Prudent Healthcare 2015

In partnership with

An International Summit

#prudenthealthcare www.prudenthealthcare.wales

Contents Ministerial Foreword

Ministerial Foreword 3 Professor Mark Drakeford AM Minister for Health and Social Services Event Schedule 4 I would like to welcome you to our first international summit on prudent healthcare, here in Cardiff. I am delighted to also Partner Section (BMJ) 9 welcome Dr. Sandra Vernero, co-founder of the Slow Medicine movement, in Italy, and Dr. Fiona Godlee, editor-in-chief of the BMJ to Wales. Dr. Godlee will share some of the work from Speaker Biographies: 10 the BMJ’s Too Much Medicine campaign www.bmj.com/too- much-medicine, particularly about over-diagnosis and over- Rt. Hon. Carwyn Jones FM – First Minister 10 treatment. Together they will give us a European and a UK- wide perspective about what we call prudent healthcare Professor Mark Drakeford AM – Minister for Health and 11 in Wales. Social Services Wales is at the forefront of a growing global movement to provide a value-based approach to health and care, based on need and which incorporates the citizen’s voice in decisions Gillian Clarke 11 about healthcare and services. In Wales, the Bevan Commission www.bevancommission.org/home has developed a set of prudent healthcare principles to Dr. Fiona Godlee 12 help guide the future of our integrated health and care system. More information about these principles and how they are being put into practice in Wales is available on our dedicated and Dr. Sandra Vernero 12 interactive Making Prudent Healthcare Happen website www.prudenthealthcare.wales Prudent healthcare cannot be delivered by the actions of our health service – NHS Wales – Dr. Don Berwick 13 alone. Ensuring we get best value from our investments in healthcare, means we cannot just look at the symptoms of disease in isolation. We must also consider the related conditions, complications, and circumstances which contribute to a person’s ill health. This can only be Eddie Butler 13 achieved by adopting a public service approach, with meaningful partnerships between all sectors and with industry. I am therefore pleased the First Minister for Wales is opening this Morning Breakout Abstracts 14 summit. I look forward to hearing the progress in making prudent healthcare happen from across Wales Afternoon Breakout Abstracts 14 – everyone has a vital role to play in creating the right culture for our health and care services to flourish. Ideas Marketplace 19 I hope you find the day stimulating and interesting. Please make time today to take part and contribute to the prudent healthcare debate and the workshops and by signing the pledge wall either in person or by using the hashtag – #prudenthealthcare – highlighting the one thing you will do differently after today’s summit to make prudent healthcare happen.

Professor Mark Drakeford AM Minister for Health and Social Services

Event Dr. Dominic Eggbeer Schedule Cardiff Metropolitan University’s International Centre for Design & Research (PDR) will provide a demonstration of how a partnership between academia, industry, and the health service is improving facial 08:30 – 09:15 Registration / refreshments reconstruction through 3D photometric scanning and prosthetic production with a piece of work funded by the Health Technology 09:15 – 09:25 Chair’s introduction – Eddie Butler and Tele-health Fund in which they partnered with ABMUHB and 09:30 – 09:50 First Minister’s address Photometrix Ltd.

09:50 – 10:20 Gillian Clarke, National Poet for Wales Why are public Chair: Professor Sir Mansel Aylward service partnerships 10:20 – 10:30 Disperse for breakout sessions The Chair of Public Health Wales and Bevan Commission will question crucial to achieving how we would start to understand whether the intended benefits of 10:30 – 11:30 Morning breakout sessions prudent healthcare? following the prudent healthcare principles are being delivered. Individual examples of prudent healthcare happening in Wales, drawing Presenters: on work from phase 1 and 2 workshops, existing case study examples, and chapter contributors to Making Prudent Healthcare Happen. Dr. Tom Kelley The International Consortium for Health Outcomes Measurement Session theme Session facilitators (ICHOM) will provide a global perspective on assessing what really matters to patients, with practical examples from their working groups. Can the prudent Chair: Dr. Ruth Hussey OBE, Chief Medical Officer for Wales healthcare agenda Dr. Sally Lewis and Dr. Glyn Jones The Chief Medical Officer will provide a brief overview of why prudent improve the healthcare matters when thinking about managing chronic conditions. management of Aneurin Bevan University Health Board, a strategic partner of ICHOM, will set out how an outcomes based approach is at the heart of chronic conditions? Presenters: their Clinical Effectiveness Programme, which is delivering significant Dr. Lindsay George and Dr. Fiona Kinghorn improvements in their services.

