Monday, 22 February 2010
28th is the World Rare Disease Day
The aim is to help raise awareness for patients, families and carers living with rare diseases worldwide. In Brussels a workshop is held on March 1st on the topic of Bridging Patients and Researchers' to Build the Future Agenda for Rare Disease Research in Europe. More info about activities in various countries and how you can help can be found on www.rarediseaseday.org/
Friday, 19 February 2010
A nudge from the King
When checking out from our hotel in Jordan we have to let them know if we don’t want to pay 1 Dinar to the Kings Cancer fund. A good and well needed nudge given that everyone seem to be smoking in this country. I would like to see more of nudges like this – like it more than the European model where everything is assumed to be the state responsibility. Better when the authorities point out what should be done instead of just doing it them self.
Thursday, 11 February 2010
All these events - so little impact
There is a lot of talk in Brussels about patients: patient empowerment, patient safety, patient information and patients’ rights. I think the one liner of the day is: we have to put patients at the center of things. This may be just talk, but there is a lot of it, as there is a bottom-up pressure for change. So on 23 February the think tank Stockholm Network will hold a conference under the headline Are Your Medicines Se? Its aim is to address “the serious problem: ensuring their safety for patients”. This is a smart move, as most agree on the importance of patient safety. Then next on 24 February the European Voice Health Check Debate on “The right to know? Should information to patients be restricted?” take place.
Now its starting to become controversial, but as long as the information is objective and preferably given by physicians or the EU, most people will say that patients should indeed be allowed more information. Well it would be surprising if they did not agree that patients who are more health-literate will manage their health better.
So safe and informed that seems to be ok with all. But on March 2nd when then approximate same (Brussels isn’t that big) crowd gather again– I don’t think it will be so cosy..
The topic of German Liberal MEP Jorgo Chatzimarkakis Life Circle meeting is “Patient Empowerment – a New Paradigm in Disease Management”. This suggests the pressure is on. Discussion at the Life Circle event should be lively, at least if Member States’ representatives from the Member States show up and participate. Not necessarily always the case – when the EU Commission last year arranged a Patients’ Rights day the room where remarkably free from health attaches.
Patient empowerment was accepted without discussion as something positive until recently, but it seems that in the new financial situation governments have gotten cold feets since they assume it would mean higher costs. This questioning of if patient empowerment is really desirable seems to have begun at the Czech presidency conference on the financial sustainability of healthcare in 2009. During the panel debate on “Defining Sustainability in Health Systems, Josep Figueras, Director, European Observatory on Health Systems and Policies as well as Melinda Medgyaszai, Secretary of State for Health Policy, Ministry of Health, Hungary. Maria de Belem Roseira Pina, Chair of the Parliamentary Health Committee, Asseimbleia da República, Portugal all questioned if all demands from patients should really be met.
After this at various conferences fears have been raised that patients may increasingly seek healthcare cross-border, thereby undermining the finances as well as the principle of the European equal (meaning everyone should have the same thing) and solidaric healthcare systems have been raised until finally the Spanjards managed to ensure a blocking minority for the Directive of Patients Rights on cross-border care. There are even fears that patients may demand treatments that are not good for them.
This might all be due to the financial crisis but I don’t think so. I think that its also because they really do not like to let go of the power they currently enjoy of being able to tell patients where and when and whether they should receive care. In Europe healthcare is still provided only to the extent that governments think it will benefit society as a whole. Think-tanks, a few politicians and the media might think differently, but they still have a long way to go to convince the Member States.
Now its starting to become controversial, but as long as the information is objective and preferably given by physicians or the EU, most people will say that patients should indeed be allowed more information. Well it would be surprising if they did not agree that patients who are more health-literate will manage their health better.
So safe and informed that seems to be ok with all. But on March 2nd when then approximate same (Brussels isn’t that big) crowd gather again– I don’t think it will be so cosy..
The topic of German Liberal MEP Jorgo Chatzimarkakis Life Circle meeting is “Patient Empowerment – a New Paradigm in Disease Management”. This suggests the pressure is on. Discussion at the Life Circle event should be lively, at least if Member States’ representatives from the Member States show up and participate. Not necessarily always the case – when the EU Commission last year arranged a Patients’ Rights day the room where remarkably free from health attaches.
Patient empowerment was accepted without discussion as something positive until recently, but it seems that in the new financial situation governments have gotten cold feets since they assume it would mean higher costs. This questioning of if patient empowerment is really desirable seems to have begun at the Czech presidency conference on the financial sustainability of healthcare in 2009. During the panel debate on “Defining Sustainability in Health Systems, Josep Figueras, Director, European Observatory on Health Systems and Policies as well as Melinda Medgyaszai, Secretary of State for Health Policy, Ministry of Health, Hungary. Maria de Belem Roseira Pina, Chair of the Parliamentary Health Committee, Asseimbleia da República, Portugal all questioned if all demands from patients should really be met.
After this at various conferences fears have been raised that patients may increasingly seek healthcare cross-border, thereby undermining the finances as well as the principle of the European equal (meaning everyone should have the same thing) and solidaric healthcare systems have been raised until finally the Spanjards managed to ensure a blocking minority for the Directive of Patients Rights on cross-border care. There are even fears that patients may demand treatments that are not good for them.
This might all be due to the financial crisis but I don’t think so. I think that its also because they really do not like to let go of the power they currently enjoy of being able to tell patients where and when and whether they should receive care. In Europe healthcare is still provided only to the extent that governments think it will benefit society as a whole. Think-tanks, a few politicians and the media might think differently, but they still have a long way to go to convince the Member States.
Thursday, 4 February 2010
More health equity?
The www.equitychannel.net, is a new online community where you can get updates on the EU policy developments affecting health and equity and participate in the the Equity Channel Forum. The Equity Channel is a new project aiming at bringing together stakeholders and bodies working in health related sectors with the goal to improve health equity. The project is initiated by EuroHealthNet - a Brussel based network of public health and health promotion agencies in EU countries.
