hope annual report 2011 · alfred hitchcock’s the birds, szilard miklos & denes miklosi –...

European Hospital

and Healthcare Federation

2011

General Report on the Activities of the

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General Report on the Activities of the European Hospital and Healthcare Federation — 2011

HOPE Pascal GAREL, Chief Executive Avenue Marnix 30, 1000 Brussels Belgium www.hope.be

The General Report on the Activities of the European Hospital and Healthcare Federation — 2011 was adopted by the Board of Governors of HOPE on 11 June 2012

Cover illustration: © Art dans la Cité

The nine projects were realized in the context of the European Biennial of Visual Arts at the hospital, Art in the City 2009 Untitled, Kader Attia – Centre hospitalier de Rouffach (France) Somewhere over the rainbow, Jota Castro – Hôpital Charles Richet de Villiers-le-Bel (France) Fusion du végétal et du sidéral, Marc Couturier – Azienda Alto Vicentino, ULSS4, Thiene (Italy) Name it as you feel it , Michael Fliri – Hôpital de Port Louis-Riantec (France) Sliding doors, Clemens Hollerer – LKH Bruck an der Mur (Austria) Alfred Hitchcock’s the Birds, Szilard Miklos & Denes Miklosi – Clinica de Psihiatrie Pediatrica de Cluj Napoca (Roumania) Promenade des énergies, Graham Stevens – Centre hospitalier d’Alès (France) La couleur du ciel, Sylvain Soussan – Hospital General Universitario Gregorio Marañón, Madrid (Spain) Seven ordinary things,Tomaž Tomažin – Nova Pedoatrična Klinika, Ljubljana (Slovenia)

All rights of reproduction, translation and adaption, even in part, reserved for any country, no matter in which form.

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European Hospital

and Healthcare Federation

2011


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Chapter 1: LIFE AND GOVERNANCE

ELECTION TIME 8

GOVERNANCE 9—11

Chapter 2: INFLUENCE

HARD LAW

DIRECTIVES AND DECISIONS ADOPTED

DIRECTIVE ON COMBATING LATE PAYMENT 14

DIRECTIVE ON PATIENTS’ RIGHTS TO CROSS‐BORDER HEALTHCARE 15

DIRECTIVE ON FALSIFIED MEDICINAL PRODUCTS 16

RULES ON SERVICES OF GENERAL ECONOMIC INTEREST 17

PROPOSED DIRECTIVES

PROFESSIONAL QUALIFICATIONS DIRECTIVE: RECAST 18

PUBLIC PROCUREMENT POLICY DIRECTIVE: RECAST 19—20

DIRECTIVE ON WASTE ELECTRIC AND ELECTRONIC EQUIPMENT: RECAST 21

ELECTROMAGNETIC FIELDS DIRECTIVE 22—23

WORKING TIME DIRECTIVE 24

TRANSPARENCY DIRECTIVE: REVISION 25

SOFT LAW AND OTHER INITIATIVES

RECOMMENDATIONS ON PATIENT SAFETY QUALITY 26

PLATFORM ON ACCESS TO MEDICINE 27

PLATFORM ON EHTICS AND TRANSPARENCY 28

MEDICAL DEVICES: EUROPEAN UNIQUE IDENTIFIER 29

COMMISSIONER DALLI WITH HOPE ON “HOSPITAL OF TODAY” 30

EU HEALTH POLICY FORUM 31

EU INNOVATION PARTNERSHIP ON ACTIVE AND HEALTHY AGEING 32—33

WORLD HEALTH DAY 7 APRIL 2011 34

ANTIBIOTIC AWARENESS DAY 17 NOVEMBER 2011 35

WHO REGIONAL OFFICE FOR EUROPEAN HEALTH 2020 STRATEGY 36

Chapter 3: KNOWLEDGE AND EXCHANGE

EU PROGRAMMES AND PROJECTS

2020 COMMON STRATEGIC FRAMEWORK IN RESEARCH & INNOVATION 39

BUILDING CONSORTIUM IN RESEARCH 40

HOPE AS A APARTNER: COMPLETED PROJECTS

EUREGIO II 41—42

E‐MEDICINIMAGE PROJECT 43

NOWHERELAND 44

C o n t e n t s

ANNUAL REPORT I CONTENTS

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ANNUAL REPORT I CONTENTS

HOPE AS A PARTNER: ONGOING PROJECTS

DUQUE PROJECT 45

EURHOBOP 46

EUROPEAN PARTNERSHIP FOR ACTION AGAINST CANCER 47—48

eGOVERNANCE 49—50

HOPE AS AN ADVISOR: RESEARCH PROJECTS

QUASER 51—52

HANDOVER 53

PROMETHEUS 54

ECAB 55

HOPE AS AN ADVISOR: INFORMATION SOCIETY

RENEWING HEALTH 56

DIGITAL ASSEMBLY 57

BENCHMARKING DEPLOYMENT OF eHEALTH SERVICES III 58

HOPE AS AN ADVISOR: PUBLIC HEALTH

PHARMACEUTICAL HEALTH INFORMATION SYSTEM (PHIS) PROJECT 59

PROJECTS IN CONSTRUCTION

JOINT ACTION ON PATIENT SAFETY 60

JOINT ACTION ON HEALTHCARE WORKFORCE PLANNING 60

EXCHANGE PROGRAMME

EXCHANGE PROGRAMME 2011 61

CONFERENCES

CONFERENCES CO‐ORGANISED BY HOPE

INNOVATION IN HEALTHCAERE. FROM RESEARCH TO MARKET 62—63

MANAGEMENT AND PUBLIC HEALTH 64

EXCELLENCE IN HEALTHCARE 65

CROSS‐BORDER CARE DIRECTIVE 66

CONFERENCES WITH HOPE AS SPEAKER

CEN ADVISORY BOARD 67—68

PATIENTS’ RIGHTS DAY: ARE CITIZENS IN THE CENTER OF EU HEALTH POLICY? 69

EUROPEAN PERSPECTIVES IN PERSONALISED MEDICINE 70

OECI AND ECPC WORKSHOP ON PERSONALISED MEDICINE 71

FACING THE FUTURE: DEVELOPING AN EU STRATEGY ON ALZHEIMER’S 72

DRGs AND INNOVATION CONFERENCE 73

HOPE AS AN ACTIVE PARTICIPANT: TWO EXAMPLES

COMMISSION CONFERENCE ON ELDERLY ABUSE PREVENTION 74—75

PHARMACEUTICALS ADHERENCE 76

PUBLICATIONS

THE CRISIS, HOSPITALS AND HEALTHCARE 77

BETTER HEALTH – A SHARED CHALLENGE FOR HOSPITALS AND PRIMARY HEALTH CARE 78

GUIDELINE FOR THE USE OF HEALTH TECHNOLOGY ASSESMENT (HTA) 79

HOSPITAL HEALTHCARE EUROPE 2011 80

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Chapter 1

L IFE AND GOVERNANCE

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2011 was an elec-

t ion year but also

an enlarging one

with three new

members

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Meeting on 20 and 21 June 2011 in Turku (Finland), HOPE, the European Hospital and Healthcare Federation, elected a new President and Vice‐President for a 3‐year term and celebrated the 30th anniversary of the HOPE Exchange Programme. Mr. Georg Baum, CEO of the German Hospital Federation (DKG – Deutsche Krankenhausgesell‐schaft), was elected President, being previously for three years Vice‐President to Dr. John M. Cachia (Malta). Mrs.Dr. Sara Pupato Ferrari, the Spanish HOPE Governor, was elected Vice‐President. The Board of Governors during which the election took place was also devoted to the major issues on the EU agenda. “The European Hospital and Healthcare Federation is facing important discussions in the term ahead”, stated the newly elected president. “The directive on cross‐border healthcare has been adopted. But we expect a lot of questions in the implementation process in the EU Member States. We thus have to take care that the benefit of the directive for hospitals and for patients is realised in the daily practice.” The newly elected President further commented: “With the revision of the EU working time directive and of the directive on mutual recognition of professional qualifications we have two key rules of the EU labour law that might be modified. Hospitals will have to get the best support in their efforts to resolve the major problem of the lack of health workforce. Hospitals will have to play a key role in this debate.”

Outgoing President Dr. John M. Cachia (left) and

newly elected President Georg Baum (right)

ELECTION TIME

Newly elected Vice‐President Dr. Sara Pupato

Ferrari and HOPE Chief Executive Pascal Garel

ANNUAL REPORT I LIFE AND GOVERNANCE I ELECTION TIME

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HOPE is gathering 34 national organisations of hospital and healthcare services — public and private — from 29 countries. In 2011, three new members joined HOPE: a third member in the French delegation, a Polish member and one from the Republic of Serbia. HOPE is organised around a Board of Governors, a President’s Committee, Liaison Officers, a network of National Co‐ordinators of the HOPE Exchange Programme and a Central Office. The Board of Governors (BoG) consists of the President and the Governors, one from each EU Member State. It is the forum for all major policy decisions. The BoG met twice in 2011. First on 20 June in Turku, Finland, as part of the HOPE Agora 2011. The second meeting, organised by the German Hospital Federation, took place on 18 November in Düsseldorf, Germany, and was followed by the Joint European Hospital Conference. Following two resignations, Mrs.Dr. Nadine Delicata‐Camilleri, Governor for Malta, and the newly elected HOPE President Georg Baum, Governor for Germany, the BoG nomi‐nated in June two new Governors: Dr. John M. Cachia for Malta and Marc Schreiner for Germany. In the same meeting, the BoG nominated two internal auditors for a term of two year: Marc Hastert, Governor for Luxembourg, and Mrs.Dr. Aino‐Liisa Oukka, Governor for Finland. In the Board meeting of November, Nigel Edwards was replaced by Mike Farrar for the United Kingdom and Jos G.M. Buijs by Jacques Bettelheim for the Netherlands. Jaroslaw Fedorowski was nominated Governor for Poland and Georgios Konstantinidis became Head of delegation of the Republic of Serbia.

GOVERNANCE

ANNUAL REPORT I LIFE AND GOVERNANCE I GOVERNANCE

Board of Governors Turku, Finland

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The President’s Committee (PsC) consists of the President, the Vice‐President and three Governors. In June 2011, Dr. György Harmat, Governor for Hungary, and Mrs. Eva M. Weinreich‐Jensen, Governor for Denmark, were nominated for a new 1‐year term. Dr. Urmas Sule, Governor for Estonia, became the new member of the PsC, replacing the newly elected Vice‐President Mrs.Dr. Sara Pupato Ferrari. Dr. John M. Cachia, Governor for Malta and former President, became co‐opted member of the PsC by power of the newly elected President. The PsC oversees the implementation and the execution of the decisions taken by the Board of Governors, co‐ordinates the work of the Liaison Officers and the working parties, acts for HOPE, and authorizes legal representation. The PsC met three times in 2011: on 24 January in Brussels, Belgium, on 6 May in Malta and on 14 October again in Brussels. The network of Liaison Officers was created to improve activities and to professionalise them. HOPE Liaison Officers met three times in 2011: on 22 and 23 March in Brussels, Belgium, on 20 June in Turku, Finland, and on 24 November in Bertrange, Luxembourg. As it does on a regular basis, the network of National Co‐ordinators of HOPE Exchange Programme met twice to work on the HOPE Exchange Programme: on 21 June in Turku, Finland, and on 25 November in Bertrange, Luxembourg. The Central Office is based in Brussels, Belgium. It is organised and directed by the Chief Executive, Pascal Garel, assisted by Mrs. Colberte De Wulf, with Health Economist Ms. Gloria Lombardi. Ms. Karolina Hanslik, EU Policy Advisor, left HOPE Central Office on 1 September and was replaced by Ms. Emilie Vergauwe. HOPE also welcomed two interns: Ms. Tamara Lemoine Dieulle from 15 September 2010 until 28 February 2011 and Grégoire Cassagneau from March until August 2011.


HOPE Central Office

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PRESIDENT Georg BAUM

CHIEF EXECUTIVE Pascal GAREL

GOVERNORS

Austria Nikolaus KOLLER

Belgium Willy HEUSCHEN

Bulgaria Mrs.Dr. Dora KOSTADINOVA

Cyprus Mrs.Dr. Androulla AGROTOU

Czech Republic Dr. Roman ZDÁREK

Denmark Mrs. Eva M. WEINREICH‐JENSEN

Estonia Dr. Urmas SULE

Finland Mrs.Dr. Aino‐Liisa OUKKA

France Gérard VINCENT

Germany Marc SCHREINER

Greece Dr. Yannis SKALKIDIS

Hungary Dr. György HARMAT

Ireland Dr. Fergal LYNCH

Latvia Dr. Jevgenijs KALEJS

Lithuania Dr. Dalis VAIGINAS

Luxembourg Marc HASTERT

Malta Dr. John M. CACHIA, Past‐President

Netherlands Jacques BETTELHEIM

Poland Dr. Jaroslaw J. FEDOROWSKI

Portugal Mrs.Prof. Ana ESCOVAL

Romania Dr. Eduard ARMEANU

Slovakia Prof. Marián BENCAT

Slovenia Simon VRHUNEC

Spain Mrs.Dr. Sara C. PUPATO FERRARI, Vice‐President

Sweden Roger MOLIN

United Kingdom Mike FARRAR

HEADS OF DELEGATION

Observer member

Switzerland Dr. Bernhard WEGMÜLLER

Consultant member

Republic of Serbia Prof. Georgios KONSTANTINIDIS


GOVERNANCE AT THE END OF 2011

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Chapter 2

INFLUENCE

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A major part of the

work of HOPE is to

confront EU law in

preparation with the

realities of health-

care.

To do so, HOPE has

to follow the devel-

opment of hard law

as well as the one of

soft law. Hard law

has a degree of legal

obligation that soft

law does not have.

But while soft law is

not binding in a legal

sense, soft law instru-

ments do carry some

authority.

With the long deci-

sion process that is

specific with the EU,

it is difficult to know

whether soft law will

not become hard.

