EDITORIAL: Time to make progress on patient safety in Europe

As Member of the European Parliament and medical physicist, I think it is time we make real progress on patient safety. The EU is at a standstill when it comes to taking forward actions called for by the Parliament and the Council. Now it is time for action.

Since my report “Resolution on Safer healthcare in Europe: improving patient safety and fighting antimicrobial resistance” was adopted in plenary on 19 May 2015, little has been done to set definitive and tangible targets for improving patient safety and quality of care throughout Europe – this, despite overwhelming support from my Parliamentary colleagues.

Time to compare Member States

That is why today I support Health First Europe in its publication of policy indicators to measure the quality and safety of healthcare systems for patients in Member States.  These policy indicators will be used to compare healthcare systems´ and to assess their achievements of the 11 recommendations already called for in the 2009 Council Recommendations on patient safety, as well as in my 2015 report.

Using its decade long work in the field of patient safety, Health First Europe believes that indicators for compliance must exist alongside standardised methodologies for achieving the defined indicators. These indicators should provide input to EU institutions and Member States with a view to enhancing the measuring of the results, failures and improvements of national policies on patient safety and AMR. It is in the interests of all EU citizens that Member States do not simply adopt policies, but measure them against targets for success, thus proving the effectiveness of the recommendations across the EU.

We know the issues at stake

We already know that patient safety and anti-microbial resistance (AMR) are major public health problems in Member States. According to figures compiled by the European Centre for Disease Prevention and Control (ECDC), 1 in 20 hospital in-patients on average suffer from a healthcare associated infection (HAI) in the EU. Every year it is estimated that 37,000 people in the EU die as a result of an HAI, although 20 to 30% of those infections are considered to be preventable by intensive hygiene and control programmes.

We know that, by 2050, 10 million people are likely to die every year because of antimicrobial resistance, and that resistance to antibiotics that were commonly used to treat causative bacteria is already at least 25% or more in several Member States.

We also know that human health, animal health and ecosystems are interconnected and the use of antibiotics in animals, particularly those intended for consumption and kept in high-density farming, can affect antibiotic resistance in humans. In light of the One Health concept, the only approach that could prevent HAIs, both inside and outside hospitals, is an approach whereby both human and veterinary medical professionals undertake initiatives to prevent resistant infections and reduce the use of antibiotics.

These issues need our utmost attention as they threaten us, our families and the health systems we rely on when we need medical care.

What is next for patients?

I welcome Commissioner Andriukaitis’ announcement in Amsterdam on 10 February 2016 to consider antimicrobial resistance as a top priority for the European Commission, however, I believe we also need to understand what this means.  How many Member States have a national policy on AMR? Are patients provided with information about AMR and hand hygiene when they enter a healthcare setting? Is there a standardised screening programme in place for HAIs?  These are the questions that Health First Europe is asking and I look forward to seeing the answers. A careful analysis of the results should be the starting point of a new effective strategy to help Europe moving forward.

MEP Piernicola Pedicini

EDITORIAL: Resisting unnecessary use of antibiotics

Anti-microbial resistance is a global health threat to health care systems’ ability to cope with infections effectively. A global report published by the WHO in 2014, revealed to the world that antibiotic resistance (the most common form of anti-microbial resistance) was putting all of us at risk and needed to be dealt with now. According to the report, failure to act would lead us into a world where antibiotics could become obsolete and dying from banal infections could once again become a likely event.

Where do we stand today?

A WHO report, a European Commission Action plan, a European Parliamentary Report and an EU/US partnership later, and we have yet to significantly move the needle. The status quo remains mainly unchanged: AMR still kills, it still hampers the control of infectious diseases, it causes significant costs to health care systems and it still poses a threat to future medical advancements. The resistance of some pathogens now reaches over 50% in certain countries, and new resistant strains are emerging and spreading rapidly.

In the European Union, Norway and Iceland, for example, 400,000 resistant infections are estimated to occur every year leading to about 25,000 deaths, according to the European Centre for Disease Prevention and Control[1]. Various practices are at the root of these alarming statistics. Human actions like the inappropriate use of antibiotics, poor infection controls or even the neglect of basic hygiene (hand washing) have accelerated the emergence and spread of AMR.

Furthermore, global tourism, the transfer of patients between facilities and the trade in animal products contributes to this global health threat.

Collaboration is the only way forward

The 53 countries in the WHO European Region adopted a strategic action plan on AMR in 2011 in which they set out 7 strategic objectives. Three years later, the WHO report went even further, proposing 10 additional measures to deal with resistance. This time around, focus was on collaboration of individuals, health workers and pharmacists, policy-makers and industry.

The European Parliament followed with a Report on Safer Healthcare in Europe in 2015 urging Member States to increase cooperation, and asking the European Commission to take the lead with a post-2016 Action Plan on AMR. But how can we move the needle and begin the process of concretely reducing unnecessary use of AMR in Europe?

As the European Commission begins it post – 2016 planning, we at Health First Europe believe that there are key actions to undertake.

