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More is not the same as better in the NHS


The NHS needs to consider the full range of treatment options available if it is deliver better outcomes for patients, Health Minister Mark Drakeford has said.

He was speaking as a new paper, Achieving Prudent Healthcare in NHS Wales, was published by Public Health Wales outlining how prudent healthcare principles can deliver better value for patients.


The report says patients will benefit more, in some cases, from receiving alternative treatments to an operation. But the NHS currently automatically refers patients into the hospital system and onwards to surgery, frequently without considering alternatives, such as lifestyle changes or less invasive treatments.


Professor Drakeford, who will take part in an Institute of Welsh Affairs debate on prudent healthcare today, said:


"Prudent healthcare is based on doing what is best for the patient, not what is best for the system.


"The traditional way we think about health services is based on the level of treatment a person gets – an escalator in which we are always pushing people up the levels of intervention. 


"The higher up the intervention level a patient goes, the more valuable it is perceived to be and the more people feel they’ve got something out of the health service. 


"Focusing on performance measures, such as clinic volumes or procedures per operating room, have reinforced this notion. The result is that our system, rather than a patient’s best interests, may be driving people to have more procedures than they would otherwise want or benefit from.”


Achieving Prudent Healthcare in NHS Wales recommends people receive the minimum appropriate intervention instead of ‘over treating’, which often leads to harm and poorer patient experience.  It says as many as one in five procedures have no effect on outcomes.


The paper focuses on four specialties – orthopaedics; ear, nose and throat; pain management and prescribing – and examines the outcomes of four workshops undertaken in Wales to look at prudent healthcare practice applied in these areas.


Professor Drakeford said:


"We need to ensure the full range of treatments and their consequences are discussed with patients, as partners, in agreeing their future care.


"Simply providing a cooling off period following an initial consultation for surgery has been demonstrated to influence a patient’s decision about whether to proceed, as they have had an opportunity to consider the alternatives.”


In relation to lower back pain for example, Achieving Prudent Healthcare says an initial multidisciplinary assessment could result in fewer tests, reduced inconvenience, less time spent by patients attending appointments and faster access to the right treatment.  The right treatment may often be physiotherapy.


Further findings from the workshops include the suggestion that medication prescribed for chronic pain should be reviewed regularly. This may prevent harm caused by the long-term use of high-dose medication.


It gives the example that patients who had been prescribed proton pump inhibitors to help avoid gastric and duodenal ulcers often suffer from side effects which could have been avoided if they had been given expert lifestyle advice.


Professor Peter Bradley, director of public health development at Public Health Wales, who is one of the authors of the paper, said:


"The perspectives of the people who use our services is vital.


"They can alert us to delays and wastage in the system and have an equal role to play in ensuring they receive the treatment that is right for them.


"We have to learn to listen and involve them more. The future of our health service depends on it.”


Professor Drakeford added:


"This is not about rationing services. It’s about providing better care and achieving improved outcomes for patients by doing some things less and avoiding unnecessary interventions, rather than basing success on the number of procedures undertaken.


"Many health boards and trusts are already practising elements of the prudent healthcare approach.  Achieving Prudent Healthcare in NHS Wales provides the NHS with practical examples of how this can be applied across the board.”

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