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HARD LAW

Three major directives

as well as one decision

were adopted in 2011:

on late payments, on

cross‐border care, on

falsified medicines and

on services of general

economic interest

DIRECTIVES AND DECISIONS ADOPTED

As a rule, HOPE intervenes at three different steps in the decision process: when the first discussions take place, when a proposal is adopted by the Commission, and finally when legislation is adopted and enters in the transposition process. This means different types of involvement for HOPE Central Office and HOPE members.

DIRECTIVE ON COMBATING LATE PAYMENTS The Directive 2011/7/EU of 16 February 2011 on combating late payments in commercial transactions is one of the success stories of HOPE. Using the specifics of healthcare, pointing at figures of the impact assessment using websites of the industry, HOPE showed that there was no serious analysis made prior to the proposal of the Commission. More important, no analysis was made of why healthcare services are late payers in some countries and not in others. HOPE’s intense work to convince Members of the European Parliament of the importance for healthcare was successful in getting exemption by extending the payment period up to 60 days instead of 30 days. The general payment term for public authorities will be of 30 days but for public entities that provide healthcare (hospitals, nursing homes, retire‐ment homes, etc), Member States can chose the payment term up to 60 days. This lobbying was all the more important that HOPE was alone in supporting its line, against the industry coalesced.

With this agreement, the Members of the Parliament showed that they understood that the healthcare sector’s problems cannot be solved over‐night. They accepted that healthcare establishments should be afforded greater flexibility in meeting their commitments. In many cases, such pay‐ment problems are the result of structural problems.

HOPE members are then following closely the transposition of the Direc‐tive in their own Member States. This 60‐day limit is only a possibility given to Member States; this does not mean that they will use it.

ANNUAL REPORT I INFLUENCE I HARD LAW

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DIRECTIVE ON PATIENTS’ RIGHTS TO CROSS‐BORDER HEALTHCARE The adoption of the Directive 2011/24/EU Directive on patients’ rights to cross‐border healthcare of 9 March 2011 is the end of a long story that started with the Kohll and Decker rulings of 1998. It is also the beginning of a new one. Why is it important for European healthcare systems? For the first time, a directive is pushing for transparency in the field of costs and outcomes of healthcare services. The “Cross‐border Care” Directive was approved after years of negotiations. HOPE has worked intensely in this issue defending that “cross‐border healthcare system should not be disproportionate in scale and cost to the level of cross‐border activity and should not have wider and unintended consequences for health systems”. HOPE had drawn in particular the attention on several major issues: the difficulties with continu‐ity of care; the way rare diseases were handled in the Directive; the lack of clarity in the design of networks of reference; the risk around the payment mechanism. As a rule, the Directive settles down that patients will be allowed to receive healthcare in another Member State and that they will be reimbursed up to the level of costs that would have been assumed by the Member State of affiliation, if this healthcare had been provided there. For overriding reasons of general interest, a Member State of affiliation may limit the application of the rules on reimbursement for cross‐border healthcare. Member States may introduce a system of prior authorisation to manage the possible outflow of patients. However, this is limited to healthcare that is subject to planning requirements, such as hospital care and healthcare that involves highly specialised and cost‐intensive medical infrastructure or equipment. More important, Member States will have to establish national contact points that must provide patients with information about their rights and entitlements and practical aspects of receiving cross‐border healthcare but also about quality and prices. This is where the attention is now drawn at national level on the transposition period that will last until October 2013. HOPE has then worked in 2011 to increase awareness on the content of the Directive, on the transposition at national level as well as on the implementation acts to be prepared by the Commission. Internal meetings, direct contacts with the Commission were complemented by the conference organised in Düsseldorf on 18 November 2011.


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DIRECTIVE ON FALSIFIED MEDICINAL PRODUCTS The Directive 2011/62/EU of 8 June 2011 amending Directive 2001/83/EC on the community code relating to medicinal products for human use, in regard to the prevention of the entry into the legal supply chain of falsified medicinal products contains safety measures that will impact hospitals. They have to be transposed in EU Member States by November 2013. The text was warmly welcomed by industry associations. It proposes new initiatives to help safeguard the medicines supply chain and protect patients. However, it was adopted without taking into consideration hos‐pital pharmacies. There are no identified cases of falsified drugs purchased by European hospitals and no analysis was made on how those drugs could possibly enter hospitals. The new Directive includes inter alia the following provisions: medicines subject to prescription must bear safety features, which

should allow verification of the authenticity and identification of individual packs throughout the supply chain, and provide evidence of tampering;

the manufacture of active substances intended for use in medici‐nal products must follow good manufacturing practice regard‐ less of whether these ingredients are manufactured in the EU or imported;

importers, manufacturers and distributors of active substances must be registered with the competent authority as brokers of medicinal products;

the new Directive also contains provisions aimed at protecting patients from receiving falsified medicines through the sale of medicines via the internet.

Interpretation of the wording may leave some elements open to debate and further refinement by working groups, for example defining the scope of the legisla‐tion. This is likely to concern only pre‐scription medicines in the first instance. However, the Directive does not exclude the possibility of a risk‐assessment ap‐proach which could mean medicines deemed to be at low risk of counterfeit‐ing are exempted. The specific issue for hospital pharmacies is the principle of checking the drug at the point of dispen‐sation. It makes sense in community pharmacies not in hospital pharmacies.

HOPE has participated in

2011 in several meetings

organised by the Euro‐

pean Commission, but

also by stakeholders, to

share its concerns to

translate the Directive

into implementable,

scalable and inter‐

operable systems.


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RULES ON SERVICES OF GENERAL ECONOMIC INTEREST After months of debate and stakeholder consultations, the European Commission adopted on 20 December 2011 a revised package of EU aid rules for the assessment of public compensation for services of general economic interest (SGEI). The new pack‐age’s overall objective is to bring clarification to key state aid rules and introduce sim‐pler rules for SGEIs that are small, have a local scope or pursue social objectives. It also seeks to take better account of competition consideration for larger SGEIs. The new package consists of four instruments that will apply to all authorities (national, regional, local) that grant compensation for the provision of SGEI: a new Communication, clarifying basic concepts of state aid, which are relevant

for SGEIs; a revised Decision that exempts Member States from notification to the Euro‐

pean Commission for specific SGEI‐categories; a revised Framework for assessing large compensation amounts allocated to

operators outside the social services field. Those cases have to be notified to the Commission and may be declared compatible if they meet certain criteria. The new rules introduce, in particular, a more precise methodology to deter‐mine the amount of compensation;

a new proposal for a de minimis Regulation, providing that compensation be‐low a certain threshold does not fall under state aid scrutiny, is expected to be adopted in the spring of 2012, after a final round of consultation.

The European Commission fulfilled one of HOPE wishes, expressed in 2009 to the new Parliament and the new Commission, to see EU policies being more coherent when having an impact on health and social sectors. There were serious contradictions in the design of some European policies; particularly visible in the debates around cross‐border healthcare as well as around services of general interest and in particular social services of general interest. Handling health and social care issues separately is a mis‐take when population is ageing, chronic diseases are booming and better coordination between all social and health activities is more than ever needed. The Decision of the Commission is clearly in the continuity of the 2005 Decision that had a positive impact on hospitals: the issue in most countries and even cross‐countries is not competition but cooperation between the different actors. But it does more by taking into consideration the realities behind the concepts. One of the major changes brought by the new Package is that all social services are henceforth exempt from the obligation of notification to the Commission, regardless of the amount of the received compensation. The services concerned must meet "social needs as regards health and long term care, childcare, access to and reintegration in the labour market, social housing and the care and social inclusion of vulnerable groups". Until now, only hospitals and social housing were exempted from notification. Other SGEIs are exempted from notification to the Commission if the public funding they receive amounts to less than €15 million a year.


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PROPOSED DIRECTIVES

PROFESSIONAL QUALIFICATIONS DIRECTIVE: RECAST The European Commission published on 19 December 2011 a legislative proposal for modernising the Professional Qualifications Directive (Directive 2005/36/EC). Considering the increasing importance of the mobility of professionals for the daily life of hospitals, HOPE followed closely the long process of consultation that preceded this proposal. HOPE participated in the public consultation launched at the beginning of the year, in which HOPE members agreed on a common position. Most of HOPE concerns were related to patient safety. HOPE also underlined “that the specifics of healthcare are well recognized in the present directive and were sufficiently mentioned in the pre‐vious discussions. It is worth noting however that the hospital and healthcare services do not employ only the professions that are clearly identified in the directive but also the widest range of competencies in the entire economic sector”. On 22 June 2011, the European Commission published a green paper. One of the measures the Commission proposed was the introduction of a European Professional card, which would enable interested professionals to have the possibility of benefiting from easier and faster recognition of their qualifications, which is expected to facilitate their mobility. The need of the card was far from convincing all HOPE members. This issue cannot be discussed in abstracto before being sure that a cost‐efficient and safe system could be put in place. The legislative proposal also suggests updating minimum training requirements for doctors, dentists, pharmacists, nurses, midwives, veterinary surgeons and architects. For example, the entry level for nursing and midwifery training would pass from 10 years to 12 years of general education, which was an issue HOPE did not agree with. On the contrary, like the Commission, HOPE was of the opinion of introducing an alert mechanism for health professionals benefiting from an automatic recognition: compe‐tent authorities of a Member State would be obliged to alert competent authorities of all other Member States about a health professional who has been prohibited from exercising his professional activity by a public authority or a court. HOPE considers also with interest the fact that the proposed Directive may introduce common training frameworks and common training tests. Automatic recognition would be given on the basis of a common set of knowledge, skills and competences or a com‐mon test assessing.


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PUBLIC PROCUREMENT POLICY DIRECTIVE: RECAST On 27 January 2011, the European Commission unveiled a Green Paper on the modernisation of EU public procurement policy marking the start of a public consulta‐tion exercise on implementation of the EU Public Market Directives (2004/18/EC and 2004/17/EC). The consultation exercise ran until 18 April 2011. On 20 December 2011, the European Commission announced the revision of the public procurement Direc‐tives. The reform of legislation on public procurement is one of the twelve priority actions set out in the Single Market Act adopted in April 2011. Along with the recent and cur‐rent budgetary constraints, public tendering has become a priority for all Member States. Apart from simplification, EU wants to ensure over‐arching objectives like the environ‐ment and social policy are properly covered. One of the options of the Green Paper was reducing some of the duties: loosening the publication requirements and introduc‐ing a more standard negotiating procedure with the publication of calls for tender. This concerns most hospitals but not all. HOPE then decided not to answer the consul‐tation but to gather HOPE members position for the adoption of the basis of a draft HOPE position on 18 November 2011.

HOPE asks for clarification of the scope of the directives and of the definitions in the directives and in particular the definition of a “body governed by public law” in line with the jurisprudence of the European Court of Justice. HOPE recalls the ECJ case‐law that considers public‐public cooperation not subject to public procurement rules as long as clear criteria are met. Those clarifications should be codified in the procure‐ment directives.


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HOPE debated on the removal or not of the criterion of the lowest price in order to develop the full potential of public procurement and if in principle there should be only one option for the award of contracts: the most economically advantageous tender – including the entire life‐cycle costs of the relevant goods, services or works. In any case, HOPE considers that increased awareness of the environmental and climate im‐pact of products and activities means that the possibility for public authorities to favour local suppliers should be considered. Any extension of the EU procurement rules into the “what to buy” area would lead to more complicated rules with many exemptions, which would be difficult to administer in practice. The directives are too detailed and have become increasingly technical and complex. At the same time, the legal risk of non‐compliance with these rules has increased consid‐erably for contracting authorities. The fear of challenge leads to a risk‐averse approach, block innovation and sustainable development, resulting far too often in the cheapest price being opted for instead of the best value. HOPE advocates clear and simple rules with a reduction in the level of detail and greater reliance upon the general principles of transparency, equal treatment and non‐discrimination. On 20 December 2011, the European Commission announced its proposal for the revision of the public procurement Directives: simplifying the rules and procedures for public procurement and make them more flexible by strengthening the possibility of increased recourse to negotiation; extending and, in the longer term, generalizing electronic communication in public procurement; drastically cutting the administrative burden through a significant reduction of documents required from economic operators. The Commission’s proposal accepted the European Parliament suggestion of dividing tenders into lots and limit the financial capacity requirements for the submission of a tender. In order to facilitate a qualitative improvement in the use of public procure‐ments, the Commission proposed taking greater consideration for social and environ‐mental criteria such as life‐cycle costs or the integration of vulnerable and disadvan‐taged persons. A fourth element was to improve the existing guarantees in terms of combating conflicts of interest, favouritism and corruption in order to better ensure the integrity of procedures, given the financial implications. The Commission proposed to appoint a single national authority responsible for monitoring, performing and checking public contracts by Member States, in order to ensure that the rules are properly applied in practice. The Commission's proposals was transmitted to the Council of Ministers and the Euro‐pean Parliament with a view to launching the legislative procedure for their adoption, expected to take place before the end of 2012. HOPE will be following these discus‐sions very closely.


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DIRECTIVE ON WASTE ELECTRIC AND ELECTRONIC EQUIPMENT: RECAST Considering that a number of substantial changes are to be made to Directive 2002/96/EC on waste electrical and electronic equipment (WEEE), the European Commission proposed in December 2008 to recast it. This proposed Directive is another example of a proposal that missed to include the specifics of the healthcare sector. In this case, HOPE defended a better balance between safety and control without risking repair, refurbishment and donations. Following the usual process of consultations and negotiations, the European Parlia‐ment voted on the proposal of the Commission in first reading on 3 February 2011 and the Council adopted a common position on 19 July 2011. The objective of the revision of this Directive was to prevent the illegal export of poten‐tially lethal waste to developing countries as only 35% of electrical and electronic waste generated in the EU meets EU reporting and processing requirements. Medical devices are part of this kind of waste; thus this has been an issue HOPE has also been working in 2011.

HOPE informed the European Parliament that some measures proposed were making legitimate repair and refurbishment activities practically impossible. They have the po‐tential of limiting availability of refurbished systems and increasing costs, as repair of equipment which warranty period has expired would no longer be possible.

