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission

22. Professor Sir Mansel Aylward CB Contact: Email: Mansel.Aylward@Wales.nhs.uk Website: www.publichealthwales.wales.nhs.uk Professor Sir Mansel Aylward, CB Chair, Public Health Wales and Bevan Commission