  • Multidisciplinary guidelines on patient safety that look at how to reduce the risks of antimicrobial resistant infections throughout the patient pathway.
  • Standardised collection of data on AMR infections.  It is the only way we can truly understand where we currently stand and how we can improve and meet the targets set out by the WHO.
  • Information and communication to patients about AMR infection and risk patients so they understand the importance of using antibiotics only when prescribed and for the specific amount of time prescribed, and well as never sharing them with others or using leftover prescriptions.

The EU was formed to find solutions to European challenges like AMR.  It has the ability to bring together stakeholders, gather data, interpret data and provide a pan-European solution for AMR. Now it’s up to us as stakeholders to support the EU to do this work.

John Bowis, HFE President

EDITORIAL: The safety of patients is at risk

Editorial by HFE President John Bowis 

After two years of debate, the Council is close to finalizing its’ position on the medical devices directive.  The MDD, as it’s known to most, was proposed in the aftermath of a scandal where patients were harmed due to fraud and lack of oversight in the approval of silicone breast implants (PIP).  At the time of its proposal, Health First Europe called for a balanced approach to the legislation in order to ensure protection from patients from undue harm, but without sacrificing the accessibility of patients to the innovative technologies they need and want.

We now sit at a crucial point in the legislative process because the Member States are very close to agreeing their position on this highly important dossier for patients. In fact, it has been reported that the ‘general approach’ of the Council will be agreed on 19 June and will open the way to start negotiations with the Parliament soon.  However, given the intense and difficult discussions around many points, it now seems that, when it comes to the issues of patient safety, Member States have forgotten the scandal that made the MDD revision so very important. One eye-catching example is how Member States want to organize the secondary use of devices.

Different safety standards for patients

The Council want to allow different sets of safety rules for reusing devices that are originally intended to be used only once. This is surprising when bearing in mind that the whole purpose of the regulation is to ensure a high level of safety for patients. With this approach to so-called ‘reprocessing’, the Council allows different re-processors to apply different levels of standards.  The patient safety concerns raised by this particular situation are typical of the challenges for patient safety as a whole in the MDD.  As a patient, how will I know which type of device is being used on me? To whom can I direct my redress in the event of a problem? And where will issues be reported so that it doesn’t continue to happen to other patients?

The current text does not foresee any requirements mandating information to patients about the differing standards of devices that could be used in their treatment.  This is in contradiction to the recent Council Conclusions adopted by Member States on patient safety and quality of care which call for prioritising greater information to patients…not less.

Think about yourselves

As individuals discussing whether to support this position on behalf of your governments, I would ask you to think about yourself.  Think about whether you want to wonder in the midst of a medical procedure whether the innovations that should help to heal you, could actually harm you.  And consider whether this regulation is achieving what we all aimed for it to do – protect patients and support innovation.

You may discover that there is more work to be done.

EDITORIAL: Community Care – With patients, by patients and for patients

Editorial by HFE Vice-President Bert Van Caelenberg

As patients, carers of patients, friends of patients and ultimately future patients, many of us have been calling for healthcare policies to support a revolution towards innovative treatments, infrastructures, and communication tools. Enhancing community care, empowering patients and partnering with targeted key stakeholders should be part of this revolution and certainly part of a more holistic solution.

Patient centred policies for community care

Recent healthcare policy debates, frameworks, consultations and reports have been quick to advocate for more patient empowerment, more sustainability, more project specific targets and ultimately more and better care for patients. But those were just that, words. Traditional systems are failing to adapt to the demographic changes and new needs and demands of health stakeholders. Luckily, Member States are rapidly coming to that realisation as the financial pressure of the ‘old’ system weighs heavier and heavier. To meet these new demands, patients, their carers and healthcare professionals agreed at the recent Health First Europe event in collaboration with the Latvian Presidency that community care is the future and that we consequently need to take important steps to ensure that high quality care can be delivered to patients where, when and how they want it. Adaptability and flexibility are thus essential.

Why should Member states look to the EU to drive community care policy?

Healthcare is unquestionably a national competence and should remain so for the foreseeable future. But this cannot and should not mean the EU can’t play an important role in reforming healthcare systems across Europe. The EU has two distinguishable qualities relevant to us: it has expertise but more importantly it has perspective. This omniscient view of the European healthcare systems should allow the EU and by association the European Commission to act as the ‘beacon of light’ Member States trust to follow when in need. The key to leading nowadays lies in influence not authority. The EU should therefore:

  • Support the acceleration and standardization of community care services through technology
  • Encourage innovative healthcare systems processes, testing protocols, treatments and policies
  • Create and disseminate best practices at a pan-European level to help Member States learn from past experiences Orient current and future policies around patients and their support systems (whether formal or informal)
  • Cater to key stakeholders on a more personal level by recognizing the specificities of their statuses and demands.
  • Allow community care policy to become true through implementation of the necessary reforms. Reforms, not only in mentality, but also in the field (for example, not to see care at home as inferior to care delivered at the hospital).

