The Vilnius Declaration – How Have We Responded to Its ‘Call to Action’?

Austerity-era cuts have undermined Europe’s health systems. The Vilnius Declaration, set down during the Lithuanian Presidency of the EU, was a call to end this attrition. Now the Latvian Presidency of the EU will take the agenda forward at a conference in Riga on 29 – 30 June, with the aim of identifying ways in which citizens can be active partners in efforts to make health systems more efficient, sustainable and equitable – and improve health for all

The Vilnius Declaration, agreed in November 2013 at the final health event of the Lithuanian Presidency, faced up to the damage to Europe’s health systems caused by the financial crisis and set out three broad calls for action to ensure systems are people-centred, sustainable and inclusive ­- and deliver good health for all.

These three core principles are:

  • To increase investment in health promotion and disease prevention;
  • To ensure universal access to high quality people-centred services;
  • To ensure health system reforms are evidence-based, promoting EU values of solidarity, quality and equity of access, whilst focussing on cost-effectiveness, sustainability and good governance.

The Vilnius Declaration is based on the understanding that health is at the heart of Europe’s success, economic future and the objectives of the EU2020 ten-year jobs and growth strategy. The Declaration was supported by the World Health Organization, the European Patients’ Forum and the European Federation of Pharmaceutical Industries and Associations.

Since the Declaration was made, work has continued to bring the principles to life. With Lithuania having set the bar, its Baltic neighbour Latvia is now taking on the cause of championing better healthcare at the final health event of its Presidency on 29 – 30 June in Riga.

Commitment from the EU

The European Commission welcomed the Vilnius Declaration as a spur to ensure the tools and policy framework are in place to help member states with reforms that:

  • Promote uptake of new health technologies in an appropriate and cost-effective way;
  • Support the development of integrated care models;
  • Promote citizen involvement;
  • Address the issue of chronic diseases;
  • Ensure health is factored into all EU policies.

Implicit in the Vilnius Declaration is the understanding that while health is a national competence, it is important not to overlook the many areas where it makes sense for member states to work together, to prevent the economic crisis becoming a health crisis.

The Vilnius Declaration was debated in December 2013 by the Council of Health Ministers, which endorsed the progress made and called for further work in its, ‘Reflection process on modern, responsive and sustainable health systems’.

Following this, in April 2014 the European Commission adopted a communication on effective, accessible and resilient health systems. This pulls together concrete measures member states can take to strengthen effectiveness, improve accessibility and increase the resilience of health systems.

Effectiveness

Suggested measures include putting a focus on patient safety, on the quality of care and on the integration of acute and social care. The communication also proposes that effectiveness should be routinely monitored using objective performance assessments.

Accessibility

One consequence of reduced health spending was the introduction of more co-payment or cost-sharing, which inevitably hits poorer people the hardest. Lower spending also has the effect of leading to cuts in the basket of care and longer waiting times.

The Vilnius Declaration drew attention to these issues. However, as yet there is no objective yard stick for measuring access. Current indicators are based on perceived unmet needs and there are no consistently applied methods for comparing and contrasting coverage, waiting times, or affordability, from one member state to another.

In recognition of this, the Commission is currently considering the development of common metrics of accessibility. This task is also being taken forward by the Patient Access Partnership, a body co-founded at the end of 2014 by the European Patients’ Forum and the National Patients’ Organisation of Bulgaria, to look at the barriers to access and consider how they could be removed.

Resilience

The Vilnius Declaration highlighted the need for greater resilience to ensure health systems could cope with the rising tide of chronic disease, and the health and care needs of an ageing population. Here the Commission is stressing the adoption of innovation – in medicines, diagnostics and treatments – but also emphasising that the way health systems are organised and run is central to making the best use of available resources and building resilience.

While the Vilnius Declaration can be seen as a direct response to the impact of the financial crisis on Europe’s health systems, it also rested on a rich legacy of previous debate and deliberation, including a reflection process with member states on how to build expertise in assessing health system performance.

This is now being taken forward by the Commission in an expert group, with work in hand to create a forum for member states to identify suitable methodologies and share best practice.

Of course, assessment is not the ultimate goal. Rather it provides a benchmark to improve health systems and deliver on the Vilnius Declaration.

Other measures by the Commission to promote the Vilnius Declaration principles include work to ensure patient safety, efforts to promote development of Europe’s healthcare workforce, the implementation of the directive on cross-border healthcare and backing for European Reference Networks.

Prevention, promotion, protection

In all of the EU-level work, the Vilnius Declaration has an important champion in Vytenis Andriukaitis, Lithuanian Minister for Health at the time of the Declaration, who was subsequently appointed Health Commissioner in Jean-Claude Juncker’s Commission.

Dr Andriukatis has since worked to deliver on three overarching principles of disease prevention, health promotion and health protection, and to ensure every initiative on health contributes to bridging the health inequalities that exist in Europe, as highlighted in the Vilnius Declaration.

The Commissioner has pledged to support efforts to make health systems more efficient and innovative, and to promote efforts to assess the performance of health systems and the uptake of innovation for healthy and active ageing

In addition, Dr Andriukatis has emphasised that accessibility, effectiveness and resilience of health systems are now an integral component of the wider discussion on European economic performance.

In summary, the Vilnius Declaration can be seen as a lightning rod that has brought a collaborative focus to the need to modernise Europe’s health systems, to put the patients at the centre, and apply tools and technologies to extract greater value from resources.

The Riga conference “Universal health: Investing in Health and Wellbeing for All” will take this movement forward.