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Author: Bevan Commission


This paper is the first in the series called ‘Exploiting the Welsh Health Legacy’ which calls for a joined-up, prudent and social model of health and care – moving away from the more traditional medical model of care.

“A New Way of Thinking: The Need for a Prudent Model of Health and Care” sets out the case for change and looks to identify a model and approach which best suits the needs of people in Wales. A model which prevents ill health and preserves and supports all aspects of wellbeing, in which everyone has a responsibility. We have looked at how this could be achieved by looking at health and care through a different lens – a prudent lens.

This proposed new model is based on the Bevan Commission’s concept of Prudent Healthcare and the application of its principles in practice. It recognises the shared responsibility of society starting with the individual. This new model promotes innovation, new ways of thinking and working and explicitly places the responsibility of improving population health and wellbeing across society as a whole. It takes into account the wider social determinants of health and helps people achieve their maximum wellbeing.

With the challenges and threats to the future sustainability of health and health services in Wales, the notion of prevention and to some extent early intervention is a recurring theme in policy documents. Enabling individuals to lead healthier and more resilient lives is a clear and accepted goal as is promoting wellbeing rather than just treating ill health. However, the balance of resource and effort to date to reflect this goal is questionable. Similarly, the prominence of wellbeing rather than health reflects the move to focus on the individual rather than an individual’s health problem.

We believe this demands a social model in which everyone has a responsibility for health and must reflect and strongly address the determinants of ill health and the many other different factors which frustrate the attainment of people’s maximum wellbeing. The desired goal of healthcare is to eliminate or minimise the impacts of ill health and disabilities through effective and timely treatment and to enhance optimum functional recovery, as prudently as possible. It is about enabling people to do as much as possible as measured by functionality. Unfortunately, the health service is not well-equipped for the latter and raises questions around its validity as the only vehicle to deliver it.

The “achievement of health and wellbeing with the public, patients and professionals as equal partners through co-production” is an overarching basic tenet to be applied alongside the other three Prudent Healthcare principles. This cannot be achieved within the confines of a strictly biomedical model which fails to include unique human attributes and the socio-economic determinants of ill health. We seek to develop a health and care model which engenders a culture of ownership by all parties in decision-making and in gaining mutually agreed goals – an important characteristic of co-production and key prudent health principle. It can promote health literacy and provide a framework for better clinical assessment, joint management of health, social and domestic matters, empowerment and enablement.

Conventional healthcare is, of course, important, but healthcare alone is not paramount in achieving good health and wellbeing. We have to recognise that improving health and wellbeing is not solely the responsibility of the NHS, but also should involve everyone. Our new way of thinking promotes the development of a health model which places responsibility for gaining good health beyond the NHS treatment service. A prudent model will need widespread sign up and active support from the public sector, industry, the third sector and the public itself. Achieving our aspiration rests a great deal on changing understanding, attitudes and behaviours.