The EU project on community care should focus on the big lines of the policy to be pursued for the promotion of community care and as such the personnel have to be explicitly mentioned. In order to make reforms a success, you need the personnel as the supportive base for those reforms. The personnel stand closest to the patient, so, they are the first line care deliverers.

Health First Europe’s role in this process

HFE’s mission is focused and aspires to complete one simple task: enable. Enable discussions, enable partnerships, but more importantly enable initiatives. We aim to bring decision-makers and key stakeholders together and provide them with a platform to allow us to advance in the same direction. We thus call for truly patient-centred healthcare and believe that every European citizen should and could benefit from more adapted care in an environment suitable to his/her needs. The patient should be centre stage, how much longer can we afford not to reform in consequence?

EDITORIAL: Enough patience for patients

Editorial by HFE President John Bowis 

We all know that the European Union’s current demographics are requiring a serious debate about the need to transform traditional healthcare systems. As patients, many of us have been calling for changes – eHealth implementation, access to care in the community, greater focus and accessibility to preventive services – but fundamental change of healthcare delivery lags behind our desires as consumers of health services.  How much more patient should we be as patients? When will the focus of health policy shift to towards the patient and away from acute-only treatment?

It’s time for genuine community care policy

The current economic difficulties faced by many European governments should force policymakers to reconsider traditional methods of healthcare spending and preferences and look for transformative policies to increase efficiency without sacrificing high quality care. This can and should be done via a strong commitment to community care policy. Patients want care closer to home. Patients want access to healthcare professionals, products and services outside of acute settings.  Patients want to be able to use the latest innovative tools and technologies to manage their health and well-being.

While austerity is being used by some to prevent such structural reforms, community care should be seen as a solution to healthcare sustainability – not a barrier. Genuinely investing in health, by looking at the long term benefits rather than the short term cost savings, will support the evolution of innovative and patient centered healthcare systems and result ultimately in a healthier, more productive population.

How do we get to there?

The variation and uniqueness of each national health system in Europe means that implementation of community care policy will be done in different ways across the continent.  Yet the challenges faced by Member States can be managed and facilitated by the exchange of information to allow Member States to learn from each other in terms of policy implementation. We need to have a strong leader driving policy on a pan-European level which is why the Commission is ideally placed to bring community care onto the EU public health policy agenda. We should focus on what the EU can do, rather than what it can’t.

  • The EU can support the acceleration and standardization of sub-components of community care services such as the use ICT in devises (e.g. medical records and communication protocols).
  • The EU can encourage innovative healthcare systems through the recognition of the value of innovation in approval processes for products, services and work place environments and develop assessment methods to showcase the overall value of community care services.
  • The EU can share best practices for dedicated innovative financing schemes across health and social care and promote options that result in improved outcomes for patients.
  • The EU can facilitate recognition of the opportunities for healthcare professionals in a dynamic community care system and leverage schemes which better support informal carers.

We’ve been patient

With the beginning of a new political term; now is an ideal time for the EU to step up and take the lead on community care policy. Community care will require multi-level action from multiple stakeholders to adapt to market and societal demands.  The EU should not sit passively but rather pave the way towards community care centered policies for all Member States.

We recognize that national governments will remain the driving forces behind healthcare policies at national, regional and local levels, the EU’s involvement is key to any reform of consequence. And as patients, we are ready.

EDITORIAL: The EU role in making technology accessible for patients

Editorial by HFE President John Bowis 

When you need medical treatment, do you ever wonder why some products and services are available and others aren’t? Perhaps your friend in another country is able to get a treatment for a similar ailment that you can’t?

If you’ve ever wondered why, it is because even though healthcare technologies may receive approval to be sold in the EU, each Member State health system independently decides the level of reimbursement for the product – which impacts the accessibility to you as a patient. This process is called health technology assessment (HTA). An HTA might be a part of helping decision-makers determine the technologies, products and services that are offered by the health system. For drugs, following approval by the European Medicines Agencies, an HTA is used to support further price and reimbursement decision making.

The EU has been involved in supporting Member States on HTA for many years, mostly by co-financing joint actions to share best practices, work jointly on methodologies and having initial pilots of joint assessment on HTA (EUnetHTA) which might be further used at national level. However, with the implementation of the Patients’ Rights in Cross-border Healthcare Directive, the EU role in HTA is growing given the establishment of a permanent network to guide strategic decisions about cooperation at EU level – such as moving towards the development of joint HTAs to serve as input in multiple Member States in order to avoid duplication of work.

While the network can provide great benefits to health authorities by sharing information and providing support and complementary activities to national work, it is fundamental that the network ensure appropriate stakeholder involvement so that patient and healthcare professional views, as well as payer and industries expertise, is included in assessments. After all, the people who will use and benefit from technologies should be considered in the evaluation. This means developing a stakeholder involvement policy that secures stakeholder interests, and views, are taken into account before, during, and post decision-making processes on HTA. It is imperative that the network allow for an appropriate amount of stakeholder representatives to take part in the strategic direction of the network as well as individual HTA assessments.

