‘Values to value’ for recovery and renewal: prudent healthcare the key to transforming the health and care system

Why now?

In times of crisis, we look to our core values.^1–3 The COVID-19 pandemic highlighted the importance of marrying our values with value to focus on what really matters. ⁴ A recent report by the King’s Fund ⁵ also reflects this position.

This central thread of a prudent approach is to manage resources in a way that helps us to achieve the best possible outcomes for all. We know that when core professional values are not adhered to, then poor quality of practice and care can result.

Reimagining our health and care system

Continuing our traditional medical model (‘more of the same’) and the associated workforce model will not achieve the promise of prudent healthcare.

The four prudent principles are:

1. Achieve better health and wellbeing with the public, patients and professionals as equal partners through co-production,

2. Provide care for those with greatest health needs first, making effective use of all skills and resource,

3. Only do what is needed – no more, no less – and to do no harm and

4. Reduce inappropriate variation using evidence-based practice consistently and transparently.

Reimagining health and care requires transformative leadership and participation. Through its Bevan Innovators programme, the Bevan Commission challenges health and care providers to find innovative, prudent and practical solutions to problems. The Commission champions innovation, transformation, disruption and challenge at every level. However, it is important to remember that innovation may also involve the acceptance that low-value work must stop (exnovation) ⁶ and resources be redirected.

Such changes can be painful but prudent healthcare helps us achieve this by articulating a Values to value message ⁷ while ensuring that resources are used to best effect for all. How this is achieved will involve new approaches to merging evidence-based medicine with innovation approaches, understanding more about behaviour change and extending the range of effects that could be regarded as ‘value’.^8,9 Doing so will involve using data to aid prudent decision making and service (re)design and all the while recognising the value held by people, patients and local communities to inform services and to help themselves.

The prudent finance approach: influence of ‘Values to value’ and population health and wellbeing

As noted by Brown et al., ⁸ costs are inherent in value-based medicine. To realise the benefits of a ‘Values to value’ approach, it is vital that finance assimilates and applies learning from programmes like the Bevan Innovators. Our health and social care system must ensure that it puts people’s needs first and not that of the system.

This requires leaders to be open to challenge and change at every level. Future investment decisions into improved health and wellbeing and population health must be based on a values-based leadership model that challenges the very heart of the medical model, facing up to questions about how the workforce will operate and be trained in the future.

To achieve this, we will need to:

• build trust and confidence of all players in a ‘values into value’ approach,

• engage the workforce in transformative approaches, challenging the professional status quo,

• consider where care best takes place,

• foster participative leadership at all levels to recognise economies and diseconomies of scale and

• check that every investment in new ways of working is prudent.

Achieving goals using ‘Values to value’ as the catalyst for change to achieve joint objectives

The frameworks used to answer these questions and orchestrate the correct ‘systems response’ need to be reconsidered to ensure that values and value become inextricably linked.

To achieve these goals, we will need to recognise that:

• the prudent vision is future focussed,

• equitable distribution of value increases sustainability – one of our core values,

• true integration requires embracing all elements of the public sector,

• governance is a challenge and

• ‘big’ innovations like artificial intelligence rely on us acting on the important values that we hold.

Conclusion

There is a need to transform our system through our values while remaining aligned to the founding principles of the National Health Service. By incorporating the prudent vision, the system in Wales understands and tackles health inequalities as part of a whole-system approach. This approach adds to the cohesiveness and stability of our whole system as well as the reciprocity and the resilience of people and the community to health and wellbeing-related challenges.

Declarations

Competing Interests

None declared.

Funding

The Bevan Commission gratefully acknowledges the support of Welsh Government funding for the research activity presented in this article.

Ethics approval

Not applicable.

Guarantor

CON.

Contributorship

PB, DB, HH and NR were responsible for the initial concept and design of the work. CON developed the draft and undertook the literature review and write up for publication. PB, HH, CON and DB contributed to subsequent drafts and have approved the final published version.

Acknowledgements

Paul Buss, Director of Clinical Strategy, Powys Teaching Health Board

Helen Howson, Director, Bevan Commission, Swansea University, Swansea, United Kingdom

Dr Claire O’Neill, Senior Research and Development Officer, Bevan Commission, Swansea University, Swansea, United Kingdom

Donald M Berwick, MD, President Emeritus and Senior Fellow, Institute for Healthcare Improvement

Provenance

Not commissioned; editorial review.

ORCID iD

Claire Bridget O'Neill https://orcid.org/0000-0003-3497-0235