Wednesday, 3 February 2010
Friday, 29 January 2010
House of Cancer Self-Help in Bonn
I learned from the latest HSCNews Bulletin that Eight German patient organisations that specialise in cancers of various types have decided upon a new way to work together. Realising that really effective networking demands quite a lot of contact they have now offices in the same building in Bonn creating a House of Cancer Self-Help. This way they can “encouraging each other in work; coming together for the preservation and improvement of the quality of medical and psycho-social care; developing common approaches to common concerns (and to representing them jointly in public); and working together to strengthen the ability of patients to self-manage their conditions.” The House of Cancer Self-Help will also run four patient conferences a year in Germany and will work to ensure “that the patients who are attending the conferences have sufficient time to question the expert speakers”. More information can be found here.
It is a winning concept – in Sweden a lot of the patient associations share a couple of corridors in the same building in Stockholm where also the main umbrella association have its head quarter. I would guess that over the year this have meant quite a lot with regards to information exchange and knowledge building for example for the smaller organizations with maybe only one person working for them.
Social networking seems to still need to be also taking place in real life or as some now say: outside of keyboard. Even if new media certainly enables and helps!
It is a winning concept – in Sweden a lot of the patient associations share a couple of corridors in the same building in Stockholm where also the main umbrella association have its head quarter. I would guess that over the year this have meant quite a lot with regards to information exchange and knowledge building for example for the smaller organizations with maybe only one person working for them.
Social networking seems to still need to be also taking place in real life or as some now say: outside of keyboard. Even if new media certainly enables and helps!
Monday, 25 January 2010
Pfizer no 1 on patient information 2nd year in a row
PatientView have conducted a global survey of 655 patient groups from 46 different countries on the topic of patient information. The findings where partly presented at the Patient Information by the Health Consumer Powerhouse seminar hosted in the European Parliament by Christofer Fjellner last week. One of the questions asked where: How well do you believe the following companies performed in 2009 in their ability to provide information to patient groups? It turns out that Pfizer takes the lead for the second year in a row. On second place comes AstraZeneca (+6) and on third place Novartis (-1). The ranking do seem to partly correlate with how well known the companies are and its therefor maybe not surprising that out of 15 companies on shared 13th place comes the rather unknown Amgen and Boehringer-Ingelheim. The full list can be found in Alex Wykes presentation here.
Friday, 15 January 2010
Monday, 11 January 2010
The question I hope Dalli gets at the EP hearing
The most important change in EU Health care policies have not been done by the Council or the Parliament but as I concluded in my previous post about the Swedish Presidency they didn’t really impact future healthcare policy during their last 6 month of power. Instead if anyone in the future will say that in second half of 2009 this happened and it really changed healthcare policy it will not be something that the Presidency did but what Barroso did when he moved several responsibilities from DG Industry to DG Sanco and appointed Dalli as health commissioner. The appointment of someone with a background in finance etc could show to be very important for the development of European healthcare policy.
This week Dalli will be heard/questioned in the EP. The answers will give us the first indication towards what direction the EU commission now will take in the area of public health. Ie if the changes will be more than formalities.
I'm quite sure most of the questions will be on the Directive for Patients Rights at cross border care but that also the Patient Information issue will be raised. One or two disease areas will most likely get their 15 min in the spotlight. Business as usual for the main part.
But what I hope someone will ask is:
- Will DG Sanco now take a real responsibility for the facilitation of a sustainable European health sector with empowered healthcare consumers trusted to really take their health into their own hands - instead of merely in all healthcare policy issues take the position that patients needs to be safeguarded and taken care off.
But that will most likely not happen. Not yet. Maybe next time. When the effects of the organisational changes starts to set in.
This week Dalli will be heard/questioned in the EP. The answers will give us the first indication towards what direction the EU commission now will take in the area of public health. Ie if the changes will be more than formalities.
I'm quite sure most of the questions will be on the Directive for Patients Rights at cross border care but that also the Patient Information issue will be raised. One or two disease areas will most likely get their 15 min in the spotlight. Business as usual for the main part.
But what I hope someone will ask is:
- Will DG Sanco now take a real responsibility for the facilitation of a sustainable European health sector with empowered healthcare consumers trusted to really take their health into their own hands - instead of merely in all healthcare policy issues take the position that patients needs to be safeguarded and taken care off.
But that will most likely not happen. Not yet. Maybe next time. When the effects of the organisational changes starts to set in.
Thursday, 7 January 2010
What did the Swedish Presidency do for your future health?
I was asked to comment on the Swedish Presidency by a journalist recently and after having given it some thought, looked at some of the material released this last 6 month and talked to a couple of people I must come to the conclusion that there have been no major achievements impacting the life of European healthcare consumers and professionals. But that we might see some changes anyway.
So why didn’t the Swedish Presidency rock the boat more? I see 2 major reasons for this besides the Swedes being Swedes – more about this in my LÁnglophone column from early autumn.
1. The first reason being structural: We had a rather weak EU commission since it was to be exchanged, for long waiting to be relieved. Also it didn’t help that the presidency in waiting (Spain) was working quite active and successfully against several of the Swedish key issues. Not so surprising given that the ministers do come from very different political backgrounds. We saw this division for example in the case of the Directive for Patient Rights. More concretely this meant that the Spaniards managed to gather a blocking minority partly by promising better deals during their presidency. I.e. that under their presidency governments would not have to hand over so much power to the patients.
2. The second reason is the Swine Flu - Now I think media and politicians alike over reacted – 1. – but no matter what you think about the focus on this issue one cannot deny that quite a lot of time and efforts by key healthcare people have been spent on this unexpected situation, time and focus that otherwise would have been spent on other issues. But what I can see the efforts around the Swine Flu showed that when needed the international community really can act fast and united. If the learning’s from this is used well by those that would like to see more international co-operation on health issues we might see surprising effects in other areas as well.
In one area where for example I do not think Industry expected or even still really understands what happened with is the info issue, i.e. the EU commissions' proposal for Information to Patients – a part of the Pharmaceutical package. It seems like still some analysts believe that if only industry says ok to pre-vetting then the issue is solved. It’s because they have not understood that the Swedes themselves have put the very controversial issue on hold not because they agree with countries like Spain or France who thinks that the EU Commission proposal is to liberal – Quite the opposite. The issue the Swedes have with the proposal is that their constitution on freedom of speech doesn’t allow for censorship – governmental pre-vetting of information. If Industry thinks this is ok sort of doesn’t help:) Makes me happy that my government stands up for principles.