I believe this is best achieved through the European Commission as Secretariat for the network precisely because the Commission is well-suited to managing stakeholder involvement in networks and expert groups. Its guiding principles and structure also help to safeguard transparency within the network and individual HTAs so that outcomes of joint evaluations can be understood, as well as the reasoning behind why certain technologies are, or are not, available to us in our healthcare system.

Of course, the EU will not be making decisions about which health technologies are reimbursed by Member State health systems, but it does play a very important role in guiding the decision-making processes of Member States on HTA. This is especially important as health systems throughout the EU look at ways to increase efficiency and efficacy of healthcare for all citizens. While HTA has an important part to play in supporting smart decision-making in healthcare, it can only do so via inclusive and transparent processes that ultimately consider all health stakeholders.

EDITORIAL: Delivering positive health outcomes for citizens in 2014

Editorial by HFE President John Bowis 

In 2014, Health First Europe will celebrate 10 years of working to ensure the well-being of European citizens by fostering access to the most innovative technologies to prevent, diagnose, monitor, manage, treat and cure diseases.  Our work this year will continue to build upon our belief that “health is wealth” by aiming for more sustainable healthcare in Europe, supporting patients to seek trusted information, protecting patients in health settings and making innovations in health systems more accessible to patients.

The focus in 2014 will be to take forward many of our previous accomplishments in 2013. For example, we worked towards making accessibility to innovation a key priority of Europe as part of discussions on the medical devices directive, the European Parliament own-initiative report on patient safety, and particularly within our Model for Community Care. We recognise that the demands of patients for healthcare results in greater patient responsibility for maintaining health and well-being, and innovations can play a positive role in developing more efficient, safe and timely care for all of us.

Achieving sustainable health care

Aiming to facilitate these reforms with a long-term view for achieving sustainable healthcare, the model was presented to EU Health Commissioner Tonio Borg on 9 December 2013. Following our fruitful discussions with the Commissioner, Health First Europe will continue to seek collaboration with EU health stakeholders and policymakers in 2014 to foster a dedicated community care policy at EU level. Health First Europe will be focused on showcasing how community care can provide high quality care while supporting individuals with chronic diseases to better self-manage conditions and live independently.

Supporting patients to seek trusted health information

Health literacy and patient empowerment are important European Commission health priorities particularly as part of discussions on chronic diseases and the expansions of eHealth.  Health First Europe believes that patient-focused solutions are the future of healthcare and we are working to encourage initiatives that not only empower patients to manage disease, but also to prevent illness. HFE believes that for patients to be empowered, they first need to have the tools to better understand health information. With this goal in mind, in 2013 Health First Europe developed a Statement on Health Literacy that focused on encouraging patients to seek trusted information about their health in order to foster healthier behaviours.

In 2014, HFE will aim to support initiatives that incentivise citizens to keep track of their health, as well as initiatives that provide accessibility to preventive services (such as screening and diagnostic testing).

Ensuring safety for patients

In 2013, Health First Europe welcomed the adoption of the Own-Initiative Report from Member of the European Parliament Mr. Oreste Rossi (EPP, Italy) which reinforced many of HFE’s recommendations on patient safety such as encouraging Member States to set national reduction targets, to utilise standardised criteria set by the ECDC, provide information to patients on risk and prevalence of HAIs to publicly report annually on HAIs and to foster advanced training of healthcare professionals in HAIs. Following this report, and the activities of Health First Europe, the European Commission launched a public consultation in December 2013 for European stakeholders on patient safety. A second progress report on the implementation of the Council Recommendations on patient safety is expected in April 2014, and Health First Europe will be closely following developments as Member States again report on the steps taken to reduce infection. In 2014, Health First Europe will also continue its participation in the European Network for patient safety and quality care as a collaborating partner.

Making innovations accessible

Health First Europe has been engaged in a continuous dialogue with policymakers on health technology assessment (HTA) since 2010. In 2013, we welcomed the official launch of the permanent European network for HTA as prescribed by the Directive on patient’s rights in cross border healthcare and sought to ensure that the network provides for the meaningful involvement of stakeholders. It is imperative that the network consider stakeholder views on HTA decisions and allow them to be part of the decision-making process for greater transparency and confidence in EU joint assessments. HFE will continue to advance these ideals in 2014 through an ongoing dialogue with the European Commission and the Council.

In our tenth year, we will again aim to encourage truly patient-centric care in all areas of health delivery. This year, as always, we will be working towards increasing positive health outcomes for all of us in Europe.

EDITORIAL: Patients (and their safety) must be beneficiaries of EU health technology assessments

Editorial by HFE President John Bowis

Access for patients to medical technologies is a key issue in Europe right now, particularly due to discussions on changing rules of approval for medical devices as well as the concluding discussions in the European Parliament regarding patient safety in healthcare settings.  Following a market authorisation (drugs) or a CE mark (medical devices and diagnostics), health technology assessments can provide fundamental information of the value of the new technology to support patient access to medical technologies. This process occurs at Member State level and guides decision-makers to choose which products and services to make available in health systems for patients.