An additional element concerns medical equipment donations. In several EU Member States, medical equipment donations are part of a strategy to improve the quality of care in developing countries. HOPE is actually working on a project co‐financed by EUROPEAID on donations of medical equipments, improving the present situation within the borders defined by the World Health Organization. This is an additional argument in the current debate. With those arguments HOPE got some positive feedback but at the end of 2011 a deci‐sion from the Council was expected but never happened.


22

ELECTROMAGNETIC FIELDS DIRECTIVE Following concerns from magnetic resonance users and patient groups, then the European Parliament and Member States, the European Union was convinced in 2007 that the unintended consequences on magnetic resonance imaging of the Electromagnetic Field (EMF) Directive were suffi‐ciently serious, that it took the most unusual step of postponing the imple‐mentation of the Directive for 4 years until 30 April 2012. Since then, the Commission has consulted widely amongst Member States and all inter‐ested parties and undertaken research and literature reviews on the possi‐ble effects of EMF on workers and specific aspects relating to magnetic resonance. However, an agreement has not been reached yet. The original directive was supposed to clarify the definitions on harmful effects on health, brings in new upper limits for exposure (frequencies recognized as having harmful effects on the human cardiovascular system and the central nervous system), and a number of clauses aiming to make life easier for employers when a risk assessment is required by law. Exposed workers or their representatives must receive the information and training required from their employer, particularly as regards the results of the risk assessment, measures taken by the employer, safe pro‐fessional practices, detecting harmful effects and conditions under which employers are entitled to health monitoring. EU policies in areas such as medical research, medical innovation, healthy and active ageing and economic competitiveness in a high tech business sector are encouraging and in some cases funding the increased use of magnetic resonance as the technique is developed to diagnose cancers, neurological, cardio vascular, muscular and many other diseases at an ear‐lier stage, advancing scientific understanding and improving patient out‐comes. In June 2011, the Commission proposed to update the current upper limits for exposure in reference to the latest scientific information, particularly as regards the upper limits for exposure to MRI in hospitals. This way, the exposure limit values specified in the Directive should not apply to medical applications using MRI but alternative safeguards should be put in place specifically for workers using MRI in the healthcare sector. The aim of this proposal was to ensure a balance between protecting the health and safety of workers, whilst allowing appropriate levels of flexibility and proportionality in order not to prevent the use and development of industrial and medical activi‐ties to an excessive extent.


HOPE has been follow‐

ing and supporting work

in yet another example

of a series of mistakes

made by not taking into

consideration healthcare

23

Some Member States, during discussions in the working party of the Council last autumn, objected to this measure and initially suggested removing the deroga‐tion. This would severely affect the ability of healthcare services across Europe to use MRI to diagnose and treat a range of serious conditions, especially cancer.

The proposal of the Commission was very welcomed by the Alliance for MRI, a coalition, in which HOPE is involved, gathering European Parliamentarians, patient groups, leading European scientists and the medical community who defend the use of the clinical and research use of Magnetic Resonance Imaging (MRI). In November 2011, the Scientific Steering Committee of the International Scien‐tific Conference on Electromagnetic Fields (EMF) and Health that met at the Commission, recognized that “the amount of radiation exposure and exposure assessment are a major source of uncertainty in research on EMF and health”. The Council working group agreed this time that there is a need for certain groups of staff to be excluded from the exposure limits, but there is disagree‐ment over how wide the scope of that exemption should be and the form it should take. A general derogation would be complex and burdensome to implement requir‐ing individual hospitals to apply for the use of the derogation and having to monitor and report back on the alternative safety measures for staff that they have put in place. In the Commission, the Directorate General Employment (DG EMPL) has started the process for a further postponement of the implementation of the Directive for another two years considering the on‐going lack of consensus at Council level. In The EU Parliament there is cross‐party support for the MRI derogation except from the Greens, strongly opposed to it.


24


WORKING TIME DIRECTIVE With the failure of the revision process of the Working Time Directive, the procedure had to start from the beginning in 2011. According to the treaties, European social partners should first be asked for an agree‐ment and only if they do not reach such an agreement would the Commission work on a proposal. The only significant public event was then on 14 April 2011, the hearing on the pros‐pects for revision of the working time directive organised by the Employment commit‐tee of the European Parliament. This was an opportunity to get the position of the European social partners. Business Europe considers that the content of the revision of the Directive should be restricted to the jurisprudence of the European Court of Justice. For them the social partners have to focus on those issues where there is scope for agreement. Broader issues should not be the objective of revision. The European Centre of Employers and Enterprises providing Public services (CEEP) considers that a balance needs to be found between health and safety and flexibility for both employers and workers in a future revision. The issue of on‐call time is obvi‐ously of great concern. CEEP calls for a negotiated solution across the sectoral level as it is an issue for the whole labour market and not sector specific. Regarding the scope for negotiations, a new working time directive has to solve the questions of on‐call and compensatory rest but there are also other problems that should be solved. The European Trade Union Confederation said it had carefully built up its position over the last decade. There have been no changes to its demands. It must be a comprehen‐sive review of the directive. The most worrying proposals would be to maintain opt‐outs, reference periods and counting of on‐call time. The objectives would be a comprehensive revision and an end to the phasing‐out of opt‐outs. The position of the European Federation of Public Service Unions (EPSU) is in line with the ETUC.

25


TRANSPARENCY DIRECTIVE: REVISION The European Commission is undertaking several activities towards the revision of the Transparency Directive to improve access to medicines of European citizens. In 2011, an impact assessment study and a public consultation were launched by the European Commission in preparation of the legislative text, which was supposed to be officially presented in 2012. During a meeting of the Polish Presidency in December 2011, the Commission presented parts of the proposals. One of the key elements of the revision proposed by the Commission is to reduce time limits for the pricing and reimbursement for generic medicine. This point will produce considerable debate. Some will welcome the shortening of these time limits; others will worry that the shortening of these time limits would have a negative impact on the quality of the Health Technology Assessments of new drugs.

26

SOFT LAW AND OTHER INITIATIVES

RECOMMENDATIONS ON PATIENT SAFETY QUALITY After the adoption by the Council on 9 June 2009 of the recommendation on patient safety and healthcare acquired infections, the Commission Patient Safety and Quality Working Group, of which HOPE is a member, met mostly in 2011 to discuss the involve‐ment of the Member States and stakeholders in its implementation. On 26 January 2011, the Working Group — composed of the representatives of the Member States and selected EU stakeholders — discussed a questionnaire for Member States about the prevention and control of healthcare acquired infection. With this questionnaire, the Commission wanted to measure if Member States adopted the rec‐ommendation of the European Council in 2009 to put in place and improve national strategies to prevent and control adverse events in all healthcare settings. On 21 November 2011, the Commission shared the preliminary analysis of the ques‐tionnaire, which show that although Member States have declared that initiatives had been put in place in their country to implement the European Council recommenda‐tions (in terms of national safety strategies, patient involvement or reporting and learning systems for example) there is a lack of details and clarity regarding which actions exactly have been undertaken. Several elements could represent, according to the Commission, obstacles to the im‐plementation of these recommendations, such as the existence of other pressing issues on the agenda (e.g. financial crisis, financial constraints or an insufficient time lapse between the adoption of the recommendations and the reporting). The Commission declared its intention of contacting some of the respondents for clarification.

ANNUAL REPORT I INFLUENCE I SOFT LAW AND OTHER INITIATIVES

27

PLATFORM ON ACCESS TO MEDICINE In 2010, as part of the Process on Corporate Responsibility in the field of Phar‐maceuticals, the Commission organised in Brussels on 24 September the first Steering group meeting of the Platform on access to medicines in Europe. Together with all Member States, HOPE was invited among key stakeholders to that meeting chaired by the Directorate General for Enterprise and Industry. Indeed, despite the official move of pharmaceutical issues to the Directorate General Health, some activities as this particular one remain in the field of DG Enterprise. The work is organised around projects that started in 2011. The Commission proposed five topics: mechanism of coordinated access to orphan medicinal products, capacity building on contractual agreements for innovative medicines, facilitating the supply in small countries, promoting a good governance for non‐ prescription drugs, and market access for biosimilars. HOPE participates in the Working Group on “Market access and uptake of Biosimilars” and “Small markets” which met several times in 2011. The aim of the biosimilar group is to promote uptake of biological medicinal product, espe‐cially biosimilars and enhance their accessibility. Unlike generics, which are origi‐nally chemical, biosimilars are medicines based on biological complex molecules. They are similar but not identical to biological medicines already commercialised and which have reached patent expiry. The use and commercialization of biosimilars is regulated by the Directive 2001/83/CE (amended by the Directive 2004/27/CE). The high price resulting from the important research investment and the lack of information on these innovative treatments causes difficulties for biosimilars to make a veritable breakthrough on the national pharmaceutical markets. The work of the project group should lead to a report with general in‐formation on biosimilars as well as three chapters of specific information: for patients, for healthcare professionals, for public authorities.


28

PLATFORM ON ETHICS AND TRANSPARENCY The Directorate General Enterprise organised on 7 September 2011, for the first time, a meeting on the relations of patients/industry as well as another one on the relations of healthcare professionals/industry. Both are part of the Platform on Ethics and Trans‐parency. Concerning the relations of Patients/Industry the work is led by the European Patient Forum. EPF made a presentation on the outcomes of a preliminary mapping exercise on some existing Codes of conduct and good practices, which are used by patients' or‐ganisations in their relations with industry. Although there are different initiatives there is no standard model of work and that it would be useful to identify the elements that could have an added value in order to agree on a common Charter. The group was told to express clearly their preference on certain issues such as possible widening of the scope, method of enforcement and others. Concerning the relations healthcare professionals/industry, the exchange of views on the current situation and on possible future actions was initiated by a presentation made by CPME, the Standing Committee of the European Doctors. There was almost unanimity on limiting the scope to pharmaceutical products. Many participants also welcomed the inclusion on the debate of related stakeholders, such as the medical de‐vices and IT industry. As far as the deliverables are concerned, there was a majority agreeing on creating an umbrella‐type Charter, while adding some specific elements by sector if needed. An ambitious timeline has been adopted: setting the general principles by June 2012 and topic‐related standards by December 2012. The outcome of this work should be placed in the framework of the sectoral platforms promoted in the CSR (Corporate Social Responsibility) Communication, which was adopted on 25 October 2011. On 25 October 2011, the Commission pub‐lished a new Communication on CSR, strongly encouraging an alignment of Euro‐pean and global approaches on CSR. The Commission also emphasized the im‐portance of involving all stakeholders, including patients and health professionals in the process, a fact welcomed by many participants. Discussion then focused on the proposal of the Commission to develop a high‐level European CSR code.


29

MEDICAL DEVICES: EUROPEAN UNIQUE IDENTIFIER Member since 2010 of the Medical Devices Expert Group, HOPE participated in 2011, for the first time, in the European Unique Device Identifier (UDI) ad hoc working group. The UDI is a series of numeric or alphanumeric characters that is created through a coding system. It allows the unambiguous identification of a specific product on the market and represents the “access key” to device related information stored in a UDI Database. The general objective of UDI is essentially to increase patient safety by facili‐tating traceability of devices, improving the identification of devices in adverse events and facilitating field service corrective actions. In the preparation of the recast of the Medical Devices Directive, the Commission is using the work of the Global Harmonization Task Force (GHTF) to study the issue of traceability. The document of the GHTF, which is a voluntary group of representatives from medical device regulatory agencies and the regulated industry, is intended to pro‐vide non‐binding guidance for use in the regulation of medical devices. The UDI comprises the Device Identifier and Production Identifier. The word "Unique" does not imply serialisation of every single device, e.g. those devices marketed in lots and batches. With a single, globally accepted source for positive identification of medi‐cal devices, healthcare professionals and patients would no longer have to access mul‐tiple, inconsistent, and incomplete sources in an attempt to identify a device, its key attributes, and a designated source for additional information. It would help ensuring the adequate identification of the device through its distribution and use and providing rapid access to key attributes relating to the device. Another element is the simplifica‐tion of the integration of information on device use into medical records.


30

COMMISSIONER DALLI WITH HOPE ON “HOSPITAL OF TODAY” There are many occasions for HOPE to meet officials of the Commission, but it was a great honour on 22 March 2011, on the occasion of the HOPE Liaison Officers’ meeting, to welcome the European Commissioner for Health and Consumer Policy John Dalli to share his views on healthcare and in particular on hospitals. The conference was titled “Hospital of Today – What you plan today will remain optimal tomorrow”. Commissioner Dalli underlined the need to explore how efficient and sustainable hospitals can be devel‐oped in the future. His perception of the sector is rather bleak. Health services are facing today new challenges: ageing popula‐tion, burden of chronic diseases, shrinking of the health workforce, growing demand for healthcare with limited means. He considers that there is a need for innovative solutions to deliver better health‐care, to more people, in a more efficient manner in the long term. According to him, making more efficient use of valuable resources applies particularly to hospitals. He highlighted there are many different aspects that contribute to the cost‐efficiency of hospitals, among others there is the use of health technologies. He acknowledged that although the progress is being done and many hospitals use electronic health records to ensure doctors can easily and safely access patients' records and medical information, there are still not more than 8% of European hospitals that exploit the potential of telemedicine and telemonitoring. Telemedicine could enable hospitals to connect with other hospitals to pool resources. Through telemedicine, hospitals could provide the best available expertise and service to their patients, relying – in some cases – on specialists from other hospitals. He stressed that the technology is there, but the time has come to unlock its potential to develop intelligent hospitals: hospitals where patients have access to their medical data and are given ownership over their own health; hospitals where doctors and nurses can access medical data and work closely with colleagues and patients, inde‐pendent of time and place – whether in their own hospital, country or elsewhere in Europe; hospitals that use telemedicine to provide home care or to connect with other hospitals. In order to achieve this, John Dalli considers that there is a need for a political will, smarter investments, better use of the structural funds and public‐private partnerships to modernise the health systems, from building infrastructure to investing in health technology. He recognized however, that there is no "one‐size‐fits‐all" approach to design hospitals, considering the diversity of health systems and the needs of different populations.