Still, in some areas there have been achievements: On MRSA for example where the commission now has been asked to come forward with a proposal for new incentives for development of new antibiotics by 2012. Small steps have also been taken concerning organ donation and alcohol policies etc. And on organ donation Spain will probably do all they can to find a solution. Spain is best in the class and will probably take the opportunity to shine in this field.
Another achievement that might be considered a big step forward for public health is the council recommendation to the Member States to introduce smoking restrictions in public places. But I think this was a given and something they just could not loose. I firmly believe that smoking will be banned altogether. It just doesn’t make sense to let people destroy their health and our common healthcare budgets by allowing smoking. Would we have an insurance system where the fees could be adapted to smoking habits or they paid themselves for their healthcare I think they should be free to kill themselves? But as long as I pay…
A small issue but with high importance is that the Swedes managed to get the council to support the European Court of Auditors very critical report on DG Sanco's work with the Public Health Program 2003-2007. This is important for all future efforts on EU level. Targets for all efforts needs to be set. There will have to be focus. We can already see the effects in for example the Work program published by DG Sanco in December. In short the budget is tighter, the focus clearer and the demands on output orientation higher. And warnings are raised that last year already only 20% of the applications where granted – this year it will be even fewer. Having previously seen some excellent but also some very, very basic work being funded in all possible and impossible areas I think this is great step forward.
On a final note most interesting is maybe that now finally the Swedes are free to say what they want. For quite some time also before their presidency they have been diplomatic in the hope that this would enable them being good chairmen. Now they will have no such restrictions and I would hope this means they can finally really take a stance for patient’s rights to choose etc. This is areas where the current government back home in Sweden has been very active. I would think the Spaniards will have quite a match with the Swedes since they do have quite different views on who should be in power in healthcare. Sometimes it's said that health issues we can all agree upon but when one looks at the Swedish and Spanish health policies it becomes quite obvious that one country thinks that the patients are taxpayers and should be in charge and that the other country believe that it’s the role of the government to ensure best possible care for all.
So why didn’t the Swedish Presidency rock the boat more? I see 2 major reasons for this besides the Swedes being Swedes – more about this in my LÁnglophone column from early autumn.
1. The first reason being structural: We had a rather weak EU commission since it was to be exchanged, for long waiting to be relieved. Also it didn’t help that the presidency in waiting (Spain) was working quite active and successfully against several of the Swedish key issues. Not so surprising given that the ministers do come from very different political backgrounds. We saw this division for example in the case of the Directive for Patient Rights. More concretely this meant that the Spaniards managed to gather a blocking minority partly by promising better deals during their presidency. I.e. that under their presidency governments would not have to hand over so much power to the patients.
2. The second reason is the Swine Flu - Now I think media and politicians alike over reacted – 1. – but no matter what you think about the focus on this issue one cannot deny that quite a lot of time and efforts by key healthcare people have been spent on this unexpected situation, time and focus that otherwise would have been spent on other issues. But what I can see the efforts around the Swine Flu showed that when needed the international community really can act fast and united. If the learning’s from this is used well by those that would like to see more international co-operation on health issues we might see surprising effects in other areas as well.
In one area where for example I do not think Industry expected or even still really understands what happened with is the info issue, i.e. the EU commissions' proposal for Information to Patients – a part of the Pharmaceutical package. It seems like still some analysts believe that if only industry says ok to pre-vetting then the issue is solved. It’s because they have not understood that the Swedes themselves have put the very controversial issue on hold not because they agree with countries like Spain or France who thinks that the EU Commission proposal is to liberal – Quite the opposite. The issue the Swedes have with the proposal is that their constitution on freedom of speech doesn’t allow for censorship – governmental pre-vetting of information. If Industry thinks this is ok sort of doesn’t help:) Makes me happy that my government stands up for principles.
Still, in some areas there have been achievements: On MRSA for example where the commission now has been asked to come forward with a proposal for new incentives for development of new antibiotics by 2012. Small steps have also been taken concerning organ donation and alcohol policies etc. And on organ donation Spain will probably do all they can to find a solution. Spain is best in the class and will probably take the opportunity to shine in this field.
Another achievement that might be considered a big step forward for public health is the council recommendation to the Member States to introduce smoking restrictions in public places. But I think this was a given and something they just could not loose. I firmly believe that smoking will be banned altogether. It just doesn’t make sense to let people destroy their health and our common healthcare budgets by allowing smoking. Would we have an insurance system where the fees could be adapted to smoking habits or they paid themselves for their healthcare I think they should be free to kill themselves? But as long as I pay…
A small issue but with high importance is that the Swedes managed to get the council to support the European Court of Auditors very critical report on DG Sanco's work with the Public Health Program 2003-2007. This is important for all future efforts on EU level. Targets for all efforts needs to be set. There will have to be focus. We can already see the effects in for example the Work program published by DG Sanco in December. In short the budget is tighter, the focus clearer and the demands on output orientation higher. And warnings are raised that last year already only 20% of the applications where granted – this year it will be even fewer. Having previously seen some excellent but also some very, very basic work being funded in all possible and impossible areas I think this is great step forward.
On a final note most interesting is maybe that now finally the Swedes are free to say what they want. For quite some time also before their presidency they have been diplomatic in the hope that this would enable them being good chairmen. Now they will have no such restrictions and I would hope this means they can finally really take a stance for patient’s rights to choose etc. This is areas where the current government back home in Sweden has been very active. I would think the Spaniards will have quite a match with the Swedes since they do have quite different views on who should be in power in healthcare. Sometimes it's said that health issues we can all agree upon but when one looks at the Swedish and Spanish health policies it becomes quite obvious that one country thinks that the patients are taxpayers and should be in charge and that the other country believe that it’s the role of the government to ensure best possible care for all.