Today marks the official launch of the permanent European network for health technology assessment (HTA) as prescribed by the Directive on patient’s rights in cross border healthcare.  The voluntary network aims to support cooperation between Member States on HTA, as well as jointly performing analyses of information to be exchanged, and will help to reduce duplication of assessments in Europe.

I believe this network can provide value to patients and professionals, as well as to Member State health systems. However, the processes governing the network will ultimately determine whether patients will be the main beneficiaries by having access to the most innovative, effective and safe technologies for prevention and treatment of disease. The permanent network will provide the strategic structure to HTA cooperation in Europe, while the Joint Action on HTA “2” will continue contributing the scientific basis for assessments (until 2015).  Yet, many questions remain about how the network will function in practice.

It is my belief that the network must pursue strategic cooperation between Member States that will fundamentally benefit patients and foster equal access to treatments. For example, the information exchanged between Member States must include the patient’s perspective on a new product or service in order to capture the full value of a technology.  Additionally, the inclusion of the patient perspective can only be guaranteed via greater transparency: both stakeholder involvement in assessments and methodologies utilised for each assessment. Making the assessments publicly available must be a component of transparency within the network as well as including an appeals process for stakeholders in the event that a joint/shared HTA may not have fully considered the patient (or other essential stakeholder) perspective.

This next step for HTA cooperation in Europe can offer opportunities for world class healthcare by involving patients, professionals, hospitals, insurers, payers and industry and taking into consideration short and long term healthcare challenges to be addressed.  However, as the network develops further and determines the strategic framework for cooperation, the focus should be on ensuring innovative products and services are, and remain, available and accessible for patients throughout Europe.

EDITORIAL: More needs to be done to protect patients…and we can help

Editorial by David Byrne, HFE Patron

This past week, EU Health Ministers gathered for an informal meeting in Dublin to discuss a variety of health issues, one of which was patient safety. In the context of discussions on the impact of the economic crisis on health systems across Europe, I commend the Irish Presidency for bringing patient safety onto the agenda because economic pressure in EU health systems will certainly impact on the safety of patients. As Health and Consumer Policy Commissioner Tonio Borg stated after the meeting, “Healthcare associated infections are something that we can reverse. 70% of cases could have been prevented with the right measures and while there has been great progress in all Member States, there is still much to be done.”

Prevention of adverse events and healthcare associated infections not only returns patients back to productive living much more quickly, it reduces costs to health systems. The European Commission has estimated that 13-16% of total hospital costs (1€ for every €7 spent) are due to healthcare related injuries and ill health. This estimation does not include the costs for treating the adverse conditions. What is even more troubling is that many of the necessary measures for prevention are already known – such as hand hygiene, surgical check lists and the use of technologies for sterilising rooms and medical equipment. It is clear from the European Commission’s report on Member State implementation of the Council Recommendations in 2009, barriers to implementing patient safety prevention measures persist. Why? And how can the EU and health ministers solve the problem which could save countless patient lives and considerable health care costs?

As Patron of Health First Europe, I believe organisations like ours can help. I believe that by allowing patients, healthcare professionals, hospitals, academics and industry to provide expert knowledge to the European Commission about problems inherent in systems, as well as the known solutions, we can achieve greater safety for all individuals. It is why the European Commission should launch a public consultation on the most recent patient safety report to understand and build upon the knowledge of health stakeholders. In 2008, the public consultation on patient safety resulted in almost 200 responses, providing the foundation for the Council Recommendations in 2009. The EU should continue encouraging Member States to adopt additional practices for the prevention of adverse events and HCAIs and there is little doubt that stakeholders like HFE, can be relied on to contribute to the development of targeted next steps for patient protection.

Challenges for today’s health systems are great and determining how to reduce healthcare costs without reducing care will not be solved just by looking at patient safety measures alone. However, there is significant added value and available cost savings in focusing on protecting patients for the benefit of us all. HFE and our fellow stakeholders can certainly help in achieving that goal.

EDITORIAL: Improving the lives of patients in 2013

Editorial by HFE President John Bowis 

Health First Europe has always believed that by bringing together all health stakeholders, solutions for challenges in healthcare can be found that benefit all patients.  In 2012, we continued in our conviction that together we could better protect patients and improve access to treatment by working with the EU institutions and other EU health stakeholders. This past year, our work on patient safety and health technology assessment (HTA) produced concrete recommendations for policymakers on how the EU can support the improvement and delivery of care for patients.

In 2013, we will not only further our work on patient safety and quality of care, but also expand our issue engagement to look beyond safety and access, to patient empowerment, health literacy and community care.  Encouraging patients to be informed about their care is of great importance as health systems adapt and change to the meet the needs of an ageing population as well as shortages of healthcare professionals and tighter budgets for delivering care.

Protecting patients

In April 2012, the HFE Task Force on Patient Safety launched and validated its recommendations for patient safety and healthcare associated infections (HCAIs) under the Patronage and Sponsorship of MEP Christofer Fjellner at a roundtable of high-level participants. The recommendations not only sought to raise awareness of the importance of quality and safety of care for patients in Europe, but also to guide policymakers as they consider how to improve patient safety in health systems throughout the EU.