HOPE Chief Executive Pascal Garel welcomes

European Commissioner for Health and Consumer Policy John Dalli

31

EU HEALTH POLICY FORUM Another tool of influence for HOPE is to develop the EU Health Policy Forum, which brings together 52 umbrella organisations representing the major European stake‐holders in the field of public health and healthcare. The Health Policy Forum has among its functions: reviewing the EU's work in various areas of public health and adopting recommendations; responding Commission’s con‐sultations and assisting in organising consultations; enabling exchange of views and experience on a wide range of topics; assisting in implementation and follow‐up of spe‐cific initiatives. On 19 May 2011, the main discussions were on the European Innovation Partnership on Active and Healthy Ageing (AHAIP); the activities of the Hungarian Presidency in the field of health; the ex‐post evaluation of the Public Health Programme (PHP) 2003‐2007 & Mid‐term evaluation of the Health Programme 2008‐2013. On 12 October 2011, the objectives of the meeting were to follow the work of the Council Working Group on Public Health at Senior Level and activities with the Euro‐pean Innovation Partnership on Active and Healthy Ageing; but also to analyse the New Health Programme and the health strategy and to do a mid‐term evaluation of the cur‐rent health programme.


32

EU INNOVATION PARTNERSHIP ON ACTIVE AND HEALTHY AGEING With the Innovation Union strategy the European Commission aims to enhance Euro‐pean competitiveness and tackle societal challenges through research and innovation. One way in which this is to be achieved is with Innovation Partnerships. The European Commission has identified active and healthy ageing as a major societal challenge com‐mon to all European countries, and an area which presents considerable potential for Europe to lead the world in providing innovative responses to this challenge. A pilot European Innovation Partnership on Active and Healthy Ageing was decided aiming at: enabling EU citizens to lead healthy, active and independent lives while age‐ing; improving the sustainability and efficiency of social and healthcare systems; boost‐ing and improving the competitiveness of the markets for innovative products and ser‐vices, responding to the ageing challenge at both EU and global level, thus creating new opportunities for businesses. In April 2011, the Commission launched a consultation on this EU Innovation Partner‐ship on Active and Healthy Ageing, in which HOPE participated explaining its Managed Outcomes research project, co‐financed by the European Commission (7th Framework

Programme). The Managed Out‐comes proposal explores the as‐sumption that healthcare out‐comes and costs are affected by the efficiency of service produc‐tion, the time/location con‐strained regional structure of healthcare delivery, and the degree to which people are em‐powered to participate in the co‐production of their care. Its aim is to develop more effective and efficient healthcare systems models with a new scientific ap‐proach building on service opera‐tions management. The main

goal of this project is to develop and disseminate theoretically rich but practical con‐ceptual models and a toolkit of the healthcare service production system. The project Managed Outcomes covers among others diabetes and osteoarthritis, two major issues particularly related to ageing. Osteoarthritis in the hip for example may limit moving and bending. This can make daily activities such as dressing and foot care a challenge. Walking aids, medication and exercise can help relieve pain and improve motion. Most successful treatment programs involve a combination of treatments tailored to the patient's needs, lifestyle and health. More generally, a key issue identified by HOPE members is the need for coherence and articulation between the hospital and healthcare sector and the social sector. Handling those issues separately would be a mistake when the population is ageing and will need better coordination between all social and health activities would be a mistake. HOPE has already worked on this issue and will continue, first focusing in 2011 on the coordination between hospital and primary care, so within the health sector.


33

Following the consultation, the European Commission has set up a high level Steering group to assist with preparatory work for the pilot partnership (EIP). Jointly chaired by Vice‐President Neelie Kroes and Commissioner John Dalli, it gathered 34 members. The composition of the steering group is rather puzzling. Its representativity has been already widely questioned, considering the over‐representation of the industry (from Philips to Danone) and the complete absence of the public health sector. On the basis of working groups to which HOPE contributed, the Steering Group of the pilot European Innovation Partnership on Healthy Ageing agreed on five specific joint actions to respond to the societal challenge of an ageing European population. Based on three areas of action (prevention, care and cure, and independent living), the determined recommendations are the following: innovating ways to ensure patients follow their prescriptions; innovative solutions to prevent falls and support early diagnosis for older people; spread and promote successful innovative integrated care models for older

patients with chronic diseases; cooperation to help prevent functional decline and frailty, with a particular

focus on nutrition; improve the uptake of interoperable ICT independent living solutions through

global standards to help older people stay independent, mobile and active for longer.

HOPE President, Georg Baum, was invited to share the views of HOPE at the European Health Forum Gastein in October 2011. In the opinion of HOPE, a European Innovation Partnership could support active and healthy ageing through innovation by being a central point were all initiatives, at least those financed by the Commission, would con‐verge and be reshaped into implementation tools. The focus in 2012 will be more specifically on ageing and ageing workforce led by HOPE German member, DKG, the German Hospital Federation. This will be an opportunity to open the issue of the social/healthcare coordination. More specifically, in this context, HOPE is taking contacts for further work in spreading a useful use of information and communication technologies in helping this coordination within and with the health‐care sector in particular on chronic diseases.


34

WORLD HEALTH DAY 7 APRIL 2011 On 7 April 2011, the World Health Day focused on efforts to combat an‐timicrobial resistance (AMR) saying “No action today, no cure tomorrow”. The WHO called for action to stop the progress of the spread of antimicro‐bial resistance by urging policy‐makers, public and patients, prescribers, pharmacists and the pharmaceutical industry to combat drug resistance. The Commission joined the World Health Organization (WHO) in calling for greater efforts to be deployed in addressing the growing threat of poten‐tially deadly bacteria developing resistance to antimicrobial drugs. In the EU alone, it is estimated that drug resistant infections cause more than 25.000 deaths and €1,5 billion in extra healthcare costs every year. Following on from the 2001 “Community Strategy against Antimicrobial Resistance”, the Commission has developed a series of initiatives to tackle this issue. The EU has prioritised research in this field, supporting numer‐ous research projects for a total amount of approximately €300 million since 1999. Currently, it is funding work on developing new medicines but further efforts are needed and a new strategy has to be put in place, said Commissioners Dalli (Health), Geoghegan‐Quinn (Research) and Piebalgs (Development).


HOPE participated in the

call to action of both the

EU and WHO concerning

antimicrobial resistance

35

ANTIBIOTIC AWARENESS DAY 17 NOVEMBER 2011 On 17 November 2011, to coincide with Antibiotic Awareness Day, the European Com‐mission unveiled its comprehensive Action Plan on Antimicrobial resistance (AMR). Recent evidence from the European Centre for Disease Prevention and Control (ECDC) shows resistance to antibiotics is increasing in Europe, a set of 12 actions was identified to be implemented in close collaboration with Member States. As in previous years, HOPE joined the European Antibiotic Awareness Day 2011 hosted by the ECDC. The Plan offers 12 concrete actions to cover seven key areas of action: ensuring an appropriate use of antibiotics; preventing microbial infection and spread of infections; developing alternative antimicrobials; supporting international collaboration to contain the risk of AMR; improving monitoring and surveillance in animal and health medicine; research and innovation; communication, education and training.

The five years Action plan was presented during a press conference by the European Commissioner for Health and Consumer Policy, John Dalli, the Commissioner for Research, Innovation and Science, Maíre Geoghegan‐Quinn and the director of ECDC, Mark Sprenger. The Commissioner for Health and Consumer Policy John Dalli mentioned the need for the illegal practises followed by some farmers who use antibiotics without any prior prescription and without a veterinary present to be addressed and controlled. The Commissioner also said that it was equally crucial to make an effort to reduce the legal use of antibiotics in patients. In addition, he brought attention to the lack of invest‐ment in the development of new antibiotics and in the fight against microbial resis‐tance. According to him, the cost of action would be minor compared to the cost these infections cost every year in Europe (€1,5 billion according to a 2007 survey). It was also highlighted that 20 to 30% of the infections contracted in healthcare could be avoided through intensive prevention and control programmes. HOPE contributed to the launch event where Ruxandra Draghia‐Akli, the Director of the Health Directorate, DG Research and Innovation, emphasized the importance of collaboration between Member States and the necessity to work with the industry to develop alternatives to existing antimicrobials.


36

WHO REGIONAL OFFICE FOR EUROPEAN HEALTH 2020 STRATEGY In its efforts to consult and engage with the EU stakeholders in the development of a new European policy for health ‐ “Health 2020”‐, and taking into account the impor‐tance of their active engagement to the success of this new Policy, the WHO Regional Office for Europe invited HOPE to participate in the meeting, held in Brussels on 12 July 2011. The aim was to inform the invited NGOs on the process and substance of this “Health 2020” policy for health and to explore how to promote and achieve a strong collaboration in designing and implementing policies in a partnership between WHO Regional Office and NGOs. One of the core component of Health 2020, which aims to represent a tool for coherence in policy making, legitimacy and synergies, is a study carried out by WHO that highlights the role of the determinants of health and inequalities, the governance for health, and how to define and have evidence on effective solutions to address the burden of diseases targeting people and citizens. HOPE sees this Health 2020 process as a timely opportunity to further increase WHO Europe collaboration with European associations on a polity which aims to be an inspi‐ration and guiding principle for Member States and other stakeholders in health in Europe and in the future.


37

Chapter 3

KNOWLEDGE & EXCHANGE

38

Development of

knowledge and

f a c i l i t a t i n g e x -

changes is at the

essence of HOPE.

Joining consortiums,

participating in pro-

jects and joint

actions is now a

regular practice.

39

EU PROGRAMMES AND PROJECTS

HOPE participated in the discussions on the 2014‐2020 strategy on public health. HOPE was also involved in the discussion on the strategy for research.

2020 COMMON STRATEGIC FRAMEWORK IN RESEARCH & INNOVATION HOPE was invited to the Advisory Workshop on Horizon 2020 Common Strategic Framework organised on 6 and 7 July 2011 by Directorate General Research & Innova‐tion. HOPE provided its views on the challenges to be tackled by EU research and inno‐vation and how to address them. The meeting was chaired by Ruxandra Draghia‐Akli, Director for Health Research. The debate turned around mostly on how to optimise healthcare and health systems, on informing and empowering the patient; moving to more disruptive/innovative tech‐nologies; on pluri‐disciplinarity; health economics for identification of best practices. There was also a discussion on harmonisation (of protocols, of questionnaires, of health indicators, of tools for planning and resources allocation) and on standardisa‐tion. It became clear after two days, efforts are required to improve decision making in pre‐vention and treatment provision, to identify and support the dissemination of best practice in the healthcare sector, to support the update of technological and organisa‐tional innovations and to enhance health promotion and prevention efforts. More generally, the main features emerging from the debate of the two days are that the European Research Area of health research is far from complete. National infra and info‐structures and protocols, data collections need common tools, common indica‐tors, harmonisation, alignment, integration; and sustainable repositories. As long as this fragmentation continues, the Commission considers that hampered information flow will prevent the full exploitation of the wealth of experience, of critical mass and of diversity in the EU, and the identification and taking up of best practices. Innovation requires acceptability of the technology developed. Taking‐up a new tech‐nology implies early empowerment of individuals and early involvement of health pro‐fessionals, including regulatory authorities and insurances, targeted health systems research and the standardisation of indicators and information tools. Empowerment of individuals implies defining health promotion strategies incorporating findings from a variety of research including behavioural studies. These reflections will feed into the preparation of the forthcoming Commission pro‐posal for the Horizon 2020 Common Strategic Framework for Research and Innovation.

ANNUAL REPORT I KNOWLEDGE & EXCHANGE I EU PROGRAMMES AND PROJECTS

40

BUILDING CONSORTIUM IN RESEARCH The Health‐NCP‐Net (the National Contact Points Network) and the Fit for Health pro‐jects invited HOPE to the Seventh Framework Programme for Research (FP7) Health Partnering event to consortium building. The programme provided information on what makes a good consortium and gave researchers from SME and academia inter‐ested in SME targeted topics. It also provided countries outside Europe a platform to present their project ideas in 5‐minute presentations. Bilateral meetings were arranged automatically by a sophisticated, user‐friendly match‐making tool following indication of interests in specific call areas by participants. Additionally to bilateral meetings among potential project partners, participants had the option to meet with representatives of support initiatives (such as the KAPPA‐Health and Access 4EU projects) and members of the organising projects for personal‐ised support and information. In July 2011, the Commission published the Work Programme for 2012 with about €7 billion, the biggest funding package under the EU's Seventh Framework Programme for Research (FP7).


41

EUREGIO II HOPE was a partner in the project EUREGIO II “Solutions for improving healthcare co‐operation in border regions”. It was co‐funded under the Public Health Programme of the European Union. The general objective of the project was to stimulate and promote cross‐border coop‐eration in healthcare by fostering the usability of various existing instruments and methods, such as structural funds, Health Technology Assessment (HTA) and indicators. Specific purposes of the project are: to improve the use of resources in cross‐border healthcare, especially with regard to the structural funds; to test Health Technology Assessment solutions in small‐size settings with multiple healthcare systems; support the establishment of a network to facilitate information exchange and best practices. HOPE was mostly involved in Work Package 4 and Work Package 5. The Work Package 4 was helping making effective use of INTERREG‐funding in cross‐border care. There were five objectives: give support for the development of cross‐border healthcare projects in border regions; provide general information on the struc‐tural fund INTERREG; identify barriers for effective cross‐border cooperation that are immanent to the systems; identify indicators and criteria for cross‐border healthcare projects to be effective; to select criteria and indicators that identify models of good practice. A review of the literature and an analysis of the current projects of cooperation involv‐ing the use of structural funds have been developed. A survey has been realised, which concerns the experiences, possibilities and problems in cross‐border activities and in the utilization of structural funds. HOPE members have been involved in this phase; they received the questionnaire and contributed to disseminate it among hospitals in border regions. In‐depth interviews in five key stakeholder/regions were realised and further on, key stakeholders were asked for a feedback on the final version of a hand‐book. The Work Package 5 was about the use of generic HTA in cross‐border cooperation. The work package realised a guideline for the use of HTA applications within the decision‐making process in border regions. It represent a useful, easy tool to support all local decision‐makers to appropriately uptake, interpret and implement the results of HTA.