Tuesday, 15 December 2009
Preliminary hearing of proposed EU Commissioners
The different proposed Commissioners need to be approved by the Parliament and for that the Parliament Question them a special Hearing. According to the draft timetable for the hearings in the European Parliament will take place from the 11th of January to the 19th of January. More exactly Máire Geoghegan-Quinn (Research) is scheduled to be questioned the 13th at 16.30 to 19-30 and Dalli (Health and Consumer) the 14th of January between 13 and 16. Look forward to hear what Dalli will do about the Patient Information and Patient Rights at Cross Border Care Directives.
If you are interested in times for hearings of other commissioners please contact me directly.
If you are interested in times for hearings of other commissioners please contact me directly.
Sunday, 13 December 2009
Heads of Commission cabinets selected
The various Commissioners to be have selected their Heads of Cabinet. Interesting is that John Bell from Sanco goes to Research. Maybe we get more healthcare focus in research in the future? Darmanin was previously deputy head of cabinet to Commissionair Borg.
See the full list below:
Health Commissioner John Dalli (Malta)
Head of Cabinet: Joanna Darmanin, Malta
Research Commissioner Máire Geoghegan-Quinn (Ireland)
Head of Cabinet: John Bell, Ireland
Commission President - José Manuel Durao Barroso (Portugal)
Head of Cabinet: Johannes Laitenberger, Germany
High Representative for Foreign Policy and Security - Catherine Ashton (UK)
Head of Cabinet: James Morrison, UK
Trade Commissioner Karel De Gucht (Belgium)
Head of Cabinet: Marc Vanheukelen, Belgium
International Cooperation and Development Commissioner Rumiana Jeleva (Bulgaria)
Head of Cabinet: Jochen Richter, Germany
Climate Commissioner Connie Hedegaard (Denmark)
Head of Cabinet: Peter Vis, UK
Energy Commissioner Günther Oettinger (Germany)
Head of Cabinet: Michael Köhler, Germany
Transport Commissioner Siim Kallas (Estonia)
Head of Cabinet: Henrik Hololei, Estonia
Economic Affairs Commissioner Olli Rehn (Finland)
Head of Cabinet: Timo Pesonen, Finland
Internal Market Commissioner Michel Barnier (France)
Head of Cabinet: Olivier Guersent, France
Fishery Commissioner Maria Damanaki
Head of Cabinet: Markopouliotis Georgios, Greece
Enterprises Commissioner Antonio Tajani (Italy)
Head of Cabinet: Antonio Preto, Italy
Development Commissioner Andris Piebalgs (Latvia)
HoC: Christopher Jones, UK (former director DG TREN)
Fiscal affairs Commissioner Algirdas Semeta (Lithuania)
Head of Cabinet: Stephen Quest, UK
Justice Commissioner Viviane Reding (Luxembourg)
Head of Cabinet: Martin Selmaye, Germany
Digital Agenda Commissioner Neelie Kroes (Netherlands)
Head of Cabinet: Anthony Whelan, Ireland
Regional Policy Commissioner John Hahn (Austria)
Head of Cabinet: Hubert Gambs, Austria
Head of Cabinet: Marc Lemaitre, Luxembourg
Agriculture Commissiener Dacian Ciolos (Romania)
Head of Cabinet: to be appointed
Internal Affairs Commissioner Cecilia Malmström (Sweden)
Head of Cabinet: Mia Asenius, Sweden
Interinstitutional relations Commissioner Maros SEFCOVIC (Slovak Republic)
HoC: Peter Javorcík, Slovak republic
Environment Commissioner Janez Potocnik (Slovenia)
Head of Cabinet : Kurt Vandenberghe, Belgium
Competition Commissioner Joaquin Almunia (Spain)
Head of Cabinet: Carlos Martinez Mongay, Spain
Enlargement Commissioner Füle Stefan (Czech Republic)
Head of Cabinet: Simon Mordue, UK
Employment Commissioner László Andor (Hungary)
Head of Cabinet: Anabela Gago, Portugal
Education Commissioner Vassiliou (Cyprus)
Head of Cabinet: Philippe Brunet, France
See the full list below:
Health Commissioner John Dalli (Malta)
Head of Cabinet: Joanna Darmanin, Malta
Research Commissioner Máire Geoghegan-Quinn (Ireland)
Head of Cabinet: John Bell, Ireland
Commission President - José Manuel Durao Barroso (Portugal)
Head of Cabinet: Johannes Laitenberger, Germany
High Representative for Foreign Policy and Security - Catherine Ashton (UK)
Head of Cabinet: James Morrison, UK
Trade Commissioner Karel De Gucht (Belgium)
Head of Cabinet: Marc Vanheukelen, Belgium
International Cooperation and Development Commissioner Rumiana Jeleva (Bulgaria)
Head of Cabinet: Jochen Richter, Germany
Climate Commissioner Connie Hedegaard (Denmark)
Head of Cabinet: Peter Vis, UK
Energy Commissioner Günther Oettinger (Germany)
Head of Cabinet: Michael Köhler, Germany
Transport Commissioner Siim Kallas (Estonia)
Head of Cabinet: Henrik Hololei, Estonia
Economic Affairs Commissioner Olli Rehn (Finland)
Head of Cabinet: Timo Pesonen, Finland
Internal Market Commissioner Michel Barnier (France)
Head of Cabinet: Olivier Guersent, France
Fishery Commissioner Maria Damanaki
Head of Cabinet: Markopouliotis Georgios, Greece
Enterprises Commissioner Antonio Tajani (Italy)
Head of Cabinet: Antonio Preto, Italy
Development Commissioner Andris Piebalgs (Latvia)
HoC: Christopher Jones, UK (former director DG TREN)
Fiscal affairs Commissioner Algirdas Semeta (Lithuania)
Head of Cabinet: Stephen Quest, UK
Justice Commissioner Viviane Reding (Luxembourg)
Head of Cabinet: Martin Selmaye, Germany
Digital Agenda Commissioner Neelie Kroes (Netherlands)
Head of Cabinet: Anthony Whelan, Ireland
Regional Policy Commissioner John Hahn (Austria)
Head of Cabinet: Hubert Gambs, Austria
Head of Cabinet: Marc Lemaitre, Luxembourg
Agriculture Commissiener Dacian Ciolos (Romania)
Head of Cabinet: to be appointed
Internal Affairs Commissioner Cecilia Malmström (Sweden)
Head of Cabinet: Mia Asenius, Sweden
Interinstitutional relations Commissioner Maros SEFCOVIC (Slovak Republic)
HoC: Peter Javorcík, Slovak republic
Environment Commissioner Janez Potocnik (Slovenia)
Head of Cabinet : Kurt Vandenberghe, Belgium
Competition Commissioner Joaquin Almunia (Spain)
Head of Cabinet: Carlos Martinez Mongay, Spain
Enlargement Commissioner Füle Stefan (Czech Republic)
Head of Cabinet: Simon Mordue, UK
Employment Commissioner László Andor (Hungary)
Head of Cabinet: Anabela Gago, Portugal
Education Commissioner Vassiliou (Cyprus)
Head of Cabinet: Philippe Brunet, France
Friday, 11 December 2009
According the UK Shadow Minister of Health - what will happen if they win next election?
