An action plan to bring patient-centred healthcare to life
23rd June 2015
The Universal Health Conference in Riga next week will build on the core principles of the Vilnius Declaration and scope out common ground where Member States can work together and support each other in the design and implementation of robust and resilient ‘all of life’ health and care services
The Vilnius Declaration of November 2013 has cemented two guiding motifs into European health and care policy, and the ongoing effort to reshape health systems to increase efficiency, ensure equity of access and improve outcomes.
The first of these is that health should be for all of life, covering health and wellness promotion, disease prevention, treatment and care. The second is that health should be factored into the formulation of all policies from education to social security and on to agriculture and transport.
The signatories of the Vilnius Declaration pledged to play their part, as actors in one of Europe’s largest and most economically important sectors, and called upon European leaders to work with them to ensure health systems are sustainable, inclusive and deliver high quality health and care for all.
The Riga Conference will set out a Roadmap with a checklist of practical measures to bring this vision to life.
Currently, Europe’s healthcare systems are caught between the rock and the hard place of escalating demand and organisational inertia. There is lots of activity but little traction. However, there is a will to move forward, and this is matched by a body of expertise, knowledge and technological innovation that is ready to be pressed into service in pursuit of reform and restructuring.
Talk of a Roadmap implies moving from A to B, when in fact what is required are streams of parallel activity. While these will play out and deliver at different rates, each is an essential component of the whole vision of people-centred systems delivering quality care for all.
Invest in disease prevention
If health care is to be for all of life, Europe needs to increase its commitment to prevention of communicable and non-communicable diseases, and of accidents. There is a substantial body of evidence around which to frame policies, including alcohol and tobacco controls, cancer screening, workplace health and safety, road safety and vaccination programmes, with research indicating there would be significant gains if each member state were to apply such measures to the standard of the country with the best practice.
Hand-in-hand with prevention must go a commitment to improve health literacy – prevention measures are undermined unless people have the means and the motivation to comply. So for example, smoking bans in public places have delivered significant health dividends, but work must continue to encourage people to give up and to stop people taking up smoking in the first place.
A central concern here must be that the policies adopted must engender health literacy in all, not just the higher socio-economic groups, as is the case at present. On the face of it, health promotion and prevention measures represent one of the most potent means of addressing the social inequalities in health, but without attention to health literacy, the risk is that the gulf widens.
Health prevention for all, for all of life, requires that poverty and social exclusion are addressed through policies that aim to end health inequalities.
Make healthcare affordable
Europe is facing the challenges of an ageing population, increased incidence of chronic disease and constrained finances. But the price of one very significant resource – computer processing power – continues to fall. Now is the time to make a concerted effort to capitalise on the many and varied ways in which digital technologies can be applied to increase affordability and sustainability, in areas ranging from epidemiological research to ePrescriptions and assisted living.
This calls for a further push to develop EU interoperability standards for electronic health systems and evaluation metrics for mobile health apps. The EU has invested heavily in creating IT infrastructures to support high performance computing and research. There could now be a similar move to deploy EU structural and investment funds to create an equivalent IT infrastructure for health-related prevention, promotion, patient self-monitoring and the delivery of services.
Europe is blessed with another critical resource from which it could be extracting far greater value, and that is its huge and growing repositories of health data. Everyone is very clear about the need to protect sensitive, personal data. Harmonisation of the rules on consent and data protection would provide reassurance, promote the productive use of existing data and create the framework for applying real world evidence to underpin faster approval pathways for new therapies and improved pharmacovigilance when in use.
Natural selection means antimicrobial resistance is inevitable, but the fact that few novel antibiotics are arriving to replace products that are losing their effect speaks to the need to de-risk the development and introduction of healthcare innovation. That is to say, innovation in all its shapes and forms, from new drugs, to improved diagnostics and imaging and systems improvements, and to ensure they are available in all member states.
Universal access to high quality, people-centred services
Establishing people-centred services requires a marriage of culture and technology. Mind sets have to change: providers must organise themselves to supply coordinated services that are available as and when needed, and citizens, patients and patients’ groups must be prepared and empowered to participate in managing their health and contributing to health care decision-making in research and treatment.
These shifts are needed to ensure continuity of care throughout the health system and to guarantee access for the excluded and vulnerable that are falling through the net currently. At a European level there should be support for partnerships of patients, providers and governments to pinpoint and bridge inequity in access.
The remodelling and integration of services around the citizen lays the ground to maximise the health span and the quality of life of older adults, and so control any rising costs associated with an ageing population.
Europe should be proud to be home to the strongest healthcare systems in the world and to have some of the longest life spans. But no matter how good any national system may be, the shifting landscape leaves no room for complacency. The Roadmap should look to this excellence to inform moves to maintain high standards and to address the inequities that exist within and between countries.