 The Minister for Health and Social Services, Mark Dreadford did explain prudent healthcare and what that means for the NHS. Minister, can you tell me what you mean by the term prudent healthcare? Well I think prudent healthcare is a way of thinking about what we do in the NHS in Wales. And I think it is a way of approaching services that draws together Mae'n gweithio ychydig yn ddigonol, mae'n gweithio'r dyfodol o'r cyfnod gyda'r cyflwyn yma, a'r cyfrannu cynnigol, yn ddweud i ddim yn gweithio'r ddweudio, i'r cyfrannu cyfrannu cyfrannu cyfrannu yma yn ymwyfu ymddangos yn ffordd y cyfrannu. A'r ddweud, dyma'n ddweud i ddim yn gallu cyfrannu, mae'n ddweud i'n ddweud i ymdill ar hwnnw. Mae'n ddweud i'r ddweud i'r cyfrannu cyfrannu gyfrannu cyfrannu yn ymweld cymdeithasol. Okay, now if you're a patient, often you measure your satisfaction or your thoughts on the NHS with how much they're doing for you, you often think well the doctor's tried this, the hospital's tried that. How does that equate with the principles of prudent healthcare? Why don't people think oh you're just rationing care? Well there are some challenges in prudent healthcare for patients as well as for the service and we do in some ways have to restructure the conversation that we have between the people who provide the service and the people who use it. Despite the huge merits that the NHS has, one of the things which I think you can level some criticism at the way the health service was established is, is that it does rather rely on a relationship in which all the power is on one side of a table and all the need is on the other and that sort of does encourage people to come through the door thinking that they are able to hand over what is happening in their lives to somebody else who will then somehow solve the problem for them and prudent healthcare along with co-production is very much a way of evening up that conversation of recognising the expertise that people have in their own lives while at the same time saying to patients that there are things which they will need to contribute if the outcomes are to be best for them and sometimes measuring what the NHS does for you by volume is not necessarily the best way of seeing whether it's doing the right thing for you. I think there's a lot we can learn from social care and the reablement movement in all of this. Part of prudent healthcare has to be that we are always asking ourselves the question what are we doing alongside this person to maximise their own ability to go on leading a life in which they have the maximum control over their own needs and circumstances and that is a different way of thinking about things. Okay so to take an example recently there's been perhaps criticism that the NHS isn't doing as much for for example bariatric patients as perhaps they might do. So rather than a patient thinking I need an operation to address this condition what might happen in the in an instance of how prudent healthcare might be applied? Well in a prudent healthcare approach we'd be asking ourselves two or three key questions here. First of all we would need to be sure that whatever we were offering that patient was based on the most tried and tested methods and it is evidence based that we are sure that we are not going on doing things where we know the evidence tells us that those things either do no good or worse still might be doing active harm in that person's life and there still is ground to be gained in the health service in making sure that we eliminate from our repertoire those things that don't do good and may do harm. So that's the first question we'll be asking ourselves. The second question we'll be asking ourselves is what is the minimum necessary intervention that we need to pursue with this person to produce the results that we are jointly trying to produce and that minimum necessary intervention will rely on thinking about what the person is able to contribute as well as what the health service is able to contribute and we should never do more than we need to do. Put it the other way round you would never want to be having a more invasive form of treatment than your condition requires so the minimum necessary principle makes a virtue of our very important point of course that does not mean that when you have exhausted the first level of intervention and found that there's more that you need to do that you won't move to that next level and it doesn't mean in the bariatric surgery example that there won't be people who require the most invasive forms of treatment but we go to those at the end of the process as the last point in the process and quite certainly not the first we only move up the hierarchy of interventions when we're confident that we've exhausted the things that lie below them okay and if you were a member of the NHS workforce how would you apply the principles of prudent health care in your day to day work what sorts of things should you be looking for how would you contribute how could you be a part of the bigger picture well I think if you're someone who's part of the workforce then the way the prudent health care principles will apply most vividly in your work is by looking at process innovation very often the way we provide services and the way we do things don't match up easily to the principles that I've just outlined so we're going to have four workshops here in Wales looking at four different examples and what we're going to be saying is if you were running pain management services for example along the lines that we have just discussed what would that service look like how would we be redesigning the service that we provide and we've got some very good examples in Wales where that's already been done if you think of our lymphedema services for example we are now treating more people more quickly more effectively and without needing extra resource to do it and we were not that long ago and that's been brought about by a very committed group of people using prudent health care principles to redesign the service that is provided making sure that we don't do things that were ineffective making sure that we do things that really make a difference making sure that we start with the basic tried and tested forms of intervention before we move on to anything more intrusive or invasive if you're working in an area and are asking yourself these questions then I think quite soon people will see ways in which the service they provide can be adapted to the way we will need to do things in the future that's right because it's a challenge for staff isn't it to explain that to patients especially when traditionally they've measured their care on the volume of activity they provided absolutely it certainly relies on those conversations but when you have the conversations and you are able to explain to people that this is so that we can put the resources that the NHS has I don't mean just money although money is very important to it but resources in terms of staff time and expertise that we are matching our resources to greatest need that we are doing the things that are most likely to work that we are doing them in partnership with patients so that their contribution to their own better health and well-being is maximised then I think it's a conversation which very quickly makes sense to people who use the service as well as those who provide it and if you're a member of the department here at Welsh Government how would you apply principles of brilliant healthcare in your day-to-day work here well here we tend to be looking at strategies for the future we tend to be looking at the way that we deploy the funding that we've got available and it's exactly the same thing really it's when we're looking at the way we want to develop things in the future that we apply exactly those same principles here in the way that we try and set out those rather larger and overarching ways of doing things so that for the person on the ground there is a clear and obvious connection between the things we say as a government that we want to see happening and the job that we ask them to do not very good thank you very much thank you