The UK healthcare system ranking as no 14 in the 2009 European Health Consumer Index as well as the recent reports about the very large difference in cancer survival rates across the country makes it quite obvious for everyone that something have to be done to reform the UK healthcare system. Given that it seems very likely that there will be a change in government after the next election I’m happy to have had the opportunity to discuss with Mr Mike Penning the Shadow Health Minister for the Tories about their plans for reforming the British healthcare system.
Initially he plays it safe by explaining that the starting point for the Tories is that Blair won the argument that NHS needs more money and that they will match the increase in funding already decided by the Labour government. But he continues that this massive increase in funding have up-to now not been matched in outcomes.
Stroke, cardiac, major trauma – all area areas where he sees that they are lagging behind in development. I might here be able to ad Allergy – having listening to Professor Prof.Dr. J.G.R.de Monchy at the Universty Medical Center Groningen and learned that in the UK 68% of patients assumed to have Allergies are not tested at all for Allegies a figure that in Germany is 15%, in Spain 27% and Italy 28%. The country that comes closest is Denmark with 40%...
Now Mr Penning explains that the problems are based in the fact that departments are very silo based – and that there is a need to look at the public health agenda. I.e. he thinks that it’s not possible to only address health at the emergency entrance. Since leadership is important the Tories will change the department of Health to the department of Public Health as a clear signal that this needs to be addressed.
I must admit that when I heard this I thought for myself that I would have looked more at the financial silos and I was quite happy when at the end of our discussion when we were talking Qualies it became clear that they did have a double approach to the silo issue. More about this further down because before we have time to go there he states that it has been a massive increased spent in bureaucracy– because of the increased of targets driven healthcare. The hospitals have had to work to meet these targets – instead of deliver on outcomes. So priorities have been driven by bureaucracy rather than clinical needs. He also promises that this means that the Tories will abolish the targets!
If the problem description probably is quite PC I’m sure that their solutions are more controversial and I had to ask if national guidelines still will be used. And yes the answer is that they will but he underlines there is no point in diagnosing bowl cancer if you then don’t treat the patients. I read this as there will be a slight different focus in the way guidelines are written compared to today but didn’t go into details.
Another area for change is their ambition to extend the choice – in elective care – and to ensure that information enabling choice is available. The rational for this is that the information now being published was available but not transparent – so what needs to be done is to ensure that this information is freed up! This would empower the patients. I ask about the information that Dr Fosters gathers and he explains that this info isn’t available for the general public or even a Shadow Minister of Health like himself, only for the Department of Health etc . Mr Penning wants instead create one single portal into the web where you should be able to check survival rate etc.
He exemplifies the problem with the recent Dr Foster report that looked at particular hospital and found quite remarkable bad management despite that an excellent report have been published one month earlier. This report came after CTC made a decision to send in team due to the suspicious mortality rates they seen in non public material. Question is how this could have been possible. The answer to this is that according to Mr Penning is that:
1. Tories do not want any pre-booked inspections and on this they will go against till management of care if needed!
2. They want the monitoring of the foundation hospitals to be not only on finance but also the clinical side in order to get a better balance in the inspections.
Asking about top-ups he explains that they will accept top-ups in certain situations meaning that if there are drugs that are available in others countries that you receive a prescription on you should have the right to continue with that particular drug.
So then we came back to the Silos. And admittedly one of the things I find most interesting is that he claims that they will change the definition of the Qualy used by NICE. The problem as he sees it is that the Qualies do not take into account enough factors for example if we have a drug that would extend life. He thinks that it should also look at what the alternative cost would be – for example if you would need 24 hours care at home or hospital instead of this drug. I.e. what should be important for a reimbursement decision is the total cost of the state when a patient has a specific disease. If this could in the same way most NICE work do set the standard of how health technology assessments should be done across Europe I would be very happy!
He mentions that he also thinks there is a need to look at the way we are negotiating with the drug companies – for example on how early the NHS would be involved in the clinical trials. A topic that I need to look more into at a later stage – its quite fantastic for me to realise that a big buyer of medicines like the NHS actually do not negotiate on price!
Quite a lot to do so I’m curious about the plan for execution. He explains that there is a 3. 6 and 9 months program as well as one for 2 and 3 years time. They are already discussing with the civil servants .But in many cases we cannot get the info before we are in place. Still civil servants seem to be aware that the current government is out of ideas and changes have to occur.
So he hopes that after 4 years – there will be more people with better outcomes, some living longer some just treated better. Key will be a massive increase in patient outcomes. Well I just hope that his realism about the quality outcomes by the NHS lasts long enough for all of this to take place.
Initially he plays it safe by explaining that the starting point for the Tories is that Blair won the argument that NHS needs more money and that they will match the increase in funding already decided by the Labour government. But he continues that this massive increase in funding have up-to now not been matched in outcomes.