HOPE AS A PARTNER: COMPLETED PROJECTS


42

The objectives were the following: identify the needs of local and hospital decision‐makers; provide them with instruments and indication to get the information they need for an effective and timely application of HTA results in border regions; help them to work together whenever the opportunity to perform their own HTA is recognised. A review of the literature concerning effectiveness, reliability and transferability of local HTA and other kinds of Evidence Based Assessments to inform the investment decisions in local settings has been performed in the first stage of the project. A ques‐tionnaire in collaboration with the other partners and some interviews have been real‐ised to collect and evaluate the needs, problems and expectations of decision makers dealing with decisions on investments and assessment of new technologies in border regions. Afterwards a draft of the guideline for the effective use of HTA within decision‐making processes in border regions will be realised and discussed by academic experts in a workshop. The revised guideline will be tested within cross‐border environments – two case studies will be realised – and its final version will be submitted to interested stakeholders through the opening of a web‐based evaluation and feedback procedure, during which they will have the opportunity to provide suggestions and add comments to the proposed guideline. The three‐year project EUREGIO II “Solutions for improving cooperation in border regions” ended at November 2011. A Handbook on the effective use of INTERREG funding in cross‐border healthcare was produced. It is intended to be used as a support tool in the decision making process as well as in providing practical guidance on devising, implementing and evaluating cross‐border health projects. Fact sheets have been developed to provide effective recom‐mendations about the conditions required when planning and implementing cross‐border healthcare activities. A legal report concerning liability and data protection issues in cross‐border cooperation was the second deliverable. The Legal Report gives insight into how border regions actually tackle legal challenges, it underlines what is of legal importance and where loopholes still exist, and shows that combined efforts can lead to best practice projects within cross‐border healthcare. The third product was the Guideline for the use of Health Technology Assessment (HTA) in border settings, a work led by HOPE.


43

E‐MEDICINIMAGE PROJECT HOPE was a partner of the e‐MEDICINimage project that aimed at developing a con‐tinuous training programme dedicated to Medical Biology physicians in Parasitology and Medical Mycology. For HOPE, it is a good example of eLearning and continuous professional development. The project started on 1 October 2009 and was concluded by a meeting in September 2011. The e‐learning training is based on real‐life cases taken from laboratory experi‐ence, written in five languages: Portuguese, Spanish, Polish, English and French. The users' work will also be assessed by tutors in their mother tongues. The e‐MEDICINimage project was funded by the European Leonardo da Vinci programme within the action “Transfer of Innovation” projects. It includes a clearly defined quality approach, whose tasks and processes were established in the Leonardo da Vinci application form. The success of the training device is visible in the increase of recruitment of users made by the specialists in the 5 countries: it represents at the be‐ginning of September 2011 more than 650 physicians for the 1stsession and 1.200 for the 2nd session. More than 2.400 training dossiers have been done since the beginning, receiving more than 2.000 replies from the tutors.


44

NOWHERELAND NowHereLand project, which closed in February 2011, also had HOPE as one of the partners. This project aimed at creating a knowledge base for providing, exchanging and developing good practice of healthcare services for undocumented migrants (UDM) through: drawing a landscape of the legal and financial frameworks on national level in

the EU 27 under which healthcare services/providers act; gaining an overview about needs and strategies of undocumented migrants in

getting access to healthcare services, compiling experiences from NGOs and other advocacy groups from their work with undocumented migrants (from European to local level);

collecting existing practice of health services in the EU on regional and local level in a database and identifying transferable models of good practice.

Estimated 1‐4% of the overall population in Europe are undocumented migrants who face extremely precarious and health threatening living conditions. NowHereland is a paradox country: inhabitants are officially not visible, but part of social reality and healthcare providers have to deal with them in the area of conflict between the basic human right for healthcare, state control logic and the simple wish to help. “Health Care in NowHereLand” has produced the first‐ever compilation of the policies and regulations in force in the EU 27, a database of practice models in 11 EU Member States and Switzerland, and has made in‐depth assessments of selected practice mod‐els and provides insights into the “daily lives” of UDM and their struggle to access healthcare services.


45

DUQUE PROJECT The project started in November 2009 and will last until 2013. The re‐search results will be presented in Berlin at the DUQuE final conference scheduled for 17 December 2012. In order to get the research conclusions on the quality assessment, the project foresees the surveys by the mean of questionnaires at the hospital and departmental levels, surveys at the patient level, and visits. The MARQuIS project was looking at quality strategies and their influence in outputs. The logical next step was to look at outcomes. Most partners of MARQuIS designed together a new research project. Called DUQuE it was accepted for funding under the 7th framework programme for re‐search (Improve quality and safety of hospital care). DUQuE is aiming at studying the effectiveness of quality improvement sys‐tems in European hospitals. This 42 months’ project is divided into 6 work packages: project management; developing hospital level measures; de‐veloping patient level measures; field test; data analysis; analysis and pol‐icy implications. HOPE is the work package leader of the last one. The general research objective is to find guiding principles for the develop‐ment of hospital quality improvement strategies that help hospitals im‐prove their systems and to facilitate an assessment of hospital quality by purchasing agencies. Research objective 1 is to further develop a comprehensive “maturity clas‐sification model” for organisational quality improvement in EU hospitals (based on existing MARQuIS maturity classification). Research objective 2 is to test associations between the maturity classifi‐cation model and measures of organisational culture, professional involve‐ment and patient empowerment (at hospital level). Research objective 3 is to test associations between the maturity classifi‐cation model and measures of clinical effectiveness, patient safety and patient involvement (at patient level). Research objective 4 is to identify factors influencing the uptake of quality improvement activities by hospitals including external pressure as en‐forced by accreditation, certification or external assessment programmes.

HOPE AS A PARTNER: ONGOING PROJECTS


HOPE is active in several

ongoing projects. Apart

from the joint action of

the European network

on Health technology

Assessment, the Europ‐

Aid project with

Humatem and the work

in the European Nutri‐

tion for Health Alliance,

HOPE is particularly

involved in DUQuE,

EURHOBOP, the Euro‐

pean Partnership for

Action Against Cancer

and the eGovernance

initiatives

46

EURHOBOP The EURHOBOP project stands for European hospital benchmarking by outcomes in acute coronary syndrome processes. Although financed by Directorate General Health, it is a real European research that aims to compare hospital activities in strict confiden‐tiality. Coronary heart disease kills more than 2.000.000 people in Europe every year and, if acute cases (> 700.000 in age range 35‐64 years) are not adequately managed, it may result in a high case fatality (currently >35%). In this context the aims of EURHOBOP are: to develop a valid standardized monitoring systems that permit European hospi‐tals to benchmark themselves in a European ranking of outcomes for procedures used in acute coronary syndrome patient management; to include the most relevant vari‐ables of severity in order to improve the quality of the risk adjusted models. This project is based on the preliminary results obtained in the EUPHORIC cardiovascular pilot study. Why is the European hospitals contribution important? The larger the number of the recorded data, the closer the output of the models to the real European context, the more reliable the benchmarking will be. Two types of collaborating hospitals have been planned: 70 hospitals that will participate with extensive data (selected in the countries of 7 partners); any hospital that wish to participate with its own data directly on the website. The advantages for hospitals will be: to calculate the risk of in‐hospital death of a particular patient for a particular

procedure or disease management; to receive the estimated risk for each patient, if you submit a patients’ data

base; to be provided with hospital benchmark for all the procedures used in acute

coronary syndrome patient management, if the submitted patients’ database is sufficiently large (at least 200 consecutive patients with acute coronary syn‐drome);

to get free access to the updated / validated / upgraded functions whenever they come up.


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EUROPEAN PARTNERSHIP FOR ACTION AGAINST CANCER The European Partnership for Action Against Cancer (EPAAC) Joint Action was launched on 1 March 2011 in Dublin. Led by the National Institute of Public Health of Slovenia, it gathers representatives from all 27 European Member States plus Norway and Iceland, as well as representatives from various national institutes involved in cancer treat‐ments and several European organisations such as HOPE, associations of industry and patients associations, but also WHO Europe and individual experts. This Joint action of the European Partnership for Action Against Cancer is funded under the Public Health Programme. This joint action aims to draw together relevant organisations to share expertise and identify challenges in order to reduce the number of new cancer cases in the EU by 15% by 2020. Moreover, this partnership provides a framework for identifying and sharing information, capacity and expertise in cancer prevention and control. It also helps to avoid scattered actions and duplication of efforts, contributing to better use of limited resources. The Joint Action is divided in ten Work Packages with among them the WP5 on Health

promotion and prevention; WP6 on Screening and Early Detection and WP7 on Health‐

care. The latest is led by the Catalan Oncologic Institute and sees the direct participa‐tion of HOPE in linking the activities performed within the joint action with the actual needs of providers, in the common objective of improving care and responses provided to cancer patients. This work package puts together partners from different organisation, from patients to industries, to reach three fundamental objectives: to identify and assess best cancer care practices across European health ser‐

vices, promoting the exchange of experiences in four key areas: multi‐disciplinary care, symptom assessment and follow‐up, care for children, and complementary and alternative medicine;

to develop, review and harmonize clinical guidelines in key areas such as nutri‐tional care and rare cancers, focusing also on effectiveness and reduction of health inequalities in the implementation of these guideline;

implementing a training strategy to improve psychosocial care and communica‐tion skills among health care providers, mapping the psychosocial needs in EU countries and organising pilot training workshops for healthcare institutions including hospitals and other healthcare and community centres to test and verify the feasibility of the solutions proposed.

WP8 on research and WP9 health information and data and WP10 on National Cancer Plans complete the picture.


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As a second step, the Open Forum of the European Partnership for action against can‐cer took place in Madrid on June 2011. It was an opportunity for HOPE, invited to pre‐sent its views and to give an overview of new strategies and opportunities in manage‐ment of cancer. When talking about new strategies and opportunities in management of cancer care, one has to take into account the impressive diversity and then should be careful with European averages. Cancer incidence per 100.000 has increased (475 cases per 100.000 in 2007 in EU, +28 cases compared to 2000) but with different paces: + 6.2% in EU, +19.0% in EU12, +3% in EU15. Differences in needs, resources and costs as well as differences in organisation and financing have to be taken into account when looking at this issue. There are however major trends with an impact on management. Today more and more people recover their health after a cancer episode. Cancer is becoming consid‐ered as a chronic disease. Patients have then new needs, in particular attentive and long‐term planned follow‐up especially after a long period of cure, treatment and hos‐pitalization. Multidisciplinary teams are developing. To reduce morbidity and ensure early detection, better links with prevention, screen‐ing and early diagnosis are implemented but with major differences among countries. It requires cooperation and coordination among actors at all levels of the health sys‐tem. Mechanisms of authorization to treat cancer patients start to appear. Sometimes they include minimum ceilings of activities such as availability of instruments for radiother‐apy, surgery, chemotherapy. Yet, if there are official European cancer guidelines, they do not exist yet for care.


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eGOVERNANCE HOPE is part of eHealth Governance Initiative, a joint action and a thematic network that started in 2011 co‐financed by Health Programme and the Competitiveness and Innovation Programme. The first meeting took place during the 9th edition of the High‐level eHealth conference held from 10 to 12 May 2011 in Budapest under the Hungarian Presidency. On 10 May, the EU Health Ministers adopted a declaration by the Hungarian Presi‐dency on eHealth and discussed on how eHealth can contribute to ensuring the sus‐tainability of health systems in the Member States. The European Commission, repre‐sented by Commissioner for the Digital Strategy Neelie Kroes and Commissioner for Health and Consumer Policy John Dalli, welcomed this declaration in which the adop‐tion of cross‐border care Directive by EU members was pointed out. The Presidency declaration defends a common, long‐term vision of healthcare and pre‐sents a raft of priorities. For example, the right for patients to receive appropriate healthcare in any EU Member State and greater development of telemedicine and telemonitoring, should help to rationalise healthcare in many areas, particularly care to patients suffering from chronic heart diseases and diabetic patients. The declaration urges the Member States to guarantee the entry into force as quickly as possible of the Directive on cross‐border healthcare, which was adopted by the Council of Ministers on 28 February 2011. More specifically, the declaration calls on the Member States and stakeholders to: support and facilitate the deployment of telemedicine, particularly for treat‐

ment designed to treat known diseases and treatments with proven efficacy; develop and adopt guidelines for healthcare professionals, with the objective of

developing innovative tools to facilitate the setting in place of integrated healthcare services;

develop joint measures to achieve the interoperability of online health systems; take initiatives for data analysis for the purposes of research and public health,

whilst guaranteeing the protection of personal and private data; agree on a sample of common data on chronic diseases, to be collected and

exchanged between the Member States. Later in the year, on 22 December 2011, the European Commission adopted a Decision establishing an eHealth Network, as foreseen by article 14 of the Directive (2011/24/EU) on Patients' Rights in Cross‐border Healthcare. For the first time, EU legislation includes provisions on eHealth with clear objectives to find modern, innovative solu‐tions for providing better and safer healthcare for all Europeans.


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The Network will bring together the national authorities responsible for eHealth on a voluntary basis to work on common orientations for eHealth. The aim is to ensure EU wide interoperability of electronic health systems and wider use of eHealth. The eHealth Network is expected to translate the results of numerous research projects and pilot projects into real‐life accessible services for European citizens. The eHealth network is mandated to draw up guidelines on a minimum set of common data to be included in patients' summaries; on methods to enable the use of medical information for public health and medical research; and on com‐mon identification and authentication measures to ensure transferability of data in cross‐border healthcare.


