How can we make sure that good health and care is everyone’s responsibility in Wales?

Helen Howson, Director of the Bevan Commission, explains how a Prudent Healthcare approach has informed the Welsh Government’s long-term plan for health and social care and can, in the 70th year of the NHS, empower communities, organisations, professionals and patients to take greater responsibility for their health and care and those around them. 

This Opinion piece was also published in the Western Mail on 6 August 2018.

The 70th birthday of one of our most cherished institutions, the NHS, has recently made headlines around the world. Its origins, of course, can be found right here in Wales, where Aneurin Bevan found inspiration in the Tredegar Workmen’s Medical Society to forge a health service across the UK, based on communal responsibility.

Although the basic foundations of the health service have remained solid in Wales – universal, free at the point of access, responsive to medical need – if we fast forward 70 years, so much has changed in terms of our population, our workforce, our access to technology and our expectations. How do we ensure that the NHS is made fit for a future its architects could never have imagined? Just what solutions would they have proposed if they were here today?

At the Bevan Commission, we develop fresh thinking on health and care which is rooted in the original principles of the Aneurin Bevan’s NHS but recognises the reality of today’s problems and tomorrow’s solutions. One of our major contributions to the health and care debate in Wales, the UK and beyond, has been the concept of Prudent Healthcare.

This recognises that health is a shared responsibility and puts people and patients at the heart of the way we think about, plan and deliver health and care services. In other words, it looks to everyone to help find solutions which best fit their needs now and those of their families in the future.

Prudent Healthcare comprises of four key principles:

  • Achieve health and wellbeing with the public, patients and professionals as equal partners.

  • Care for those with the greatest health need first, making most effective use of all skills and resources.

  • Do only what is needed – no more, no less – and do no harm.

  • Reduce inappropriate variation using evidence-based practices consistently and transparently.

Our prudent model of health and care is outlined in a series of reports, Exploiting the Welsh Health Legacy, which provides a blueprint for NHS leaders and frontline professionals to think, plan and do things differently.  This series recognises that the demands are increasing and resources diminishing, and emphasises the shared responsibility we all have for making the health and care system fit for the future.

To think differently, we have to take into account the wider range of factors outside of the healthcare system that can have an impact on an individual’s health; linking up more effectively the NHS with other crucial frontline agencies such as social services, local authorities, housing associations and more. To plan differently, we need to ensure that everyone in Wales understands that with a right to universal healthcare comes responsibility - we all have a role to play in using the NHS prudently and actively contributing our ideas to ensure it remains sustainable, not just reacting in a crisis.

Our latest report recognised that good health and care is everyone’s responsibility and asked: how we can do things differently? It included a number of practical case studies of individuals and organisations across Wales who are applying the principles of Prudent Healthcare, finding better solutions and taking responsibility to transform the future of the NHS here in Wales.

This includes Solva Care, a care cooperative set up and run by local residents to provide self-sufficient support and social services to the community of Solva, a small village in West Wales. Another example is Wellbeing Champions who have been embedded within the Abertawe Bro Morgannwg University Health Board (with the support of the Bevan Commission). These champions are working with team leaders and line managers to increase awareness of staff health and well-being and are proven to increase attendance and reduce sickness absence. Another interesting case study is the Anglesey Social Prescribing project, which enables children with complex needs to remain cared for at home and manage their own conditions as independently as possible.

What is clear from those few examples alone is that good ideas to improve the health and well-being of Wales through a prudent approach can come from anywhere – from within the NHS, from our employers, from our local authorities and from our communities. At the Bevan Commission we want to drive a grassroots movement by capturing as many ideas as possible and ensuring that the Welsh Government and NHS leadership translate them into action on a national scale.

The Welsh Government’s long-term plan for health and social services, A Healthier Wales, “builds on the philosophy of Prudent Healthcare” and seeks to empower people across Wales to not only take responsibility for their own health and care, but that of their friends, family and neighbours.

Over the next 12 months we want to collect and implement radical ideas and create a movement for change encompassed by the Bevan Commission People’s Health Charter, in which we not only set out our rights but also our collective responsibilities. This could include choosing services more wisely, self-managing chronic conditions and providing feedback to NHS professionals, or influencing people around us to make healthier decisions

The celebrations of the 70th birthday of the NHS should serve as an important clarion call to us all that we should not take things for granted. It should remind us about how challenging life was before the NHS, when everyone had to pay for their own medical care. We should not forget that despite its problems, the NHS is still without doubt the ‘jewel in the crown’ - the envy of the world but also too precious to take for granted.

This year I hope that we will all make it our mission to contribute the fresh ideas and enthusiasm to keep the NHS in good health for many years to come, and show how Wales as the birthplace of the NHS can lead the way in innovation, collaboration and transformation. After all the NHS came from our communities and from its people, so let us now find those new solutions together for the next 70 years. What will you do differently?

Helen Howson is Director of the Bevan Commission, Wales’ premier think tank for health and care, hosted and supported by Swansea University School of Management.

This Opinion piece was also published in the Western Mail on 6 August 2018.

The views contained within this blog are those of the author and do not necessarily represent the views of the Bevan Commission.

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