Cardiff and Vale University Health Board will set out how they are using Why are public Chair: Darren Mepham the prudent healthcare to help the organisation confront one of the service partnerships The Chief Executive of Bridgend County Borough Council will set out biggest international public health issues – diabetes. crucial to achieving how making prudent healthcare happen will require meaningful and prudent healthcare? Andrew Crowder and Professor David Owens strong public service partnerships. The all Wales Diabetic Retinopathy service will describe how they are Presenters: leading the way in the United Kingdom, spearheading innovative approaches, and delivering measurable improvements to patient value. Julie Boothroyd and Eve Parkinson Monmouthshire County Borough Council will describe how work Chair: Mr. Hamish Laing Will innovation be undertaken in partnership with others to transform adult social care the driving force for The Medical Director of Abertawe Bro Morgannwg University Health has delivered results and is, in many ways, consistent with the prudent prudent healthcare? Board will argue that prudent healthcare will not happen without healthcare principles. innovation, citing the recent experience of his organisation. Samia Saeed Edmonds and Gareth Coles Presenters: Melanie Thomas MBE and Jane Fitzpatrick Leaders from the Valleys Steps social impact bond project will The all Wales Lymphoedema service will describe how innovation demonstrate how a new and innovative partnership model is aiming is as much about a continuous process of change, as pushing the to better meet patient’s needs by developing alternatives to prescribing boundaries through new techniques, including micro surgery. antidepressants.

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Will ‘Prudent Chair: Dr. Anthony Calland 4. What practical examples of early intervention and prevention should Clusters’ provide a we be replicating? Lessons from Cwm Taf occupational therapist A Bevan Commission Member and former GP, Dr Calland will explore pathway to primary Alyson Davies and the Bevan Commission’s Lucy Scowen. why strengthening primary care will be vital to the delivery of Prudent care success? Healthcare. 5. How can we make real our ambition for a truly cross-service approach to prudent healthcare? Lessons from Hafal’s Presenters: Matthew Pearce. Professor Ronan Lyons 6. How should the proposed Choosing Wisely Wales approach operate and move the prudent healthcare principles to practice? Lessons Swansea University will demonstrate how the Secure Anonymised from Dr. Paul Myers. Information Linkage Databank is helping people to plan at the cluster level, with a practical example from the Abertawe Bro Morgannwg Health Board area. Dr. Don Berwick video presentation Professor John Palmer Wales is at the cutting edge of a growing international movement to John has recently (February 2015) been appointed Interim Director of ensure patients get better outcomes and the NHS gets the best value Primary, Community & Mental Health Services at Cwm Taf University from investment in healthcare. Health Board.’ He will be talking about the primary care plan focused In this unique video to Prudent Healthcare 2015 Dr. Berwick shares 14:00 – 14:20 on primary care clusters and what the future for primary care in Wales his perspective on making prudent healthcare happen in Wales, from looks like through a prudent lens. the Institute of Healthcare Improvement in Massachusetts. Charting the opportunities and challenges that lie ahead, Dr Berwick focuses on some of the systemic and cultural implications to support prudent 11:30 – 12:00 Coffee break healthcare – with improved patient outcomes and continual learning at its heart. 12:00 – 13:00 Perspectives on prudent healthcare