Stroke, cardiac, major trauma – all area areas where he sees that they are lagging behind in development. I might here be able to ad Allergy – having listening to Professor Prof.Dr. J.G.R.de Monchy at the Universty Medical Center Groningen and learned that in the UK 68% of patients assumed to have Allergies are not tested at all for Allegies a figure that in Germany is 15%, in Spain 27% and Italy 28%. The country that comes closest is Denmark with 40%...
Now Mr Penning explains that the problems are based in the fact that departments are very silo based – and that there is a need to look at the public health agenda. I.e. he thinks that it’s not possible to only address health at the emergency entrance. Since leadership is important the Tories will change the department of Health to the department of Public Health as a clear signal that this needs to be addressed.
I must admit that when I heard this I thought for myself that I would have looked more at the financial silos and I was quite happy when at the end of our discussion when we were talking Qualies it became clear that they did have a double approach to the silo issue. More about this further down because before we have time to go there he states that it has been a massive increased spent in bureaucracy– because of the increased of targets driven healthcare. The hospitals have had to work to meet these targets – instead of deliver on outcomes. So priorities have been driven by bureaucracy rather than clinical needs. He also promises that this means that the Tories will abolish the targets!
If the problem description probably is quite PC I’m sure that their solutions are more controversial and I had to ask if national guidelines still will be used. And yes the answer is that they will but he underlines there is no point in diagnosing bowl cancer if you then don’t treat the patients. I read this as there will be a slight different focus in the way guidelines are written compared to today but didn’t go into details.
Another area for change is their ambition to extend the choice – in elective care – and to ensure that information enabling choice is available. The rational for this is that the information now being published was available but not transparent – so what needs to be done is to ensure that this information is freed up! This would empower the patients. I ask about the information that Dr Fosters gathers and he explains that this info isn’t available for the general public or even a Shadow Minister of Health like himself, only for the Department of Health etc . Mr Penning wants instead create one single portal into the web where you should be able to check survival rate etc.
He exemplifies the problem with the recent Dr Foster report that looked at particular hospital and found quite remarkable bad management despite that an excellent report have been published one month earlier. This report came after CTC made a decision to send in team due to the suspicious mortality rates they seen in non public material. Question is how this could have been possible. The answer to this is that according to Mr Penning is that:
1. Tories do not want any pre-booked inspections and on this they will go against till management of care if needed!
2. They want the monitoring of the foundation hospitals to be not only on finance but also the clinical side in order to get a better balance in the inspections.
Asking about top-ups he explains that they will accept top-ups in certain situations meaning that if there are drugs that are available in others countries that you receive a prescription on you should have the right to continue with that particular drug.
So then we came back to the Silos. And admittedly one of the things I find most interesting is that he claims that they will change the definition of the Qualy used by NICE. The problem as he sees it is that the Qualies do not take into account enough factors for example if we have a drug that would extend life. He thinks that it should also look at what the alternative cost would be – for example if you would need 24 hours care at home or hospital instead of this drug. I.e. what should be important for a reimbursement decision is the total cost of the state when a patient has a specific disease. If this could in the same way most NICE work do set the standard of how health technology assessments should be done across Europe I would be very happy!
He mentions that he also thinks there is a need to look at the way we are negotiating with the drug companies – for example on how early the NHS would be involved in the clinical trials. A topic that I need to look more into at a later stage – its quite fantastic for me to realise that a big buyer of medicines like the NHS actually do not negotiate on price!
Quite a lot to do so I’m curious about the plan for execution. He explains that there is a 3. 6 and 9 months program as well as one for 2 and 3 years time. They are already discussing with the civil servants .But in many cases we cannot get the info before we are in place. Still civil servants seem to be aware that the current government is out of ideas and changes have to occur.
So he hopes that after 4 years – there will be more people with better outcomes, some living longer some just treated better. Key will be a massive increase in patient outcomes. Well I just hope that his realism about the quality outcomes by the NHS lasts long enough for all of this to take place.
Monday, 7 December 2009
A patient rights vote for a Swine Flu shot?
Last week a blocking minority (Spain, Poland, Portugal, Slovakia, Greece and Rumania) in the Council put an end to the hopes of getting a decision on the directive for patient rights at cross border care.
Despite that the Swedes basically had sold out everything that would for real have empowered patients and put forward a proposal that merely id codify the current case law and gave plentiful of guarantees that governments should still be in power of healthcare. But the hard core of the minority came well prepared after having had their own pre-meetings and where not satisfied and instead they wanted a proposal that restricted case-law – i.e. discriminating private providers - since that was assessed to go against the constitution the Swedes could not accept going further and revising their proposal even more..
One of the things impacting the outcome where that Greece who up to now have been positive have had a change in government and the recently elected health minister didn’t know what to do. According to my sources who attended the meeting the Spanish Health Minister Trinidad knowing this promised her Greek colleague that the issue will be managed during her presidency meaning that the Greeks could without hesitation not make up her mind yet and instead vote no in order to have more time for contemplation and potentially vote yes later. Right.
There is also a guessing game ongoing on what the Romanians got from Trinidad. What is clear is that the Poles didn’t get what they wanted. The Polish Health Minister Kopacz her own problems since she has missed order swine flu vaccines and then tried to claim that 1. There is no Swine Flu in Poland and secondly if they would get it that the ordinary flu vaccine would work. She did before the meeting try to get Sweden to give her vaccines out of the Swedish stock. This happened when Swedish Health Minister Hägglund visited Warszawa to talk about the Directive about Patient Rights at Cross border care. Hägglund answered that it’s not the government but the counties in Sweden that owns the vaccines but Kopacz didn’t rest and send a letter to Hägglund. Unfortunately the Swedes have classified the letter and correspondence around the topic but this decision have been questioned by Swedish Radio and with some good luck the Swedish constitutional transparency regulations will prove useful.
Good to know for the future, given the appointment of Dalli, is that Malta did in the end line up with the majority in favour of the directive. Maybe Dalli when in charge DG Sanco can ensure that they continue to push the issue. Or maybe Trinidad just didn’t want the Swedes to get this through and actually will deliver to the Greeks so that we will have a new proposal this spring. In the meantime patients will suffer.
