HOPE is representing its members in the European arena covering all policies with an impact on hospitals and health services. HOPE contributes to the legislative agenda but also to the non-legislative activities in particular through participation in European projects and joint actions. Since its creation HOPE has produced comparative information on the ways healthcare systems are organised and financed. It includes as well a unique annual exchange programme for health professionals, together with study tours, workshops and conferences
The reorganisation of primary healthcare including the implementation of multi-professional primary healthcare facilities for at least 1% of the population by the end of 2016, could not be achieved, mostly due to the massive opposition of the doctors’ chamber. However, the health reform package for the coming period 2017-2020 reaffirmed the strengthening of near-home and multi-professional primary healthcare and devoted 200 million Euros for this purpose. “We are confident that the relevant legal base will be decided in the foreseeable future and that these provision model can finally be implemented in Austria”. This is intended to make the working environment in the public healthcare system more attractive and to provide a better work-life balance for healthcare providers. Patients will be offered longer opening hours and more services and better coordination of different areas of treatment. This will reduce the burden on hospitals and their outpatient clinics.
It is a clear ambition that our improvement work will be much more patient centred and focused on value for the patient. The expectation relies on starting closer with citizens, patients and carers. However, it is needed to tear down some walls between hospital and society, in order to actively prevent health problems, and to help citizens taking an active role in their own health. New initiatives have been developed in this area. The synergy of all the initiatives taken will hopefully take place in 2017.
In 2017, we hope to reach collective agreement in the health sector with the Estonian government, Health Insurance Fund and healthcare workers unions. To achieve this agreement the government has promised to make the long-term financing of healthcare their priority. The government has created a special working group to find long-term solutions to the healthcare financing sustainability. This working group in cooperation with the Ministry of Social Affairs and the Ministry of Finance have to present their proposals to the government by the end of first quarter of 2017. Estonian Hospitals Association is looking forward to political decisions to improve the situation. We find that some of the political decisions made in the last years have had a negative effect on cooperation between primary care and hospital care. In 2017, we will aim to find solutions on how to make the system more effective through integrated services.
The preparation of the New Social and Welfare Reform as well as on the Acts on the healthcare services financing will continue. Cancer centres, rare diseases centres and bio-banks will be (re)organised and new joint realities formed. Discussions on patients and citizens’ rights and responsibilities in relation to society’s capabilities will (hopefully) advance.
The main expectation for 2017 is a better integration of healthcare and social care with a shift from hospital care to community care, and the strengthening of social care. This would permit to address the challenges the country is currently facing with the rise of chronic diseases along with the ageing population. These chronic diseases are preventable through closer partnership among all the stakeholders within the health sector. Finally, another expectation for 2017 is the promotion of the use of new technologies to support patients in their care. The new technologies are indeed opportunities to address the inequalities, to improve the quality and efficiency of the system.
A major challenge for the near future will be the introduction of further instruments for insurance of quality. For this reason, the recently established Institute for Quality Assurance and Transparency in Healthcare (IQTiG) is, as a contractor of the GBA, developing the methodological basis for the inclusion of quality aspects when it comes to preparing the hospital plans by the Federal governments and for a better coordination of primary and secondary care. Moreover, further instruments have to be developed for quality assurance, for better quality of healthcare provision, for surcharges or deductions of fees in relation to quality of hospital care. At EU level, German hospitals were and are supporting the strong opposition against standardisation of healthcare services. European standardisation bodies are exploring the healthcare field to create standards on services provision. DKG is also open to contribute constructively to the evolving discussion to further develop HTA – Health Technology Assessment at EU level. The European Commission is currently developing plans to compare HTA-methodologies and procedures. It should be a common aim to improve HTA-intelligence by sharing knowledge and experience. This could give support to the responsible Institutions in the Member States to base their HTA-decisions on a good basis.
