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.

This is the third paper in the Exploiting the Welsh Health Legacy series, and describes how we can drive and embed prudent health and care in Wales by building upon existing initiatives, using established networks to engage wider views and collaborating further with others to use the knowledge, experience and expertise of people and organisations including universities, industry and agencies.

The Bevan Commission recognises the unsustainability of the current health and care system that predominantly treats ill health at the expense of promoting health and wellbeing. Future health and care services will also need to be more focused upon addressing people’s needs, not just on paper, but in reality.

A Prudent Social Model sets out a clear vision and way forward for future Health and Care in Wales. It reinforces the need for rapid transformational change, moving away from traditional thinking and a solely medical model of care towards one that empowers and engages the passion and ideas of people to deliver innovative approaches based upon their own experience, ideas and expertise.

There is an urgent need to translate the thinking behind the development and application of the Prudent Model, reinforced by the Parliamentary Review into Health and Social Care which called for revolution not evolution and the more recent Welsh Government’s Long Term Plan: A Healthier Wales: our plan for Health and Social Care.

Action is now required to engage the ideas and passion of people and communities to shape current and future health and care services. A combination of approaches are needed to drive and embed Prudent Health and Care in Wales, including opportunities for patients and the public to describe what matters to them. The Bevan Commission’s ‘Big Conversation’ is the start of an ongoing process to help make this happen.

The paper describes how this can be done by;

• Building upon existing ideas and initiatives through schemes such as the Expert Patient Programme, Making Every Contact Count, Social Prescribing, will help ensure we are making the most of our current knowledge and expertise.
• Using established networks to engage wider views, skills and expertise will also help. Existing networks such as the National Federation of Women?s Institutes (NFWI) the third sector, community connectors, health and care facilitators all offer access and insight to the needs and solutions held by others.
• Collaborating further with others to use the knowledge, experience and expertise of people and organisations including universities, industry and agencies such as the Life Sciences Hub Wales and the Bevan Commission.

Programmes which try out and test new ideas such as the successful Bevan Exemplars and Advocates provide a tried and tested infrastructure to assist people in developing their own innovative ideas and creating social movements for change, driven by people themselves.

We must also challenge ourselves and our ways of thinking and working our current practice, our individual behaviours and our organisational cultures, so that we are receptive and open to deliver the seamless new models of care required with a workforce that is fit for now and for the next 70 years.

This paper is the second 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 Planning: Working Towards a Prudent Model of Health and Care” sets out the planning, thinking and approach required to implement this new, social more Prudent model of Health and Care in Wales. In our first paper, we set out the case for change and described the new model – a model 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.

A Prudent Model of Health and Care will:

Actively encourage everyone to take collective action and responsibility to help us all live the healthiest lives for as long as possible;

Call upon all agencies to act together and assume joint responsibility in whatever way they can best do this to ensure we make the most of the resources we have to meet individual and population health needs;

Develop a strong, robust and prudent integrated health and care system to support both our health and care needs;

Make the most effective use of all skills and resources available including local people, patients and the third sector;

Ensure that those with the greatest needs are prioritised and the hard to reach groups are included.

A Prudent Health and Care System is one:

• In which we all share responsibility for maintaining our health and that of others and that we have high quality, effective and efficient services which meet the needs of people, as and when needed;
• Where the focus is on the joint ownership of the NHS by all in Wales, through the co-operative concept of ‘Our Welsh Health and Care Service’, ensuring that this is;
• A shared responsibility belonging to the people of Wales, who use it and pay for it;
• Focused on preserving and protecting health and wellbeing, not just treatment and ill health;
• High quality, integrated prudent health and care services, equally available for all, working with everyone to ensure the most prudent and right care is provided.

Moving forward and next steps

This paper represents the first stage in a process of essential and fundamental change and the rebalancing of the NHS in Wales. Further ongoing engagement and consultation are needed to expand upon and test out whether the ideas in this paper fully represents the feedback and views received to date and in determining the next steps.

This model is designed around the needs of people in Wales, not the systems the processes or the professionals. It embraces the principles set out by Aneurin Bevan for a National Health Service, namely; comprehensive, free at the point of delivery and accessible by all, alongside the fundamental 4 Prudent Healthcare Principles. It builds upon its origins whereby communities, people, professionals, patients and local employers all played a key part and responsibility in maintaining health and in caring for its communities and the people within it with great pride.

The Bevan Commission proposes to ensure that the people of Wales recognise both their rights and responsibilities and are able to respond by getting involved and finding solutions to the challenges that the NHS faces. It will seek to ensure that our NHS in Wales is co-owned by them, similar to members of a ‘unique NHS club’ in which we all have our individual club numbers and clear ‘rules’ by which it operates in response to services and support received.