The BMJ’s Editor-in-chief Dr. Fiona Godlee 14:20 – 14:30 Disperse for breakout sessions Dr. Sandra Vernero – co-founder and vice-president of Italy’s Slow Medicine 14:30 – 15:30 Afternoon breakout sessions movement Mini question time style sessions with panel members including 13:00 – 13:55 Lunch break / Ideas marketplace session contributors to the Making Prudent Healthcare Happen website. Use the lunch break to continue the debate about making prudent healthcare The panels will be chaired by eminent members of Bevan happen by visiting the ideas market place. Hear from those leading Commissonand will test the extent to which prudent healthcare is programmes of work contributing to Prudent Healthcare in Wales, who will be happening, the challenges/barriers, and how they these are being asking the following questions: overcome – what works. 1. How do we capitalise on the expertise of people and communities in Each session will be framed around a thematic question, with securing improved health and wellbeing? Lessons from Ben Dineen and panelmembers being given 90 seconds each to offer reflections before David Russell of SPICE Innovations. opening up to audience questions. 2. What turns a good idea into a significant shift in the way in which we improve services and outcomes? Lessons from Professor Keith Harding and Maureen Fallon of the Welsh Wound Innovation Centre. 3. Where can we secure improved value from our investment in medicines? Lessons from Professor Phil Routledge and the Prudent Prescribing Implementation Board.

6 7 www.prudenthealthcare.wales Partner Question time panel Panel Chair Panel Members Section 1. What steps should we Dame Carol Black Darren Mepham (Bridgend CC) take to redraw the Donna Emma Davies (BMJ) relationship between (ABMUHB) the citizen and state in Mary Cowern (Arthritis UK) the context of prudent healthcare? Richard Williams (RNID Cymru) Syndicate room D Peter Lewis (National clinical lead, planned care) 2. In an era of evidenced Sir Anthony Newman Taylor Richard Lewis (BMA) based medicine, Mark Baker (NICE) why do we still have over diagnosis and Dr. Carl Hughes (Bangor overtreatment? University) Council Chamber Dr. Fiona Godlee (BMJ) Dr. Paul Myers (Academy of Medical Royal Colleges in Too Much Medicine? Wales) 3. How can we use the Professor Sir Mansel Aylward Dr. Tracey Cooper (PHW) Almost certainly prudent approach Professor Gareth Williams to reduce the health (Cardiff University) inequalities that exist in Wales? David Russell (SPICE) Ferrier Hall Steve Moore (Hywel Dda UHB) Our Too Much Medicine Peter Davies (Commissioner campaign highlights the for sustainable futures) threat to human health posed 4. What sort of workforce Lieutenant-General Louis Ruth Crowder (COT) by overdiagnosis and the waste do we need to quickly Patrick Lillywhite Alan Rees (RCP) of resources on unnecessary care. achieve a stepped change in the health of people in Professor Ceri Phillips Through the campaign we work with others Wales? (Swansea university) to increase awareness of the true benefits and Main Assembly Hall Linda Penny (Aneurin Bevan UHB) harms of treatments and develop ways to wind back Julie Rogers (WG) medical excess, safely and fairly.

15:40 – 16:00 Health Minister’s address – Beyond making it happen. • Interactive Timeline See how The BMJ has covered overtreatment in recent years • Themed Issue A digital theme issue on overdiagnosis, published in March 2015, looks at what is too much medicine and who gets to decide?

www.bmj.com/too-much-medicine

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Speaker Rt. Hon. Carwyn Jones Professor Mark Drakeford AM – Minister for Biographies FM – First Minister Health and Social Services