Following the publication of the Commission’s report on the Member States’ implementation of the Council Recommendations on patient safety, we organised a follow up debate to discuss the current state of infection control and the next steps for reducing HCAIs in Europe. Though encouraged by the progress achieved by Member States since the adoption of the Council Recommendations in 2009, stakeholders agreed that there is more to be done – specifically in terms of standard setting, targets and comparable reporting systems for infection.

In 2013, we will continue to monitor the developments at EU level following the Commission’s report, calling for a public consultation in order to better understand stakeholders’ views on the implementation of the recommendations. Additionally, we will be furthering our participation in the European Network for Patient Safety and Quality of Care.  We believe that safety and quality must always be at the centre of healthcare delivery and Health First Europe will be at the forefront of ongoing discussions for protecting patients.

Improving access to treatment

Health First Europe has been engaged in a continuous dialogue with policymakers on health technology assessment (HTA) and recently launched its recommendations for policymakers on HTA in November of 2012 calling for more transparency in HTA processes and greater stakeholder involvement. Health First Europe welcomed the provision in the Patients’ Rights in Cross-border Healthcare Directive for a permanent collaborative network for HTA to facilitate knowledge-sharing and cooperation among Member States. However, it is imperative that the network consider stakeholder views on HTA decisions and allow stakeholders to be part of the decision-making process (particularly patients).  HFE will continue to advance these ideals in 2013 through an ongoing dialogue with the Commission and the Council as they formulate the network and prepare for formal launch in September 2013.

Empowering patients: health literacy

Though the European Year of Active Ageing has come to an end, it is important to keep the momentum going and to continue empowering citizens (both young and old) to manage their care so that they can remain independent regardless of their health condition.

Health First Europe is convinced that patient-focused solutions are the future of healthcare and we are determined to ensure that initiatives for empowering patients gain even more ground at the European level. We believe that for patients to be empowered, they first need to have the tools to better understand health information. With this goal in mind, in 2013 Health First Europe shall engage in a project dedicated to health literacy and personalised healthcare plans.

Additionally, in order for patients to be empowered, they must also understand the options available to them to prevent and treat conditions and the Medical Devices Directive will play a significant role in determining information about devices for treatment as well as access for treatment.  As a multi-stakeholder organisation, it is important to have a clear position on the new regulation for medical devices, particularly in terms of how the regulation could impact patients and healthcare professionals.

Caring for patients in the community

Finally, Health First Europe considers that community care is a very important aspect of healthcare which has not yet been fully realised.  Community care can support independent living for patients with chronic diseases as well as encourage self-management of conditions.  Caring for patients in the community can also ease the burden on health systems, re-focus drivers of healthcare towards prevention rather than treatment, and provide patients with greater quality of life.  In 2013, Health First Europe will look to develop a horizontal model for community care which could be used by Member States to treat patients with chronic conditions.

This year as every year, Health First Europe will continue to raise awareness about the issues most important to patients and together with policymakers and stakeholders, look to provide solutions that can facilitate the improvement of healthy living for all European citizens.

EDITORIAL: The International Alliance of Patients’ Organizations (IAPO) sets up Non Communicable Diseases and Patient Safety as global health strategies

In the run up to the United Nations (UN) “High-level Meeting of the United Nations General Assembly on the prevention and control of non-communicable diseases” also known as the UN Summit on NCDs the International Alliance of Patients’ Organizations (IAPO) has been carrying out a number of activities to ensure that there is a strong patient voice in the development of strategies to fight NCDs.

The Summit will take place on 19-20 September 2011 in New York, USA and will bring together Heads of State and Government to discuss the issue. It is expected that the Summit will focus on initiating and strengthening action at global and national levels to halt and address the health and socio-economic impact of NCDs through multi-sectoral approaches. It is also expected that the Summit will generate global commitment and momentum to implement the World Health Organization (WHO) Global Strategy for the Prevention and Control of Non-communicable Diseases (NCDs) and its related Action Plan.

NCDs are the leading causes of preventable morbidity and disability, and currently cause over 60% of global deaths, 80% of which occur in developing countries. By 2030, NCDs are estimated to contribute to 75% of global deaths.[1]The World Health Organization defines NCDs as cardiovascular diseases, cancers, respiratory diseases and diabetes. These diseases are connected by four common modifiable risk factors: tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. In discussions with many of IAPOs members, there was concern that by WHO limiting the definition to four disease areas, the conditions they represent will become less of a priority for decision-makers. IAPO will continue to advocate to WHO for a continued focus on chronic conditions more broadly and in particular, to include the patient voice in its work and hope to increase opportunities for IAPO members to engage with WHO in this area. Alongside IAPO, many IAPO member organizations will also be present at the Summit[2].

IAPO continues to advocate for appropriate focus on all chronic conditions with WHO, it also recognises the particular opportunity that the Summit presents to secure global commitment to a plan of actions and set of indicators that can lead to real improvement for all patients. Therefore, IAPO will also strongly make the case for a patient-centred approach and for securing wider commitment to ensure that chronic conditions are addressed while not undermining the opportunity to have, for the first time, high-level global commitment to addressing the NCDs identified by WHO.