There are expectations regarding certain projects within the SNS. One of them refers to the recent implementation in public hospitals of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CM/PCS) – that started on January 1st 2017. This change was mainly due to the limitations to properly reflect the diversity of diagnoses and procedures as well as the acknowledgement that the ICD-10-CM/PCS provides a more exhaustive and adequate methodology. Another structuring project is regarding the new mechanism for accessing the healthcare in the Portuguese hospitals through the Free Circulation and Access (FAC) – Livre Acesso e Circulação (LAC). It is imperative to create a shift in the healthcare demand paradigm by restructuring the system and making it about the patient and his needs and expectations, thus ensuring the equity when it comes to access, the quality of services and humanized, timely and sustainable healthcare services. The implementation of the FAC system presents numerous advantages for patients since it ensures them the opportunity of the free choice. The advantage for the professionals consists in improving the existing trust relationship that must exist with the patients while the one for the SNS consists in improving the efficiency, maximising the installed capacity and quality of healthcare services and ensuring the continuity of care to the users.
The expectations for 2017 regard the impact on the economic situation in the hospital sector. At the beginning of the year, many hospitals are facing liquidity problems, which are expected to be solved by the resources of the state budget. The salaries in public sector will continue to increase. Since the cost of health workforce represents more than 60% of all costs, the expectation in relation to the hospital sector is that this increase will be covered through higher prices. Furthermore, since the waiting lists are increasing, the expectation is that financial resources will be transferred to decrease both waiting lists and waiting times. Finally, there is the expectation that the reform of the healthcare system on which the Ministry of Health is working now, will improve the organisation and management of hospitals and other healthcare institutions and that it will provide an adequate financing of healthcare services.
The Spanish Society of Cardiology (SSC) recently launched a strategy for quality improvement in cardiovascular disease named SEC-CALIDAD (SSC-Quality). The RECALCAR (Resources & Quality in Cardiology) registry is a key element of this strategy. The Spanish Medical Societies are collaborating with the Ministry of Health to promote strategies that aim to improve and homogenize the quality of the medical care in Spain, and to diminish these inequities. The registry has shown significant differences between Spanish regions and between hospitals in terms of healthcare quality, and in the management of acute myocardial infarction mortality and readmissions, which has led to organizational health care reforms. At this moment RECALCAR is analysing the association between heart failure management and health outcomes. Following the path of the Spanish Society of Cardiology, other medical societies are developing RECAL (Resources & Quality) projects. Moreover, in view of the health problem posed by chronic hepatitis C in our country, the Spanish National Health System’s Interterritorial Council unanimously adopted a resolution in favour of preparing a Strategic plan for Tackling Hepatitis C in the Spanish National Health System. This Plan has been led by the Secretary General of Healthcare and Consumers Affairs of the Ministry of Health, Social Services and Equality and is structured in four strategic directions, setting out some specific objectives and top-priority actions to be carried out over the course of the next years. It will be carried out in collaboration with different agents: Regional Health Services, the Ministry of Health, Social Services and Equality, Management Centres, prison institutions and the Carlos III Health Institute.
In 2017, main topics on the political agenda will probably continue to be: coordination and concentration of highly specialised healthcare; equality in health and healthcare services; number of hospital-beds; recruitment of doctors, nurses and other health professionals; further steps to improve healthcare by using digital technologies; profits made by private companies providing welfare services; long-term financing of healthcare.
The NHS’s funding depends largely on the overall performance of the economy. A risk for the NHS arising from Brexit is therefore linked to a possible prolonged period of economic slowdown. Leading economists are almost unanimous in concluding that leaving the EU will have a negative effect on the UK economy, which in turn will impact on public spending. The impact of Brexit on the UK’s economy is however very difficult to quantify at the moment, as the situation will evolve constantly and hard data on the economy will not be available for some months. The NHS is heavily reliant on EU workers, with around 10 per cent of our doctors and five per cent of our nurses being EU migrants. The biggest danger in the short term is that the prospect of Brexit could discourage EU citizens from staying or coming to the UK, due to fears of being unwelcome and concerns around employment rights. Brexit could also impact on NHS clinical research and innovation. Collaboration with leading counterparts across Europe has helped us to develop new treatments, adopt innovation more quickly, and improve the quality of healthcare we provide to our patients. It has also facilitated enrolment of NHS patients in clinical trials, allowing them to access innovative, life-saving treatments, when no other medical option was available to them. The NHS’s participation in EU collaborative research will be impacted in the event the UK no longer had access to the EU framework programme for research post-Brexit, and were the UK’s regulatory framework (on clinical trials, authorisation of new medicines, data privacy, etc.) to diverge from the EU’s in the future.