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QUASER HOPE was invited in the expert advisory board meeting of the EU co‐financed research project QUASER (quality and safety in European Union hospitals), which took place in on 26 September 2011. The aim of the three years QUASER study that started in April 2010 is to explore the relationships between the organisational and cultural characteristics of hospitals and how these impact upon clinical effectiveness, patient safety and patient experience in European Union hospitals. Central to this is a multilevel, longitudinal comparative study of two hospitals in each of the five partner countries (the Netherlands, Portugal, Sweden, Norway and the UK) with a more detailed study of a clinical micro‐system in one of the two sites in each partner country. The majority of located studies that have been published in the last three years high‐light the fact that the testing of the validity and reliability of indicators is vastly lagging behind and that most indicators are used despite a lack of evidence. Most evidence is based on descriptive studies and secondary analysis of existing datasets. Patient experience is only ever addressed through questionnaires, which are not generalisable as they are generally developed for a particular clinical group. The review highlights the need for a standardised assessment tool for quality indicators. The included articles described a large number of indicators, some existing, some newly developed during the study. Definitions of the same indicator vary between studies, which make comparisons difficult. The majority of the studies address indica‐tors, which aim to assess hospital performance but are based on data relating to one clinical speciality. The majority of articles fail to specify which type or facet of reliability or validity has been addressed. No indicator has been tested on all facets of reliability and validity, which results in a fairly fragmented picture in terms of these indicators. The review did not locate any controlled trials for the assessment of validity or reliabil‐ity in quality and safety indicators. The process of selecting hospitals in each partner country based on a common set of indicators has highlighted the differences between countries in Europe not only in the data collected but also in its availability to the public and to researchers. Only three indicators were available in all countries and it is not certain that these are directly comparable, since the underlying definitions for the same indicator varied between countries. For example, caesarean section rates in England are defined as the total number expressed as a percentage of the total births during the previous year, whereas in the Netherlands, this indicator is defined as the percentage of caesarean sections in proportion to the expected.

HOPE AS AN ADVISOR: RESEARCH PROJECTS


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Another complication in comparing hospitals across the EU is the level at which per‐formance data are available and collated. For example, in countries such as Portugal, hospital organisations have autonomy and data are only available at the group level with national data aggregated, whereas in England these data are publicly available for each hospital at the national level and in Sweden there is a mix of national, county council and hospital level data. This work also highlighted the different approach taken in each country to the accreditation of hospital organisations against quality standards with Norway and Sweden having no formal system, the Netherlands and Portugal having voluntary schemes and England having a compulsory scheme covering all hospi‐tal organisations. The end‐product QUASER project will have to deal with all the aspects mentioned above, including the pressures and influences coming from both inside and outside the hospital. It will have to recognize the peculiarities of healthcare governance styles, and identify local practices. These issues lead to an important challenge for the QUASER team, which needs to deal with the tensions between paying attention to contextual factors, providing a simple guide and advising on the process of guidance that can be used in practice. The objective of QUASER end‐product is to function well in the daily practice of hospital wards and be spread in and between organisations. This means that QUASER’s findings must be translatable across local contexts.


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HANDOVER HOPE, member of the advisory board of HANDOVER, was invited for the presentation of the “final” HANDOVER toolbox at the final HANDOVER meeting in Florence on 23 September 2011. The aim of FP7 European HANDOVER Project was to optimize the continuum of clinical care at the primary care/hospital interface. When a patient’s transition from the hospi‐tal to home is less than optimal, the repercussions can be far‐reaching: hospital read‐mission, an adverse medical event, and even mortality. Without sufficient information and an understanding of their diagnoses, medication, and self‐care needs, patients can‐not fully participate in their care during and after hospital stays. Additionally, poorly designed discharge processes create unnecessary stress for medical staff causing failed communications, rework and frustrations. A comprehensive and reliable discharge plan, along with post‐discharge support, can reduce readmission rates, improve health outcomes, and ensure quality transitions. The goals of the European HANDOVER Research Collaborative were to:

analyze the barriers and facilitators during transitions between inpatient and

outpatient care settings; identify key strategies and tactics for standardized approaches for reducing re‐

admission that can be applied across EU countries and organisations; understand actionable strategies for engaging community organisations across

the continuum of care; strengthen patient involvement in and understanding of their care; apply effective tools to identify and leverage opportunities for improvement; design an action plan to implement the HANDOVER toolkit; measuring the effectiveness of these practices in terms of costs and impact on

patients. At the final meeting, however, participants expressed their disappointment on the emptiness of the nice web toolbox, on the vagueness and over ambitious recommen‐dations as well as the usual request for more research.


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PROMETHEUS The European Observatory on Health Systems and Policies has released the initial results of the project PROMeTHEUS – Health PROfessional Mobility in THe European Union Study – to which HOPE has been giving advice. The research project PROMeTHEUS, launched in January 2009 for a 3‐year period and co‐funded by the European Commission, aims at understanding the scale, relevance and directions of health professional mobility, the reasons behind it, its possible impli‐cations, and the tools most adequate to respond to it. The initial findings of the project show that, although workforce flows overall have in‐creased only moderately so far in the 27 EU countries studied, some countries have experienced greater changes. For example, figures from 2008 indicate that physicians from another country comprise more than 10% of doctors in Austria, Belgium, Ireland, Norway, Portugal, Slovenia, Spain, Sweden, Switzerland and the United Kingdom (up to 37%), while reliance on nurses from another country exceeds 10% of the nursing work‐force in Austria, Ireland (up to 47%), Italy and the United Kingdom.

Between 7 and 9 December 2011, a variety of health stakeholders gathered at the International Conference “Ensuring tomorrow’s Health: workforce planning and mobil‐ity”, which took place in Brussels, Belgium. Workforce planning and forecasting; strate‐gies and practices at national level; data and monitoring: standardization and harmoni‐sation of data collection; and International framework and mechanisms were the four panels. HOPE gave advice for the organisation of the Conference.


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ECAB HOPE is member of the advisory board of ECAB (European Cross Border Care Collabora‐tion), a research project co‐financed by the European Commission to help patients in the decision process of whether to seek healthcare in another Member State. A meeting took place in Vienna on 22 September 2011. This project is designed in the context of cross‐border directive. The main aim of the meeting was to review progress on the numerous individual work packages. Among them, one is focusing on media reporting of quality of care, taking Methicillin‐resistant Staphylococcus aureus (MRSA) infection as an example. A mapping exercise has been followed by in depth cases studies on reporting and risk communication and media influence on health policy decision making in five countries: UK, Germany, The Nether‐lands, Spain and Austria. Another work package is looking at long‐term care public reporting on the quality of long term care and the performance of care providers. Patient Choice and Public Reporting is another topic of the research with a systematic review of information needs of patient making choices on healthcare and treatment strategies. A comprehen‐sive analysis of existing web‐based reporting systems about healthcare in European countries has been made. Several other work packages are covering treatment pathways, prescriptions and medicines, telemedicine/eHealth, medical records, health care professionals, hospital collaborations and dentistry.


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RENEWING HEALTH On February 2011, HOPE joined the User Advisory Board meeting of RENEWING HEALTH, REgioNs of Europe WorkINgtoGether for HEALTH. The project, co‐funded by the European Commission, DG Information Society and Media in the Competitiveness and Innovation Framework Programme (CIP), aims to improve telehealth services in Europe for the increasing number of patients suffering from chronic conditions – in particular diabetes, cardiovascular disease and chronic lung problems. The mission of the User Advisory Board is to ensure that the needs of the key actors are properly recognised and taken into account throughout the project and its evaluation. HOPE will check if the interests of the hospitals and healthcare organisations in Europe are well understood and recognised. The overall project goal is to improve quality of life and to enable patient involvement and empowerment while optimising the use of resources in health provision through telehealth based services. The project will establish and continuously enhance a com‐prehensive, multidisciplinary and reusable evaluation methodology to strengthen the evidence‐based use of telehealth‐based services in Europe and worldwide. The project involves a consortium of 9 of the most advanced regions in the implementation of health‐related ICT services, belonging to 9 different Member States or Associated Countries.

HOPE AS AN ADVISOR: INFORMATION SOCIETY


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DIGITAL AGENDA ASSEMBLY HOPE was invited to participate to the first annual Digital Agenda Assembly that took place in Brussels on 16 and 17 June 2011. The Assembly is considered as a significant milestone in the delivery of the Digital Agenda, Europe's strategy for a flourishing digital economy by 2020. It assessed progress in delivering the Digital Agenda, and seek ways to improve where necessary and identified challenges ahead for implementation. It was also seeking to mobilise stakeholders in carrying the process forward. The European Commission therefore invited a broad range of participants from industry, the research community and NGOs, as well as representatives from Member State Governments, and the other EU. Participating in the Assembly was an opportunity to meet and discuss views and actions to deliver the benefits of the Digital Agenda for Europe's citizens. The assembly comprised two plenary sessions and parallel workshops addressing key topics. A work‐shop was more specifically devoted to health with the topic “Addressing demographic change: a socio‐economic challenge and opportunity for Europe”.


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BENCHMARKING DEPLOYMENT OF eHEALTH SERVICES III Continuing with its advisory work on eHealth, on January 2011 HOPE was invited to comment the first results of the EU financed study on “Benchmarking deployment of eHealth services III" carried out by Deloitte, in association with Ipsos Belgium, on be‐half of the EC's Information Society and Media Directorate‐General. This study aims to analyse the different models of long‐term care provision to older people potentially affected by chronic diseases in the European Union. It is the first time that the Euro‐pean Commission has measured eHealth in acute hospitals in 30 countries. The scope is to understand their openness to innovation in the area of ICT‐enabled home care services. The study brings together quantitative and qualitative information from primary and secondary sources and analyses them in the context of the long‐term care models and their characteristics. The emerging picture is to throw a clearer light on how the Mem‐ber States of the Union can address the challenges of an ageing population and increasing prevalence of chronic diseases stemming from the demographic change, by means of different technologies commonly referred to under the headings of eHealth and telecare. The study shows a fast development in European acute hospitals in terms of: connec‐tion, videoconferencing, electronic patient record systems, common electronic patient record system, eBooking and picture archiving and communication system, clinical test results and systems for electronic service order placing. On the other hand, wireless single infrastructures are not so well developed nor ePrescription, telemonitoring of outpatients, electronic medical data exchanges outside the hospital with other provid‐ers, cross‐institution electronic medical exchanges and exchange across countries. The data used for the report were collected by means of a survey of acute hospitals, which targeted Chief Information Officers (CIOs), and Medical Directors: CIOs were asked about the availability eHealth infrastructure and applications in the acute hospi‐tals whereas Medical Directors were asked about priority areas for investment, im‐pacts, and perceived barriers to the further deployment of eHealth. The survey was carried out in 2010 in all 27 Member States of the European Union and in Croatia, Iceland, and Norway. The presentation and discussion of the interim results of the study, called “Coping with an ageing population – Learning from good eHealth and tele‐care practices”, was held on 19 May 2011 in a workshop in Brussels HOPE was invited to. The aim of the sessions was to validate the study findings and the conclusions drawn, and to make suggestions for concrete good practices on the basis of the pre‐selection carried out by the study team and the steering group. The survey revealed that there are notable geographic, system and organisational dif‐ferences among countries in terms of their responses to infrastructure, applications available, data exchanges and the security levels or approaches used in the hospitals.


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PHARMACEUTICAL HEALTH INFORMATION SYSTEM (PHIS) PROJECT

HOPE was invited to the closing of the Pharmaceutical Health Information System (PHIS) Project that took place in Sofia on 28 and 29 April 2011. The PHIS project, in which HOPE has been working as an advisor, aimed at increasing knowledge and exchange of information on pharmaceutical policies in the EU Member States, in par‐ticular on pricing and reimbursement. It takes on account both the out‐patient and the in‐patient sector. PHIS (Pharmaceutical Health Information System) is an European Commission funded project, commissioned by the Executive Agency for Health and Consumers, DG SANCO, and co‐funded by the Austrian Ministry of Health. All work packages were duly fulfilled according to the Grant Agreement: Terminology: a glossary was developed and uploaded on the website. Library: country‐specific information on the in‐ and out‐patient sector were

published on the website either as full reports or as conscious information in poster format (see http://phis.goeg.at à PHIS Library).

Database: PHIS indicators were developed. Hospital Pharma: several country‐specific PHIS Hospital reports were published

on the PHIS website; the results were disseminated among others at the PHIS Hospital Seminar in Bratislava in February 2010.

Networking: five network meetings were organised accompanied by various updating information sharing within the network throughout the whole project.

Dissemination: presentation of the results of the PHIS project at international conferences (e.g. EAHP congress in Vienna in March 2011 in Vienna) as well as via the publication of articles and the submission of abstracts.

Mr. Anders‐Lamark Tysse, on behalf of the European Commission Directorate General SANCO, welcomed the PHIS network and mentioned that due to the adoption of the cross‐border healthcare directive, since projects in the field of Health Technology Assessment (HTA), e‐prescribing and e‐health will receive a lot of attention in the future.

HOPE AS AN ADVISOR: PUBLIC HEALTH


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JOINT ACTION ON PATIENT SAFETY HOPE will be an active partner in the Patient Safety and Quality Working joint action. The Joint Action on Patient Safety was approved in October 2011 and will be co‐ordinated by the French Haute Autorité de Santé (HAS). The Joint Action is viewed as a continuity of the European Network on Patient Safety (EUNetPaS) project, a 30 month project that started in 2008 to establish an umbrella network of all 27 EU Member States and EU stakeholders to encourage and enhance collaboration in the field of Patient Safety. HOPE played an important role in EUNetPaS, whose work package 4 (WP4) to medication safety was supervised by HOPE. One of the aims of the WP4 was to build medication safety recommendations on the basis of the implementation of a limited number of good selected practices from one country to another.

JOINT ACTION ON HEALTHCARE WORKFORCE PLANNING HOPE has been working with other partners under the authority of the Belgian Ministry of Health to prepare the joint action on healthcare workforce planning, included in the call for proposal for the public health programme launched in December 2011. In order to prepare the content of the proposal answering this call, two workshops were organised in 2011 with the countries that have expressed an indicative interest of leadership of work packages. The aim of these workshops was to have an enhanced technical section of the proposal with clear objectives, outcome, deliverables and coherent work packages.