Previous meetings of this nature have led to coherent strategies for action, secured pledges of financial commitment and political support and provided a stage for international advocacy. Therefore, some of the key asks from IAPO are that policies and activities must be patient-led i.e. designed in consultation with affected communities according to local priorities. Additionally the Summit needs to ensure the success of the implementation of the WHO Global Strategy for the Prevention and Management of NCDs is measured on its contribution to strengthening health systems in terms of chronic disease.

The NCD Alliance is a group of four NGOs representing the four disease areas identified as NCDs by WHO. They are the: International Diabetes Federation (IDF); International Union Against Cancer (UICC); World Heart Federation (WHF); and International Union Against Tuberculosis and Lung Disease. They are calling for:

1.     Governments to be accountable and measured on NCD plans

2.     Framework Convention on Tobacco Control (FCTC) to be fully implemented

3.     A global commitment to prevent the preventable

4.     Globally agreed approaches to NCD treatment and care

5.     Resources to deliver NCD interventions

6.     NCDs in the MDG successor goals

IAPO is a member of the NCD Alliance’s Common Interest Group and supports its position. In addition IAPO is working to ensure that the outcomes of the Summit lay the foundations for a wider approach to preventing and managing chronic disease that is patient-centred. IAPO believes that this is the best way to serve its members on this issue.

In the past year IAPO has conducted a number of activities to ensure that key messages on patient-centred healthcare systems are heard in the build up to and during the UN Summit. These include capacity building with members in Africa as part of a regional network meeting, facilitating patient engagement in the WHO global forum: Addressing the challenge of NCDs, interventions and a side meeting at the 64th WHO World Health Assembly and participation at the UN Informal Interactive Hearing on Non-communicable Diseases. In these activities, IAPO continues to call for the following actions:

  • Ensuring the WHO Global Strategy for the Prevention and Management of NCDs is implemented equitably to prevention, diagnosis, treatment, care and support. That the important focus on four diseases is not achieved to the detriment of all chronic diseases.
  • Ensuring effective implementation as measured by strengthening health systems.
  • Ensuring that the patient voice and perspective are solicited and actively engaged in the design, leadership, implementation, monitoring and evaluation of effective and sustainable interventions to prevent and manage all NCDs.
  • Ensuring that patients’ organizations have an active role in the development, implementation, and monitoring of legislation, health policies, regulatory frameworks, strategies, guidelines, and standards for NCD prevention and management.
  • Committing to a plan of improvements in health literacy.
  • Increasing research on the prevalence and incidence of NCDs and their impact on the lives of patients, families and their caregivers.
  • Promoting early diagnosis and treatment to reduce morbidity and mortality and improve quality of life.
  • Ensuring all policies, programs, and strategies are based on the fundamental right to patient-centered healthcare based on unique needs, preferences and values, as well as patient autonomy and independence.

For people living with NCDs, patient safety is a serious concern. People with NCDs may regularly be admitted into hospital where patient safety issues such as the threat of medical error or healthcare associated infections are an issue. They may also take medicine on a long term basis and need to take these correctly in order to be safe and effective. Therefore, it is crucial that there is a global commitment to improving health literacy and that patient safety issues such as these are considered when strategies are developed in order to effectively reduce the medical burden of NCDs.

An example of IAPO’s work in this area is Patients for Patient Safety (PFPS) which is an innovative model which is the patient-led action area of WHO Patient Safety.  IAPO has been on the Steering Group of PFPS since its launch in 2004. This initiative is developing and coordinating patient involvement in the WHO’s patient safety work to bring the patient voice to global initiatives.  In parallel it is supporting the development of a base of patient advocates skilled to participate in safety related health policy initiatives.

In order to effectively tackle NCDs, and to meet the needs of patients worldwide there needs to be increased patient engagement and a broad multi-stakeholder commitment to the recommendations made by patients and patient groups worldwide.

[1] WHO Moscow Declaration: http://www.who.int/nmh/events/moscow_ncds_2011/conference_documents/moscow_declaration_en.pdf

[2] IAPOs membership is made up of groups representing many disease areas that IAPO and other stakeholders have in the past also considered as ‘non-communicable’, a term which has been used interchangeably with ‘chronic disease’ and ‘long-term condition’.

EDITORIAL: Honorary President of HFE, John Bowis, highlights effective solutions to prevent HAIs – They’re out there!

Though we live in countries with well-funded and advanced healthcare settings, we all know that receiving medical treatment inevitably carries risk with it. However, less is known about the procedures in place to minimise the risk of adverse events. Should I be scared to enter a healthcare setting? How do I know if the hospital where I am treated has a procedure in place to minimise risk so that it is not complicated by an infection?

The issue of patient safety, as a critical component of the quality of healthcare, is of considerable significance to me as a former Minister of Health, a former Member of the European Parliament and most importantly, as a patient. In my role as Honorary President of Health First Europe, I continue to encourage Member States and EU institutions to find avenues to ensure the patient is capable of choosing where his/her treatment can be best acquired so that fear of medical procedures is reduced and risk is minimised.

