Is Prudence here to stay?

Introduction by Professor Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

In this week’s blog, Alan Willson calls Prudent Healthcare ‘the new show in town’ – the latest in a long line of policy initiatives designed to effect a step change in the way services work – and asks whether it will survive? This is the latest in our ‘20 blogs for 20 years series’, to mark the Institute’s 20th anniversary. Alan was until recently the pioneering inspiration behind much of the huge effort to improve healthcare systematically in Wales, and with Jonathan Grey has clearly made change happen in this vital area.

Is Prudence here to stay?

Happy 20th birthday to everyone at WIHSC. Congratulations on surviving and thriving. You seem to have learned the secret of longevity. Thank you for your excellent work and especially thanks to Marcus for your values AND scholarship – you personify your work.

And happy 20th-ish birthday to the Welsh me. I arrived in 1992 from the London NHS so we have had a similar upbringing in Welsh healthcare.

What have we learnt? Back then, we had too much demand for not enough money and we thought the answer lay in more primary care and better disease avoidance. The familiar ring of the problem and the solution means we could have done better. We can’t be criticised for being short of ideas but our failures have been in failing to understand how change happens. There have been recurring themes of simplistic, top-down solutions and flipping between opposing ideas. We do not learn, we give up.

Back in 1992, I must admit I was attracted by the idea of the Welsh Health Planning Forum. On reflection, it may have been the gravitational pull of all that paper. Its demise 20 years ago mimics that of Ozymandias although he is at least findable on Google. Since then we have been through commissioning, fundholding, innovation, locality-ism, programme management, deliverology and integration (horizontal and vertical) (no – me neither). And those are things we intended to do. In between, there were a lot of crises to contend with.

Prudent healthcare is the new show in town and the question is, is it different? Will it be more successful than what has gone before? Importantly, it is driven by what happens when people meet with carers and it is based on real need and value. It is also helped by an international movement with similar intentions. But it will need time and consistency if it is going to work and good luck if it is to stay away from crises. It will be a struggle and there will be failures as well as successes: that is what happens with learning.

The NHS needs its academic partners to support this learning. Prudence is a very worthwhile goal. It needs to survive 20 years and WIHSC can play a vital role in ensuring its longevity.

 By Alan Wilson



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