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Prudent Healthcare Conference 2016

 

The Welsh are rightly proud of the role famous son and Labour politician Nye Bevan played in the formation of the UK National Health Service. Delivering on that vision of a world class health system for all has long been a challenge for a country with a small population, mountainous terrain and high levels of social deprivation and long-term conditions. Problems in performance prompted then British Prime Minister David Cameron in 2014 to taunt political rivals by referring to Offa's Dyke (the symbolic border beliweer England and Wales) as "the line between life and death".

It was around that time that a new concept in health policy started being spoken in Wales - 'Prudent Healthcare'. in the two years since it was coined by Welsh Health Minister Mark Drakeford this term has come to mean a series of principles:

  • The elimination of waste and the maximisation of clinical skills of staff
  • The importance of fairness and focussing on those in greatest need by involving the public and patients in decision making
  • The avoidance of unproven, unnecessary and over-use of treatment

In autumn 2016 AbbVie worked with the Bevan Commission, an independent think-tank after the NHS founder and dedicated to fairness and sustainability, to bring together 250 Welsh public, patients, policymakers and healthcare professionals in Cardiff to discuss how these principles were being put into practice. The day-long conference followed Bevan's maxim of "from cradle to grave" and looked at how prudent healthcare is being rolled out across age groups. 

 

 

 

OLDER YEARS

Debate in this area focused on how overcoming social isolation and loneliness experienced by many older people was a critical issue not just for improving the health of individuals, but also to empower them to become partners in their healthcare. Challenging care takes bravery, particularly when you may be ill, frightened and have difficulties in communicating.

Speakers talked of holistic services that allow people to do this and that enable them to be healthy and independent for as long as possible. The establishment of community friendship groups in some areas of Wales and the need to maintain good quality community transport were highlighted as examples.

The aim of all this should be to avoid unnecessary admissions to hospital, poor care in hospital, and people losing their ability to self-care after a hospital stay. Examples in Wales include the ‘Care Active’ project supporting people living with pain, and ‘Care & Repair’, which works with the hospital discharge team to get people home from hospital.

In deciding who has the greatest needs, delegates called for value to be placed not only on adding years to life but life to years.

 

WORKING AGE

The focus in this session was on how healthcare systems can support people to get back into work and stressed importance that healthcare professionals are confident to participate in active discussion about work. Early and rapid intervention is essential; once people are sick for a year, 95% remain on sickness allowances. Highlighting that people shouldn’t have to be 100% fit to be in work. With good clinical care and a supportive employer, people with disabilities or chronic fluctuating conditions can re-enter the workplace.

Examples raised included using a work coach model for benefit claimants to avoid people having multiple hand-offs to different services. Others included NHS schemes to promote early intervention and rapid referral, through to teaching people the skills to self-manage their condition in the workplace or at home to maintain independence and function. In North Wales physiotherapists are delivering early intervention programmes in GP practices and an award-winning pain management programme run by Allied Healthcare Professionals.

 

TEENAGERS AND YOUNG PEOPLE

Speakers voiced real concerns and a call to action to support young people. The conference heard that policymakers say they want to know what matters to young people and to hear their voices, but questioned whether this actually happened in practice.

Delegates were warned this is the first generation that will be poorer, less fit, and less happy than their parents, unless there is change. In particular the need for responsive mental health services was seen as key for this age group.

Examples raised included the ‘Switched On’ project, which works with young people aged 25 and under in Cardiff & Vale and provides education and advice to young people who have issues around substance misuse or mental health difficulties. The ‘Inspire programme’ offered by the Integrated Youth Service in Wrexham works to support children from 11-19 who are at risk of self-harm, with the aim of reducing hospital admissions.

Overall speakers agreed new ways needed to be found to gather the views of young people and act upon them, including better communication from health professionals. Members of Young Wales in attendance advocated the importance of early intervention, good advice and support to help young people be more resilient.

 

EARLY YEARS

Delegates heard how investment in early years pays: Sophie Howe, Well-being and Future Generations Commissioner for Wales stating that every £1 invested returns between £1.30 and £17.

Debate focused on helping the next generation of parents to maximise the chances of good health for their children. The Public Health Wales’ report on Adverse Childhood Experiences (ACEs) show that children in households with domestic abuse or substance misuse are more likely to have issues affecting them in future. Wales has been recognised by the UN as taking a lead internationally with the Well-being of Future Generations Act.

The healthy schools agenda is having a positive effect, particularly around children having a free healthy breakfast and a nutritionally balanced school lunch. Through the curriculum primary school children are also learning about diet, exercise, and substance misuse but more time for physical exercise could be the next improvement.

One project highlighted was the Flying Start Programme in four disadvantaged areas of Wales working to change life chances by supporting families with children aged 0-3 through: enhanced health visiting; speech, language and communication support; parenting and individual family support; and funded childcare provision. Its ‘Golden Ticket Pathway’ – focussed on the first 1,000 days.

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