We know that the healthier people are before surgery, the fewer complications they may have and the better their outcomes can be. Eating healthily, being active and stopping smoking all make a real difference to health and people who are in good general health usually recover better from surgery and have fewer complications.
Throughout Devon, from 1 August 2017, we will be implementing a health improvement programme for people with specific risk factors, so that they can access support to improve their health prior to surgery.
This programme is designed for patients undergoing non-urgent, elective surgery. It does not affect emergency or urgent surgery or diagnostic procedures. It will be rolled out in a phased approach, beginning with hip, knee and hernia, followed by hand and wrist and plastics, with more procedures being introduced over the coming months.
A set of criteria have been developed by primary and secondary care clinicians in Devon. These criteria cover blood pressure, anaemia, irregular heart rate, heart murmurs, diabetes and smoking status. The criteria define the level at which a patient’s risk in surgery may be increased and are based on best practice.
The pathway recommends early detection and management of risk factors, with GPs working with patients to improve their health before a referral for surgery where additional benefit of primary care treatment can be had. This could mean helping the patient to manage their diabetes or blood pressure or it could mean helping them to stop smoking. In some more complex cases, patients will be referred into secondary care to help them improve their medical health, prior to being referred for surgery.
There is support available to help people improve their health. Patients will be signposted to healthy lifestyle services by their GP and by secondary care clinicians. An important feature of this work is consistent messages from all healthcare professionals and consistent access to support services.
We believe that we all have a responsibility to promote healthy behaviours and integrate prevention of ill-health into our services. We also believe that we should be encouraging people to take a greater level of personal responsibility for their health and wellbeing and this is also an important priority of the NHS Five Year Forward View.
This programme aligns with the Making Every Contact Count (MECC) programme which is shortly to be rolled out across Devon as part of the STP work on prevention. MECC is an approach to behaviour change which makes the most of every interaction we all have with patients, to encourage them to lead healthier lives.
This is a comprehensive attempt at improving the safety, effectiveness, experience and value for money of surgery. There are clear benefits as it will help us reduce the risk of complications and the resulting length of stay in hospital and achieve improvements in surgical outcomes.
There are also longer-term positive impacts of controlling chronic disease and avoiding risky health behaviour. These are significant for individual patients and their families and they are also important for the NHS and for social care.