PROJECTS IN CONSTRUCTION


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EXCHANGE PROGRAMME 2011 128 professionals participated in HOPE Exchange Programme 2011. The 30th anniver‐sary of HOPE Exchange was focused on the improvement of the relation between hospitals and primary care, the 2011 topic. Participants brought back in Turku the results of their stay abroad. Their research was gathered in the work published in November 2011, “Better Health – a shared challenge for hospitals and primary health care“. Despite some common challenges, the picture was rather diverse as it could be expected. However, this gave quite a lot of opportuni‐ties to identify good practices. 111 institutions from 22 countries were available for this 4‐week training period (May‐June), intended for managers and other professionals with managerial responsibilities working in healthcare facilities. Several thousands of professionals have benefited of the exchange programme since it was created in 1981. The spread of chronic diseases and the demographic changes are pushing for better articulation, even integration of care levels. A lot still needs to be done. “In this context, the ageing of health workforce and the ageing of patients have to be seriously considered” said HOPE new President in presenting this as the topic for the 2012 HOPE Exchange. HOPE Exchange Programme is the best example of HOPE’s vision of working together, sharing knowledge and best practices to improve European health systems. It also delivers an optimal training for healthcare professionals who want to learn abroad. It is based on the cooperation between members and would not be possible without the common effort of HOPE members. With 30 years existence and expressed satisfaction, both by participants and their organisations, the HOPE Exchange Programme is one of the main successes of our organisation.

EXCHANGE PROGRAMME


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INNOVATION IN HEALTHCARE. FROM RESEARCH TO MARKET HOPE was invited to co‐organise the conference of the European Commission entitled: “Innovation in Healthcare. From research to market” that took place on 30 and 31 March 2011 in Brussels.

Three Directorates General were involved along with several stake‐holders: DG Research and Innovation, DG Enterprise and Industry, DG Health and Consumer Affairs. Over 500 participants (stakeholders, policy makers including Members of the European Parliament, the Government’s representatives, clinicians, representatives of university and other research institution) discussed European innovation needs in the healthcare field, the importance of partnerships and the adaptation of the healthcare

delivery to economic and productive patterns. Simon Vrhunec, HOPE Governor for Slovenia, was among the plenary speakers. Eight parallel sessions analysed the current situation through a broad approach, foster‐ing different actors of the healthcare sector to discuss about their own experiences and good practices sustaining Research to Market. The first two parallel sessions dealt with ways and proposals to accelerate knowledge creation, such as new models for R&D collaboration partnership, including framework programmes for collaborative research, Public‐Private Partnership (PPPs), and the Innovation Union Partnership. They also explored alternative financing sources for innovation in healthcare.

CONFERENCES

Apart from its annual conference linked to the exchange programme, HOPE was involved in conferences at

three different levels: co‐organiser, speaker and active participant.

CONFERENCES CO‐ORGANISED BY HOPE

ANNUAL REPORT I KNOWLEDGE & EXCHANGE I CONFERENCES

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Two other parallel sessions dealt with the issues of fostering entrepreneurship and “Pricing and reimbursement”. These put the light on what can be done to develop an entrepreneurial spirit and management culture to support innovation in Europe and explored the policies of reimbursement, in particular the differences and difficulties in keeping into account all aspects of effectiveness, efficacy and long‐term issues. A num‐ber of scientific, regulatory, organisational challenges are related to the introduction of innovation in healthcare. This is especially true with personalised medicine. Hence, there is a growing need of linking payments to healthcare outcomes. At the same time, the right balance between equity of access and sustainability of care has still to find a solution. The last sessions dealt with innovative knowledge transfer, translation of ideas in cur‐rent market supply and the issue of responsible innovation in healthcare. Experiences on technology and knowledge transfer between research and industry were exchanged and better ways to foster partnership between higher education institutes, research centres and businesses at regional, national and international level were discussed. Responsible innovation is a sector that requires the cooperation of doctors, patients, hospitals, researchers and industry at any level in order to deal with the societal changes and to adapt the healthcare delivery to new economic and productive patterns. These debates are thought to highlight key elements necessary to enhance relationship between the different actors to permit policy makers to bring solutions to improve innovation in healthcare.


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MANAGEMENT AND PUBLIC HEALTH HOPE joined forces with the School of Advanced Studies in Public Health (EHESP) and the European Association of School of Public Health (ASPHER) to develop a pre‐conference on present and future issues, methods and strategies in management in the field of public health. This one day meeting took place in Copenhagen (Denmark) on 9 November 2011 as a pre‐conference to the 4th European Public Health Conference, held the following days also in Copenhagen. The Issues and Challenges in Management of Health Services Delivery were introduced by HOPE immediate Past‐President, Dr. John M. Cachia of Malta. This intervention was an opportunity to present two HOPE comparative studies: The Crisis, Hospitals and Healthcare published by HOPE in April 2011, that gives

an in‐depth analysis of the effects of the crisis in EU Member States; Better Health – A Shared Challenge for Hospitals and Primary Health Care, a

complete comparative overview of the most relevant experiences of integra‐tion and coordination among the different levels of care in the European coun‐tries, published by HOPE in November 2011.

Two roundtables gathered high level managers and professionals in healthcare. The first roundtable was looking at “Profiling the Manager in Healthcare: Competencies and education.” Anne Karin Lindahl, Executive Director, The Norwegian Knowledge Centre for the Health Services was facilitating a discussion between Katarzyna Czabanowska, Assistant Professor International Health Maastricht University, Suzanne Hobbs, Associate Professor University of North Carolina at Chapel Hill, and Stuart Anderson, Associate Dean of Studies, London School of Hygiene and Tropical Medicine. The second roundtable was devoted to “Ethical Aspects and Social Accountability of healthcare Education.” Egil Marstein, Associate Professor, The Norwegian Business School facilitated a discussion between Peter Duncan, Senior Lecturer in health promo‐tion and health & society, King’s College London, and Louise Lemieux‐Charles, Profes‐sor and Chair, Department of Health Policy, Management University de Toronto. Other speakers included: Carole Orchard, Associate Professor & Coordinator of Inter‐professional Education Initiatives at the University of Western Ontario speaking on the “Interprofessional Collaborative Practice Teams and Quality Improvement”; Stéfane Kabene, Professor of Health Management, EHESP School of Public Health and Head of EHMBA presenting “Recruitment and retention of Health care Professionals”; Laurent DEGOS, Former President of French National Authority for Health, Hematology Specialist, Saint‐Louis Hospital, Paris giving his views on “Cost effectiveness of Health‐care delivery.”


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EXCELLENCE IN HEALTHCARE

HOPE participated in the organisation of a conference that took place on 10 and 11 November 2011 in Ljubljana (Slovenia) on “Excellence in Healthcare: Comparability of Quality, Patient safety, Competences and International Accreditation.” The core organiser was the Minister of Health of the Republic of Slovenia. The aim of the conference was to discuss several issues in the context of the discussions around the transposition of the Directive on cross‐border care. It was organised around three modules: Which tools can be used to assess quality in healthcare? What will be the impact of the Directive on the application of patients' rights in

cross‐border healthcare on quality and safety in Member States? The modernisation of the system for mutual recognition of qualifications for

health professionals in Europe. This last module was an opportunity for HOPE to present the views of hospitals. The European legislative agenda re‐opened both the issues of the mobility of patients and of the mobility of professionals. HOPE pointed out that this takes place in rather paral‐lel ways and in a context much different from previous episodes. The modernisation of the system for mutual recognition of qualifications cannot be envisaged in isolation. It should in particular be put in perspective with quality improvement strategies. The diversity in approaching this and more generally the organisation of healthcare is a striking particularity in the European Union. HOPE concluded on the research findings and further developments at EU level that are opening new perspectives for the im‐provement of the quality of care in which qualifications play a central role.


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CROSS‐BORDER CARE DIRECTIVE On 18 November 2011, HOPE was co‐organising with the European Association of Senior Hospital Physicians, presided by Dr. Joao de Deus, and the European Association of Hospital Managers, presided by Heinz Kölking, the first Joint European Hospital Conference. The morning was devoted to the European policy in the health field. Mars Di Bartolomeo, Minister of Health of Luxembourg, delivered the keynote speech. He first positioned the public health policy within the context of the most recent EU initiatives, in particular, “Europe 2020“ and “Digital Agenda“. He then delivered a lively descrip‐tion of what makes the European health policy and how it developed in the past ten years. Commenting Mr. Di Bartolomeo’s presentation Georg Baum, President of HOPE and Chief Executive of the German Hospital Federation, clearly showed how hospitals and healthcare services are more and more impacted by various European policies; several of them having limited regards to the specifics of the healthcare sector. Georg Baum concluded on the major incoming impact: the Cross‐border directive (the direc‐tive on the application of patients’ right to cross‐border healthcare), the focus of the afternoon session. The afternoon was indeed devoted only to the Directive and its current process of transposition. The Directorate General Health was represented by Annika Nowak who presented the origin and context of the Directive as well as current developments of the work with Member States on the transposition. Representatives of organisations in six countries where then invited to present the current transposition mechanisms and the issues already identified by their organisations in their countries. Elisabetta Zanon presented the detailed analysis made in the UK by the NHS Office in Brussels. György Harmat explained the point of view of the Hungarian Hospital Associa‐tion, shared by the Hungarian Ministry of Health. Robert Nicodème gave the percep‐tion of the French Medical Chamber. Miek Peeters of Zorgnet Vlaanderen had a very precise lecture of the legal challenges for Belgium. Finally, Thomas Zilling shared the views of hospital managers from Sweden and Dimitris Kremalis from Greece. The closing words by Dr. Raymond Lies, Past‐President of AEMH, captured the essence of the afternoon by identifying the challenges ahead of us.


HOPE President Georg Baum at he first Joint

European Hospital Conference in Düsseldorf

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CEN ADVISORY BOARD HOPE was invited, for the first time, to the European Committee for Normalisation (CEN) Advisory Board for Healthcare Standards (ABHS) held on 12 January 2011 in Delft (The Netherlands). HOPE presented its activities and current issues. The meeting was organised by the Dutch Normalisation Organisation (NEN). The CEN Advisory Board for Healthcare Standards (ABHS) is involved in all current issues affecting healthcare standardization. One of the principle aims of standardization in healthcare, and there‐fore of the ABHS, is to ensure a high degree of patient safety and to support public health objectives whilst breaking down international bar‐riers to trade. ABHS has responsibility for all healthcare standardization matters: co‐ordination of the relevant CEN technical committees; solving problems that are common across the healthcare commit‐

tees; analysis of the latest developments affecting healthcare stan‐

dardization; managing CEN healthcare actions that come from the European

Commission/European Free Trade Association; ensuring that useful information and advice is passed on to the

CEN Technical Board and other committees. The CEN Advisory Board for Healthcare Standards (ABHS) is involved in all current issues affecting healthcare standardization, for example: healthcare and the Environment Resolutions and Guidelines; the relationship between European and international healthcare

standardization; global harmonisation of medical device legislation; risk management for medical devices; eHealth standardization activities; harmonizing medical device nomenclature; tissue engineering in medical devices; quality systems for medical device manufacturer; materials used in medical devices; quality systems for medical device manufacturer.

CONFERENCES WITH HOPE AS A SPEAKER


At the request of mem‐

bers (Zorgnet Vlaan‐

deren on 28 January,

Entente des Hôpitaux

Luxembourgeois on 12

October and the French

Hospital Federation on 2

December), of compa‐

nies (SHIRE on 14 April

and PwC on 15 April) or

even part of a wider

conference (The Econo‐

mist on 17 March in

Geneva), HOPE had

many opportunities to

share its views

68

The CEN Advisory Board for Healthcare Standards (ABHS) was created by CEN in December 2005 to replace the CEN Healthcare Forum (CHeF). The first meeting of the ABHS took place on 16 and 17 March 2006. It is made up of representatives from the following groups: national standards bodies; technical committee Chairmen and Secretaries; European federations and trade associations; European Commission (EC) / European Free Trade Association (EFTA); staff of the CEN Management Centre and other European and international

standards organisations.


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PATIENT’S RIGHTS DAY: ARE CITIZENS IN THE CENTER OF EU HEALTH POLICY? HOPE was invited on 11 and 12 April 2011 at the European Economic and Social Com‐mittee in Brussels to deliver an award and share views during the 5th Annual European Patients’ Rights Day entitled “Putting Citizens at the Centre of EU Health Policy.” Active Citizenship Network, a component of the Italian citizen movement, Cittadinanzattiva, was behind this event. The conference, attended mostly by patients’ organisations and individual patients from all over Europe, aimed at presenting the outcomes of a EU co‐financed project undertaken by Active Citizenship Network members to determine how their self‐defined rights of patients are implemented. The report was based on rights outlined in Active Citizenship Network’s European Charter of Patients’ Rights. The criteria to verify whether those rights are respected or not were very much debatable and debated as so was the methodology. The conference began with an outline of the project and the methodology utilised to determine how patients’ rights are respected throughout the Member States. The criteria used are of very different kind, including perception. But they were only “checked” in less than five hospitals. On this basis, the project considers that the right of patients to access care, the right to free choice and the right to the respect of patients’ time have not been respected. On the other hand, the rights to personalised treatment, preventive measures, privacy and confidentiality and physical access were found to be “almost respected.” Two round table were organised, giving an opportunity to HOPE to advise for revision of the method, more transparency and collaboration as well as better links with the EU charter Lisbon treaty. Another speech was much noticeable, the one delivered by Antonya Parvanova, Member of the European Parliament (ALDE) from Bulgaria. She suggested an appeal for a million signatures to get a directive on patient’s rights. She did not mention this time her wish to change the fresh Lisbon treaty. The highlight of the conference was the presentation of good practices and award cele‐bration: Engaging citizens and Patients in Health Policy: good practices from around Europe, that sends a positive message giving value in particular to the work and com‐mitment of healthcare professionals. This was followed by a speech delivered by Health and Consumer Commissioner John Dalli in which he emphasised that the financial difficulties health systems now face should not cause Member States to lose sight of the values and principles on which EU health is based. He clearly cited the need to improve patient safety and argued that investment in eHealth systems will serve as the basis for sustainable and equitable European health systems.