Despite that the Swedes basically had sold out everything that would for real have empowered patients and put forward a proposal that merely id codify the current case law and gave plentiful of guarantees that governments should still be in power of healthcare. But the hard core of the minority came well prepared after having had their own pre-meetings and where not satisfied and instead they wanted a proposal that restricted case-law – i.e. discriminating private providers - since that was assessed to go against the constitution the Swedes could not accept going further and revising their proposal even more..
One of the things impacting the outcome where that Greece who up to now have been positive have had a change in government and the recently elected health minister didn’t know what to do. According to my sources who attended the meeting the Spanish Health Minister Trinidad knowing this promised her Greek colleague that the issue will be managed during her presidency meaning that the Greeks could without hesitation not make up her mind yet and instead vote no in order to have more time for contemplation and potentially vote yes later. Right.
There is also a guessing game ongoing on what the Romanians got from Trinidad. What is clear is that the Poles didn’t get what they wanted. The Polish Health Minister Kopacz her own problems since she has missed order swine flu vaccines and then tried to claim that 1. There is no Swine Flu in Poland and secondly if they would get it that the ordinary flu vaccine would work. She did before the meeting try to get Sweden to give her vaccines out of the Swedish stock. This happened when Swedish Health Minister Hägglund visited Warszawa to talk about the Directive about Patient Rights at Cross border care. Hägglund answered that it’s not the government but the counties in Sweden that owns the vaccines but Kopacz didn’t rest and send a letter to Hägglund. Unfortunately the Swedes have classified the letter and correspondence around the topic but this decision have been questioned by Swedish Radio and with some good luck the Swedish constitutional transparency regulations will prove useful.
Good to know for the future, given the appointment of Dalli, is that Malta did in the end line up with the majority in favour of the directive. Maybe Dalli when in charge DG Sanco can ensure that they continue to push the issue. Or maybe Trinidad just didn’t want the Swedes to get this through and actually will deliver to the Greeks so that we will have a new proposal this spring. In the meantime patients will suffer.
Friday, 27 November 2009
Dalli EU lead in health and DG Sanco gets responsability for pharma
John Dalli from Malta will be in charge of Health and Consumer Policy in the new Barrosso commission. At the same time the reponsability for pharmaceuticals is being moved to DG Sanco. Mr Dalli who today is Social Policy Minister has a background both in industry as well as in consultancy and should be well equiped to manage the change in responsability. Its going to be very interesting to see what this will mean formost for the patient information proposal - maybe some of the tension around the issue can be eased with this transfer since DG Sanco now has to take responsability for the dossier instead of viewing their role only to safeguarde the safety of the patients and consumers.
Healthcare not the big driver of UK public sector cost
Sometimes those really boring statistical documents shows very interesting figures and I must say that the latest report from the UK Office for National Statistics (ONS) Centre for the Measurement of Government Activity is one of the most interesting documents I seen for a long time.
They have studied how the costs in public sector have grown over a period of 10 years. And they make a productivity measure by looking at cost per unit. Interesting enough the results shows that the healthcare expenditure actually with its average of 3.8 % per year grows exactly on average in the public sectors! The educational, social care, Police, Public order and safety, Children and Adult social care all grew more. Now this type of material is not my speciality but I did miss a comparison with the general inflation in society. I didn’t see anywhere that this material was inflation adjusted and if not its sort of hard to put the yearly 3.8 % increase in cost in perspective.
What was in there was a calculation showing that labour cost grew faster than in the broader economy (5.6% against 4.5% on average). So the reason the lower total spend despite the higher spend on cost of labour is probably that in healthcare the cost of goods and services only increased with 1% compared to the average 2.5%. Generic substitution is pointed out as one of the major reasons behind this low increase in costs for goods and services.
I can only make two conclusions:
1. Its not healthcare that is the problem in public spending.
2. To increase productivity for the future its not the products used in the system that needs to be in focus but the processes and not products to ensure a lower price per unit.
Healthcare is the largest individual spending area (30 % out of the total) in the UK. The study took place from 1997 to 2007 and can be found here.
They have studied how the costs in public sector have grown over a period of 10 years. And they make a productivity measure by looking at cost per unit. Interesting enough the results shows that the healthcare expenditure actually with its average of 3.8 % per year grows exactly on average in the public sectors! The educational, social care, Police, Public order and safety, Children and Adult social care all grew more. Now this type of material is not my speciality but I did miss a comparison with the general inflation in society. I didn’t see anywhere that this material was inflation adjusted and if not its sort of hard to put the yearly 3.8 % increase in cost in perspective.
What was in there was a calculation showing that labour cost grew faster than in the broader economy (5.6% against 4.5% on average). So the reason the lower total spend despite the higher spend on cost of labour is probably that in healthcare the cost of goods and services only increased with 1% compared to the average 2.5%. Generic substitution is pointed out as one of the major reasons behind this low increase in costs for goods and services.
I can only make two conclusions:
1. Its not healthcare that is the problem in public spending.
2. To increase productivity for the future its not the products used in the system that needs to be in focus but the processes and not products to ensure a lower price per unit.
Healthcare is the largest individual spending area (30 % out of the total) in the UK. The study took place from 1997 to 2007 and can be found here.
Friday, 20 November 2009
A bit easier to get EU funding for health projects
Found some good news for researchers, NGOs and others longing for EU funding for their projects. The EU Commission, the will publish a call for proposals in line with the Work Plan for the implementation of the EU Health Programme 2010, for projects, operating grants, conferences and joint actions already in 2009. The deadline for submitting proposals will be around March 2010. This might not seem important but my experience is that especially for those who want to find funding for projects this will make a big change as you must find money also somewhere else than from the EU Commission. This of course takes time and has its special limitations. I.e. other organisations also have budgets and financial steering instruments with deadlines etc for commitments of funds.
So far this have been quite complicated as the publication of tenders have been made in the spring with a deadline early summer the same year.Thus this formally small change in procedure is an important adaptation to other realities such as organisations being able to adopt their budgets before the new budget to the calls they might participate in the following year. Better financial planning will be possible and hopefully more organisations will be able to submit proposals for their projects.
More info on calls for proposals on the Executive Agency for Health and Consumers website.