Carwyn Jones was born in 1967, he was educated at Brynteg Mark was born and brought up in west Wales before moving Comprehensive School, Bridgend, University of Wales, to Cardiff more than 30 years ago. Since then he has lived Aberystwyth and Inns of Court School of Law, London. Prior in the Pontcanna area of Cardiff. A former probation officer, to his election, he was a barrister in chambers in Swansea youth justice worker and Barnardos project leader in Ely and specialising in Criminal, Family and Personal Injury Law and Caerau, he has been a professor of Social Policy and Applied a professional tutor at Cardiff University Law School. He has Social Sciences at Cardiff University. Mark has also taught been a Bridgend County Borough Councillor and was Chair previously at Swansea University. of the County Borough Council Labour Group. He is also a In the 1980s and 1990s Mark was a Labour Councillor member of Amnesty International, Unison, Unite the Union on South Glamorgan County Council, specialising in and the Fabian Society. He has been a Labour Party member since 1987 and played an active education issues, including Welsh medium education. Between 2000 and 2010 he worked role in the ‘Yes for Wales’ campaign. as the Cabinet’s health and social policy adviser at the Welsh Government, and was latterly Carwyn Jones was appointed as a Deputy Secretary in March 2000 and replaced Christine head of the First Minister’s political office. He has a 30 year knowledge of the Cardiff West Gwyther as Agriculture and Rural Development Secretary on the eve of the Royal Welsh constituency. Agricultural Show in July 2000. Mark became the Assembly Member for Cardiff West in May 2011. He was Chair of the In March 2002 the role of Business Minister was added to his Rural Affairs portfolio. In June Assembly’s Health and Social Care Committee from July 2011 – March 13 and of the All-Wales 2002 he was appointed Minister for Open Government. In May 2003 he was appointed Programme Monitoring Committee for European funds from July 2011 – March 13. He was Minister for the Environment, Planning and the Countryside. In May 2007 he was appointed appointed Minister for Health and Social Services in March 2013. Minister for Education, Culture and the Welsh Language and from July 2007 was appointed @WG_HealthMin Counsel General and Leader of the House. Following the retirement of Rhodri Morgan AM in December 2009, he was appointed First Minister of Wales. He was appointed to the Privy Council on 9 June 2010. Following re- election to the National Assembly for Wales in May 2011, Carwyn Jones was re-appointed First Gillian Clarke Minister by Her Majesty The Queen, following nomination by the National Assembly for Wales. His interests include sport, reading and travel. He is a fluent Welsh speaker. Born in Cardiff, Wales. Poet, playwright, editor, translator @fmwales (from Welsh), President of Ty Newydd, the writers´ centre in North Wales which she co-founded in 1990. Tutor on M.Phil. course in Creative Writing, the University of Glamorgan, since 1994. Freelance tutor of creative writing, primary schools to adults. Her poetry is studied by GCSE and A Level students throughout Britain. She has travelled in Europe and the United States giving poetry readings and lectures, and her work has been translated into ten languages. She has a daughter and two sons, and now lives with her husband (an architect) on a smallholding in Ceredigion, where they raise a small flock of sheep, and care for the land according to organic and conservation practice.

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Dr. Fiona Godlee Dr. Don Berwick

Fiona Godlee has been The BMJ’s editor in chief since 2005. Donald M. Berwick was President and CEO of the Institute for Healthcare Improvement (IHI) for nearly 20 years. In She qualified as a doctor in 1985, trained as a general July 2010, President Obama appointed Dr. Berwick to the physician in Cambridge and London, and is a fellow of the position of Administrator of the Centres for Medicare & Royal College of Physicians. Since joining The BMJ in 1990 Medicaid Services, a position he held until December 2011. she has written on a broad range of issues, including the He was formerly Clinical Professor of Paediatrics and Health impact of environmental degradation on health, the future Care Policy at the Harvard Medical School, and Professor in of the World Health Organization, the ethics of academic the Department of Health Policy and Management at the publication, and the problems of editorial peer review. Harvard School of Public Health. In 1994 she spent a year at Harvard University as a Harkness fellow, evaluating efforts to bridge the gap between medical Dr. Berwick has served as vice chair of the US Preventive Services Task Force, the first research and practice. “Independent Member” of the American Hospital Association Board of Trustees, and chair of the National Advisory Council of the Agency for Healthcare Research and Quality. An On returning to the UK, she led the development of BMJ Clinical Evidence, which evaluates elected member of the Institute of Medicine (IOM), Dr. Berwick served two terms on the the best available evidence on the benefits and harms of treatments and is now provided in IOM’s governing Council and was a member of the IOM’s Global Health Board. He served 9 languages worldwide to over a million clinicians. In 2000 she moved to Current Science on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Group to establish the open access online publisher BioMed Central as editorial director for Healthcare Industry. He is a recipient of several awards and author of numerous articles and medicine. In 2003 she returned to BMJ to head up its new Knowledge division. She has served books, including Curing Health Care and Escape Fire. as president of the World Association of Medical Editors (WAME) and chair of the Committee on Publication Ethics (COPE) and is co-editor of Peer Review in Health Sciences. @donberwick She lives in Cambridge with her husband and two children.