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EUROPEAN PERSPECTIVES IN PERSONALISED MEDICINE Since HOPE was working in 2011 on a report on personalised medicine (published in 2012), the two‐day conference on Personalised Medicine that took place in Brussels on 12 and 13 May 2011 was a good opportunity to present the first results. The European Commission's DG Research and Innovation hosted the event that was following four main workshops in 2010 on the issue. The topic of Personalised Medicine is still somewhat new, but it is believed to offer more effective treatment to patients by providing the right treatment to the right patient at the right time. There are currently a couple of such therapies with required testing beforehand (for example cancer, AIDS). However, the use of this approach is hoped to be broadened. The first day of the conference included more technical and detailed information on the roles of “omics” research, biomarkers and clinical trials in connection with person‐alised medicine. These fields are the base for the subject and hence it is essential to understand challenges, opportunities and needs in the relevant areas. The second day reflected on the approval process and uptake of such medicines by patients and clinicians. Several problems and challenges have been identified. It is clear that more research is needed in order to estimate the cost effectiveness of the drugs, identify further important biomarkers and understand diseases better. Moreover, in the actual phase of use, issues such as data protection, reimbursement, and integra‐tion into practice are all examples of many discussions that still need to be held. It is necessary to acknowledge that such medicines will shift healthcare. Without a good regulatory framework and training of professionals, it will be difficult to integrate new medicines into the society and make sure that all patients have equal benefits and ac‐cess to them.


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OECI AND ECPC WORKSHOP ON PERSONALISED MEDICINE A second opportunity to present the first results of HOPE survey on personalised medi‐cine was the workshop on personalised medicine, which was jointly organised by the European Cancer Patient Coalition (ECPC) and the Organization of European Cancer Institutes (OECI) on 23 November 2011 at the European Parliament in Brussels. John Bowis, a former MEP (EPP), chaired the workshop, which addressed the question of the medical, economical and social potential of personalised medicines, as well as issues related to patient access to personalised medicine and how they could be inte‐grated into healthcare provision in Europe. The first panel focused on the potential uses of personalised medicine and biomarkers, on the various challenges they represent, but also on what potential benefits they could bring. Emphasis was put on the legal, political, ethical and economical challenges of personalised medicine. Wolfgang Wein from Europa Bio admitted that personalised medicine was just at its beginning and that the requirements for clinical development programmes were highly complex. The fact that more expertise was greatly needed was also put forward by many speakers.

However, most of the participants agreed to say that personalised medicine and the use of biomarkers could present great benefits and opportunities in terms of achieving better results for patients, reducing ad‐verse reactions, improving the allocation of healthcare services or reducing un‐necessary costs. David Byrne, former EU Health Commissioner, stressed the fact that adverse drug reac‐tions were the fourth lead‐ing cause of death in the EU

and that the efficiency rate of drugs was currently about 60%. According to him, targeted medicine would be an advantage for everyone. The second panel focused on how personalised medicine could be integrated in the health system. Attention was brought to the fact that to integrate personalised medi‐cine in our healthcare systems, investment had to be made not only in the medical area, but also in areas such as ICT, infrastructure and diagnostics. For Adam Heathfield from Pfizer, investments have to be made to make the whole system more individual and more research‐orientated. According to Iordanis Gravanis from the European Medicine Agency (EMA), going from untargeted therapy to targeted therapy will how‐ever represent a complete paradigm shift that will take a lot of time to be achieved.


72

FACING THE FUTURE: DEVELOPING AN EU STRATEGY ON ALZHEIMER’S A panel debate “Facing the Future: Developing an EU Strategy on Alzheimer’s” was organised in Brussels on 21 September 2011. HOPE intervened at this Parliament Magazine discussion hosted in the European Parliament by Frédérique Ries MEP and held in association on the World Alzheimer’s Day. The debate focused on how the four key objectives of the EU strategy on Alzheimer's disease (early diagnosis, improved research conditions, sharing best practises and respecting the rights of people living with the disease) were evolving. A recent poll commissioned by the Harvard school of public health and Alzheimer Europe found that in the majority of countries surveyed, Alzheimer's disease was the second biggest health fear after cancer. As life expectancy increases in the EU, the number of Europeans suffering from Alzheimer's disease and related disorders will double over the next 20 years, unless decisive action is taken at national and European levels. Previous attempts to tackle Alzheimer's disease at national level within the EU have been characterised by fragmented action and uneven policies. However, since 2008, EU leaders took the decision to pool their resources and coordinate their actions to ensure better research, prevention, diagnosis, treatment and care for those affected.


73

DRGs AND INNOVATION CONFERENCE HOPE was invited to speak at a conference on “DRGs and Innovation” held in Brussels on 30 November 2011, chaired by Prof. Giovanni Fattore, PhD Dpt. of Institutional Analysis and Public Management & Centre for Research in Healthcare Management (CERGAS) Bocconi University. This conference is part of the Eucomed (the lobby of the medical devices industry) HELPs, an educational programme, which aims at improving the level of knowledge and expertise of Eucomed members on matters around health economics, with a special focus on medical devices. HOPE participated in the afternoon to the multi stakeholders’ policy panel that ad‐dressed the question of “what may hamper and facilitate the uptake of innovation in Europe” with HOPE Chief Executive, Zoltan Kaloof of Eötvös Loránd University in Hun‐gary, Maria Landgren of Vinnova group (the innovation agency of Sweden), and Veronika Dubajova of Goldman Sachs. The panellists had to comment the assertion that although being highly valued by multiple stakeholders in the health field, medical technology innovation is also deemed to be one of the driver of rising healthcare cost, especially in the hospital setting. Healthcare policy makers often face decisions that reduce impact on short‐term budgets but may delay access to innovative devices. Ad hoc funding mechanisms and pathways may provide useful options to adopt and use innovation in healthcare. The morning “technical panel” described how innovative technologies are included in DRGs in various countries such as Germany, the United Kingdom, the Netherlands and Italy. Ways to fund innovations in Germany was presented by Martin Braun, Health Care Management (formerly InEK), in Italy by Marino Nonis (Ospedale Cristo Re), in The Netherlands by Rene Meijer of DBC Onderhoudand in the UK by Martin Jordan of HTSS. This conference was attended by participants coming from academia, European Com‐mission, patients’ organisations, payers’ and providers’ representatives and medical technology industry.


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COMMISSION CONFERENCE ON ELDERLY ABUSE PREVENTION HOPE actively participated to “Ageing in Dignity: Designing effective strategies for tackling elder abuse”, a conference organised by the Com‐mission on 28 November 2011 in Brussels. An overview of what has been achieved by recent EU projects on elderly abuse and at exchanging views on what could be done both at national and EU level to protect the dignity and well‐being of elderly people was presented. The World Health Organization (WHO) estimates that every year, 4 million older people experience some kind of abuse in the WHO European Region: this maltreatment can be physical, sexual, financial or psychological. In addition, the majority of these abusive acts are perpetrated by someone the elderly person trusts, a relative or friend, very often the person who cares for them. According to WHO, along with the well‐acknowledged ageing of the European population, the number of older people in need of long‐term care (LTC) is expected to become more and more important in the coming decades, leading to a probable significant rise in the number of elderly people victim of maltreatment. The first part of the conference focused on presenting the various EU projects related to elderly abuse. Basic figures on the number of elderly people who are victim of abuse in Europe were provided by different par‐ticipants, including regional comparisons, and attempts of explanations in regards to elderly abuse were put forward. One of the main elements that stood out from the discussion was that abuse towards elderly people should not be seen as intentional or driven by malevolent intentions. The abuse or neglect elderly people suffered from is very often an unintended consequence of the difficulty residing in the carer’s work itself, may it be formal or informal care. A more efficient way to tackle elderly abuse would be to make sure carers benefit from adequate support, by provide them with training, psychological, financial or material help and making sure that they have days off from their caring responsibilities.

HOPE AS AN ACTIVE PARTICIPANT: TWO EXAMPLES

HOPE was active in several

other conference.

Two of them are worth

mentioning


75

The second part of the conference addressed the issue of tackling and preventing elder abuse in Member States and at EU level. An overview of what was being done in terms of national strategies on elder abuse was given. What came out of the discussion was that in most European countries, although some local initia‐tives exist, there is no national legislation and often no global system in place to fight elder abuse. One this topic, participants raised the question of whether pos‐sible future legislation should be specific to elderly abuse or encompass a wider range of abuses, based on general vulnerability and dependence. The role of the EU was also questioned, in terms of awareness raising, putting elderly abuse to the agenda and supporting Member States’ initiatives. Various portals of action at the EU level were identified, such as the Europe 2020 Strategy or the Social Protection Committee’s Working Group on age.


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PHARMACEUTICALS ADHERENCE “Improving the Sustainability of Healthcare Systems through Better Adherence to Therapies” debate organised in September 2011 by the Standing Committee of European Doctors (CPME), the European patients’ Forum, the European Federation of pharmaceutical industries and associations (EFPIA) and the pharmaceutical group of the European Union (PGEU). The event’s key message was to point out the existing under‐estimation amongst policy makers, health managers and healthcare professionals of the opportunity to improve health outcomes through a better monitoring of what happens after a medicine has been prescribed. Participants highlighted the importance of the number of patients who did not follow up their treatment after being prescribed a drug, or who did not follow their treatment properly, resulting in increased financial costs and in increased morbidity and mortality. In the EU alone, according to the industry, 194.500 deaths each year are estimated to due to wrong dosage of and non‐adherence to prescribed medication. The debate focused on the reasons behind this non‐adherence to prescribed therapies and the solutions that could be undertaken to act upon it. The necessity for coopera‐tion and exchange of best practises between Member States was strongly emphasized.


77

THE CRISIS, HOSPITALS AND HEALTHCARE The financial and economic crisis is hitting European hospi‐tals and healthcare services. Spared at an earlier stage, most of them are now clearly impacted. HOPE has been looking for the direct and indirect effects of the crisis on the European health systems. Its results were made available with the publication “The Crisis, Hospitals and Healthcare”. The comparative report details impacts and measures taken, on hospital and healthcare services, on healthcare professionals and on patients and citizens. Representing more than 8% of European GDP, the health‐care sector receives the greatest share of its financial re‐sources from public money. It is then directly affected by measures that have been cutting public expenses. The main consequences of the resources restrictions on healthcare professionals are visible in employment policies

and retirement reforms adopted by most European Member States.

Various measures, mirrors of the diversity of healthcare systems, have been adopted: increasing out‐of‐pocket and citizens’ contributions, wage cuts, spending ceilings and budget reductions. Some of them are not related to the crisis; but in any case they are all changing the healthcare landscape.

The report was presented on several occasions and in particular in a special edition of eSharp following a debate organised in Brussels on 25 January 2011.

PUBLICATIONS

ANNUAL REPORT I KNOWLEDGE & EXCHANGE I PUBLICATIONS

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BETTER HEALTH — A SHARED CHALLENGE FOR HOSPITALS AND PRIMARY HEALTH CARE HOPE published in November 2011 “Better health ‐ A shared challenge for hospitals and primary health care”, a report ex‐ploring strategies and means adopted in European countries to improve health of patients and citizens through better coordination between the different levels of health‐care. The report builds on the results of the HOPE Exchange Programme 2011, which ran from 23 May to 22 June 2011 and was concluded by the traditional HOPE Agora, hosted in Turku by the Finnish HOPE member. During this event, all participants gathered and presented in a one‐day conference the main findings of their experience abroad. It report illustrates comprehensive reforms that aim at foster‐ing healthcare systems’ integration and new pathways of care for the treatment of disease with high need of coordination, with a particular look at the implementation of home care. It also presents the new, multifaceted tasks that nurses and general practitioners are holding and points out the role of Information and Communication Technologies in fostering communication and conti‐nuity of care. The report examines the reforms that some countries are implementing to foster a more integrated structure of the health system, and explores how others are rethinking the system organisation looking at examples all over Europe. In many countries, regional and local changes deal with the introduction of specific pathways of care or new patterns for facing specific problems. Some are exploring new ways of co‐ordination in the treatment of mental health. Others are also improving strategies for the treatment of chronic diseases, respectively tackling diabetes, stroke and cancer care. One of the main implications of a more integrated healthcare system is the change in the role of healthcare professionals. General practitioners are becoming more and more connected with hospitals and nurses are taking over some of the competences in the past reserved to doctors. Home care seems as well and interesting and promising way developed to face the lack of resources and to improve the health of citizens. This concept has different applications, but it always requires good communication and co‐ordination among all care levels. Finally, the report shows the several roles that ICTs and e‐health solutions play in enhancing the efficient and effective cooperation of the healthcare systems in all its different parts. This translates in facilitating all care and administrative procedures or in the implementation of tools to identify patients and their respective needs and enable the exchange of timely and secure information. All European countries are clearly enhancing the coordination within the system and the integration between its different parts, improving the use and distribution of resources as well as the level of quality and safety for citizens.


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GUIDELINE FOR THE USE OF HEALTH TECHNOLOGY ASSESSMENT (HTA) HOPE leaded the editing of Guideline for the use of Health Technology Assessment (HTA) in border settings, one of the three deliverables the project EUREGIO II produced. This Guideline has been designed to inform decisions about the introduction of a new technology – often a new instrument or equipment, an organisational procedure, or a new treatment – in local cross‐border settings. The document aims to empower all decision‐makers in border regions to effectively develop and implement new technolo‐gies. The Guideline has been tested in two experimental case studies – developed in the University hospitals of Maastricht and Aachen and coordinated by Saskia Knies of the Maastricht University – which represent the first and unique examples of HTAs in small‐sized, local cross‐border settings. They have been included in the document.


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HOSPITAL HEALTHCARE EUROPE 2011

HOPE published in spring 2011 Hospital Healthcare Europe 2011, the Official HOPE reference book.

The first part of HHE 2011 contains Representing Public and Private Hospitals, an article about the structure of HOPE, the scope of the organisation and the work developed over the last years. Another article presents the consequences of the financial constraints and the increasing number of chronic patients on hospital activities. Demographic trends, financial and human resources, hospital capacity and delivery of care, are presented. A study on How is the current crisis affecting hospitals and health‐care, is presented on the basis of information provided by HOPE members. How health policy gets made at EU level explains the way EU Institutions work and make, together with stakeholders and Member States, policies on health matters. The other parts of the publication offer dozens of articles on different subjects like cardiology; clinical, nursing & patient care; pharmacy & therapeutics; as well as there is one section about HOPE. This book is distributed in several thousands of European hospitals.


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European Hospital and Healthcare Federation

2011

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European Hospital and Healthcare Federation

2011

hope annual report 2011 · alfred hitchcock’s the birds, szilard miklos & denes miklosi –...

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