So far this have been quite complicated as the publication of tenders have been made in the spring with a deadline early summer the same year.Thus this formally small change in procedure is an important adaptation to other realities such as organisations being able to adopt their budgets before the new budget to the calls they might participate in the following year. Better financial planning will be possible and hopefully more organisations will be able to submit proposals for their projects.
More info on calls for proposals on the Executive Agency for Health and Consumers website.
Thursday, 19 November 2009
The shift in the perception of health
I had a meeting a couple of days ago with a representative of Swedish Haemophilia Society association. Chatting about various things he mentioned that he recently had been climbing in Nepal and that the team had been monitoring their oxygen levels. He rightly pointed out that in these times of swine flu of course their oxygen levels while climbing would had caused quite some concerns at an emergency ward. And then he ended in an: But of course we were all healthy people.
A totally natural comment for him but for me who knows that not only has he haemophilia but the treatment given to him in the 80th as a child also as a side effect gave him HIV this was a bit well it wasn’t what I expected to hear.
Haemophilia today at least if you receive treatment in line with the Swedish preventive strategy is just a chronic disease that needs regular treatment. Quite similar is the HIV situation. In Sweden. But if you live in other parts of the world and do not get the medicines you need it is very different. Without treatment each of these 2 diseases is deadly – your life expectancy is substantially shortened.
This might seem trivial but give it some thought what this shirt in perception of health means for our healthcare system. And what it means that the innovation in medicines have given to society. The achievements my friend has managed during in his case very active working life would never have been possible without new modern medication.
It should also makes me to seriously doubt the use of pan European measurement of self-reported health status as for example have been done by for example the Eurofounds European Quality of Life Survey database and the Eurobarometer 2009 on not the childrens but the parents view of their childrens health. It all comes down to subjective individual perceptions and cultural contexts. Not really comparable on a European level.
A totally natural comment for him but for me who knows that not only has he haemophilia but the treatment given to him in the 80th as a child also as a side effect gave him HIV this was a bit well it wasn’t what I expected to hear.
Haemophilia today at least if you receive treatment in line with the Swedish preventive strategy is just a chronic disease that needs regular treatment. Quite similar is the HIV situation. In Sweden. But if you live in other parts of the world and do not get the medicines you need it is very different. Without treatment each of these 2 diseases is deadly – your life expectancy is substantially shortened.
This might seem trivial but give it some thought what this shirt in perception of health means for our healthcare system. And what it means that the innovation in medicines have given to society. The achievements my friend has managed during in his case very active working life would never have been possible without new modern medication.
It should also makes me to seriously doubt the use of pan European measurement of self-reported health status as for example have been done by for example the Eurofounds European Quality of Life Survey database and the Eurobarometer 2009 on not the childrens but the parents view of their childrens health. It all comes down to subjective individual perceptions and cultural contexts. Not really comparable on a European level.
Tuesday, 10 November 2009
Pharmacy monopoly in Sweden now sold out
The part of the Swedish Pharmacy monopoly that was devided into clusters to enable the privatisation is now sold at a final price of SEK 5.9 billion.
Apoteket Hjärtat, owned by Altor, acquires 208 pharmacies, with a turnover of SEK 7.1 billion and 1500 employees.
Kronans Droghandel, owned by Oriola-KD and KF, acquires 171 pharmacies, with a turnover of SEK 4.4 billion and 930 employees.
Medstop Holding AB, onwed by Segulah, aquires 62 pharmacies, with a turnover of SEK 3.1 billion and 660 employees.
Its a pity non of the international playeers have entered the market - I hope the reason is that they will establish new pharmacies instead of taking over old stores with old staff.
More information can be found here.
Apoteket Hjärtat, owned by Altor, acquires 208 pharmacies, with a turnover of SEK 7.1 billion and 1500 employees.
Kronans Droghandel, owned by Oriola-KD and KF, acquires 171 pharmacies, with a turnover of SEK 4.4 billion and 930 employees.
Medstop Holding AB, onwed by Segulah, aquires 62 pharmacies, with a turnover of SEK 3.1 billion and 660 employees.
Its a pity non of the international playeers have entered the market - I hope the reason is that they will establish new pharmacies instead of taking over old stores with old staff.
More information can be found here.
Changes in rutines due to Swine Flu mistakes that will benefit all
It has turned out that 4 out of 6 in Sweden that died from Swine Flu actually visited a clinic or hosital in order to get care at an earlier stage but where sent home again. One region (Skåne) has learned from the mistake and has changed their routines and as from now no-one shall be sent home without having seen a doctor…
Still if the care centres and emergencies would use very simple routines albeit with modern medical technology could help them as pointed out yesterday in Aftonbladet. At Södersjukhuset one of the Stockholm hospitals they use a triage sorting method. There are a several ( see more here) but at this hospital they check pulse, blood pressure, oxygen level in the blood, fever and the patients breathing capability. For measuring the oxygen level in the blood they use a devise that is very simple to use and cost them only 800 Euros to buy.
Let’s hope that those clinics where you don’t get to see a doctor at least ensure they sort patients a bit more careful in the future and make use of the devices available.
Another good thing is the boost the Swine flu discussions have for general hygiene standards. Hand washing seems too been given a real and needed boost. Long term I think this will saving more life’s than the vaccines in many disease areas!
Still if the care centres and emergencies would use very simple routines albeit with modern medical technology could help them as pointed out yesterday in Aftonbladet. At Södersjukhuset one of the Stockholm hospitals they use a triage sorting method. There are a several ( see more here) but at this hospital they check pulse, blood pressure, oxygen level in the blood, fever and the patients breathing capability. For measuring the oxygen level in the blood they use a devise that is very simple to use and cost them only 800 Euros to buy.
Let’s hope that those clinics where you don’t get to see a doctor at least ensure they sort patients a bit more careful in the future and make use of the devices available.
Another good thing is the boost the Swine flu discussions have for general hygiene standards. Hand washing seems too been given a real and needed boost. Long term I think this will saving more life’s than the vaccines in many disease areas!
Subscribe to:
Posts (Atom)
Subscribe To
Posts
All Comments