@fgodlee Eddie Butler (conference chair)

Edward Thomas “Eddie” Butler is a journalist, sports commentator, and former Welsh rugby union player, who Dr. Sandra Vernero won 16 caps for the Wales team between 1980 and 1984. He played as a number eight as a Cambridge Blue and Dr Sandra Vernero, Medical Doctor, specialises in Anesthesia captained Wales on six occasions. He also captained the and Intensive Care and has been active in healthcare powerful Pontypool RFC side between 1982 and 1985 as quality improvement and evaluation and measurement part of one of the most feared packs in club rugby history. for many years. She is a member of the board of SiQuAS- He was also chosen to represent the Barbarians and the VRQ (Italian Society for Quality in Health care) and of the British Lions. EFQM European Health Sector Group. She is currently head After hanging up his boots, an equally successful career in broadcasting and journalism of the Accountability Project in Bologna Health Authority; followed, as he became the BBC’s voice of the Six Nations, presenting, commentating and co-founder and vice-chair of Italy’s Slow Medicine; and reporting with sympathy, wit and insight. His rugby columns in The Observer and The Guardian coordinator of Italy’s campaign “Doing more does not are always eagerly anticipated and well received, combining as they do the lyricism of the mean doing better”, part of the International campaign on rugby romantic with the pragmatism of the Pontypool number 8. Choosing Wisely. @SVernero

12 13 www.prudenthealthcare.wales Morning Session 3 Breakout Session 1 How important are outcomes to understanding the prudent principles? Abstracts How can the prudent healthcare agenda improve the management of chronic conditions? Chair: Professor Sir Mansel Aylward The Chair of Public Health Wales and Bevan Commission will question how we would start to Chair: Dr Ruth Hussey OBE, Chief Medical Officer for Wales understand whether the intended benefits of following the prudent healthcare principles are being The Chief Medical Officer will provide a brief overview of why prudent healthcare matters when delivered. thinking about managing chronic conditions. Presenters: Presenters: Dr. Tom Kelley Dr Lindsay George and Dr. Fiona Kinghorn The International Consortium for Health Outcomes Measurement (ICHOM) will provide a global Cardiff and the Vale University Health Board will set out how they are using the prudent health perspective on assessing what really matters to patients, with practical examples from their working care to help the organisation confront one of the biggest international public health issues, groups. diabetes. Dr. Sally Lewis and Dr. Glyn Jones Andrew Crowder and Professor David Owens Aneurin Bevan University Health Board, a strategic partner of ICHOM, will set out how an outcomes The all Wales Diabetic Retinopathy service will describe how they are leading the way in the United based approach is at the heart of their Clinical Effectiveness Programme, which is delivering Kingdom, spearheading innovative approaches, and delivering measurable improvements to significant improvements in their services. patient value.

Session 2 Session 4 Will innovation provide the driving force for prudent healthcare? Why are public service partnerships crucial to achieving prudent healthcare?

Chair: Mr Hamish Laing Chair: Darren Mepham The Medical Director of Abertawe Bro Morgannwg University Health Board will argue that prudent The Chief Executive of Bridgend County Borough Council will set out how making prudent healthcare will not happen without innovation, citing the recent experience of his organisation. healthcare happen will require meaningful and strong public service partnerships. Presenters: Presenters: Melanie Thomas MBE and Jane Fitzpatrick Julie Boothroyd and Eve Parkinson The all Wales Lymphoedema service will describe how innovation is as much about a continuous Monmouthshire County Borough Council will describe how work undertaken in partnership with process of change, as pushing the boundaries through new techniques, including micro surgery. others to transform adult social care has delivered results and is, in many ways, consistent with the prudent healthcare principles. Dr. Dominic Eggbeer Cardiff Metropolitan University’s International Centre for Design & Research (PDR) will provide Samia Saeed Edmonds and Gareth Coles a demonstration of how a partnership between academia, industry, and the health service is Leaders from the Valleys Steps social impact bond project will demonstrate how a new and improving facial reconstruction through 3D photometric scanning and prosthetic production with innovative partnership model is aiming to better meet patient’s needs by developing alternatives to a piece of work funded by the Health Technology and Tele-health Fund in which they partnered prescribing antidepressants. with ABMUHB and Photometrix Ltd.

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Afternoon Offer your perspective on what should be done to Session 5 Breakout accelerate the prudent healthcare movement by Why should strengthening primary care be at the heart of prudent healthcare? participating in a question time panel chaired by an Abstracts eminent member of the Bevan Commission: Chair: Dr. Anthony Calland A Bevan Commission Member and former GP, Dr Calland will explore why strengthening primary care will be vital to the delivery of prudent healthcare. Session 1 Presenters: Professor Dame Carol Black will ask what steps should we take to redraw the relationship between the citizen and state in the context of prudent Professor Ronan Lyons healthcare? Swansea University will demonstrate how the Secure Anonymised Information Linkage Databank is helping people to plan at the cluster level, with a practical example from the Abertawe Bro Panel members will include: Morgannwg Health Board area. Darren Mepham (Chief Executive, Bridgend County Council); Professor John Palmer Donna Emma Davies (ABMU EPP Cymru Coordinator and Nurse); John has recently (February 2015) been appointed Interim Director of Primary, Community & Mental Health Services at Cwm Taf University Health Board.’ He will be talking about the primary care plan Mary Cowern (Director, Arthritis Care Wales); focused on primary care clusters and what the future for primary care in Wales looks like through a Richard Williams (Director, RNID Cymru); and prudent lens. Peter Lewis (Planned Care Programme Clinical Lead, Welsh Government and Surgeon Aneurin Bevan UHB).

Session 2 Sir Anthony Newman Taylor will ask in an era of evidenced based medicine, why do we still have over diagnosis and overtreatment? Panel members will include: Dr. Richard Lewis (Welsh Secretary of the BMA); Mark Baker (Director of the Centre for Clinical Practice, NICE); Dr. Carl Hughes (Director, Wales Centre for Behaviour Change, Bangor University); Dr. Fiona Godlee (Editor in chief, BMJ); and Dr. Paul Myers (Academy of Medical Royal Colleges in Wales).

16 17 www.prudenthealthcare.wales Ideas Session 3 Use the lunch break to continue the debate about Marketplace making prudent healthcare happen by visiting Professor Sir Mansel Aylward will ask how can we use the prudent the ideas marketplace. Hear from those leading approach to reduce the health inequalities that exist in Wales? and Pledge programmes of work contributing to prudent healthcare in Wales, who will be asking the Panel members will include: Wall following questions: Dr. Tracey Cooper (Chief Executive, Public Health Wales);

Professor Gareth Williams (Director of the Cardiff Institute of Society, Health and Well-Being in the 1. How do we capitalise on the expertise of people and communities in securing improved School of Social Sciences at Cardiff University); health and wellbeing? Lessons from Ben Dineen and David Russell of SPICE Innovations. David Russell (Head of Health and Social care SPICE);

Steve Moore (Chief Executive, Hywel Dda UHB); and 2. What turns a good idea into a significant shift in the way in which we improve services and outcomes? Peter Davies (Commissioner for Sustainable Futures). Lessons from Professor Keith Harding and Maureen Fallon of the Welsh Wound Innovation Centre.

3. Where can we secure improved value from our investment in medicines? Lessons from Professor Phil Routledge and the Prudent Prescribing Implementation Board. Session 4 Lieutenant-General Louis Patrick Lillywhite will ask what sort of workforce 4. What practical examples of early intervention and prevention should we be replicating? Lessons from Cwm Taf occupational therapist Alyson Davies and the Bevan Commission’s do we need to quickly achieve a stepped change in the health of people Lucy Scowen. in Wales? 5. How can we make real our ambition for a truly cross-service approach to prudent Panel members will include: healthcare? Lessons from Hafal’s Matthew Pearce. Ruth Crowder (Policy officer, College of Occupational Therapists);

Dr. Alan Rees (RCP vice-president for Wales); 6. How should the proposed Choosing Wisely approach operate and move the prudent healthcare principles to practice? Professor Ceri Phillips (Head of the College of Human and Health Sciences and Professor of Health Lessons from Dr. Paul Myers. Economics at Swansea University); Linda Penny (Nurse practitioner Aneurin Bevan UHB); and Julie Rogers (Director of Workforce and Organisation Development, Welsh Government). With the sticky notes provided in your delegate pack, please add your thoughts to our pledge wall in the main assembly hall. What actions can we take at an individual level in our daily working lives to help ensure that prudent healthcare becomes a reality?

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