Too often, patients enter care settings unaware of possible adverse events that may occur during a hospital stay. Healthcare Associated Infections (HAIs) are all too frequent and are one of the most prominent reasons for failure of advanced medical treatment. I still find it hard to believe that between 8% and 12% of patients are harmed while receiving healthcare, even in today’s well-funded and technologically advanced settings. An estimated 4.1 million patients in the EU will contract an infection while being treated, causing considerable increases in illness, mortality and costs. They magnify the burden on medical staff, payers and employers, with the largest burden falling on the patient. They cause further time away from work and increase the burden on healthcare systems and the economy – both in terms of productivity lost and additional services required. Moreover, there are too many instances in which HAIs could easily have been prevented. Proper hand hygiene can most certainly have an impact, but there are numerous other methods which contribute to effectively reducing HAIs and can decrease the suffering of patients and healthcare professionals in Europe. What are we waiting for? Why don’t we embrace them?

I believe that in order to enshrine safety for patients in both the hospital and homecare settings, Member States must define strategies for the reduction of HAIs within their health policy. This includes determining the continuous training and education of medical professionals and increasing the access of innovative medical technologies which are especially designed to reducing the risk of infection. The medical technology industry is continuously discovering new ways to deliver effective treatments which reduce the human error and, therefore, limit the chances of infection. These include antimicrobial coatings, ‘closed’ catheterisation systems which minimise the opportunities for bloodstream infections, highly efficient surgical site barriers and dressings, and needlestick prevention mechanisms. Additionally, effective rapid screening technologies, monitoring systems to identify and limit the spread of infections, and diagnostic systems to ensure appropriate targeted usage of antibiotics can play a vital role.

However, policy must develop with technology. The EU is playing a role in encouraging the adoption of measures to develop national policies which include reporting systems for HAIs (as part of the Council Recommendations on Patient Safety 2009) and is facilitating the uptake of medical technology through the Innovation Union (under the Europe 2020 Strategy). Yet, both programmes fall short of demanding concrete, quantifiable measures for the reduction of HAIs and specific benchmarks for monitoring the uptake of medical technologies that assist in HAI reduction.

As both a patient and a policymaker, I feel strongly that statistics on the incidence of HAIs and the availability of technologies for patients must be readily available to patients, allowing them to be assured that they will receive the best quality of care. Every single patient, myself included, deserves the peace of mind of knowing that, when entering a hospital or any other healthcare setting, they will be safe from entry to exit.

John Bowis

EDITORIAL: The contribution of HFE to policy-making in 2011

Editorial by HFE President John Bowis 

At Health First Europe, we believe that “Health equals wealth.” We believe that investment in the healthcare systems throughout Europe will contribute to a more efficient, effective and productive society. And we believe that citizens must have access to the innovations that are a result of that investment in health. That is why every year we devise a working programme which enlists us to undertake specific awareness raising campaigns and events which further these beliefs based on the agenda of EU policymakers. We use our working programme to make a real difference in the lives of patients – which in essence, is each and every one of us.

2011 is no exception and Health First Europe endeavours to engage with policymakers on some of the issues most pressing to patients. Our working programme consists of four themes: e-Health, patient safety, Health Technology Assessment (HTA) and the Innovation Partnership on Active and Healthy Ageing. These four themes append the continued work of the EU institutions and aim to demonstrate where the collective voice of patients, healthcare professionals, experts and industry is lacking.


Regarding e-Health, Health First Europe will advance the recommendations encompassed in our “E-Quality in E-Health” publication. Our recommendations look to establish the strongest demands of our members from each health constituency perspective. The EU continues to devise ways to further the uptake of e-Health products and services through the e-Health Action Plan and through the Innovation Partnership on Active and Healthy Ageing. At the same time, we look to contribute our ideas as to how the patient, healthcare professional and industry can be better equipped to face the current barriers in the e-Health domain.

Patient Safety

Additionally, Health First Europe will be looking to policymakers to determine more stringent guidelines following the review of the Council Recommendations on patient safety including the prevention and control of healthcare associated infections. Health First Europe will be forming a Task Force to determine the next steps on patient safety in conjunction with the European Commission’s review of the Member States’ implementation of the recommendations from 2009.

Health Technology Assessment (HTA)

More and more Member States are turning to HTA as a means to determine which innovative products and services should be allowed on the market. Though the process is intended to safeguard the patient, many times HTAs inevitably reduce the ability of patients to access technologies which could ease their afflictions. In order to ensure that the determinations of HTAs are well-founded, Health First Europe will look to encourage further transparency of HTAs and increased stakeholder involvement in the HTA process.

Innovation Partnership on Active and Healthy Ageing

The European Commission has set out to extend healthy living years of European citizens by two years by 2020 under its EU 2020 strategy. The Innovation Partnership on Active and Healthy Ageing is the first pilot partnership to be undertaken as part of the Innovation Union under this strategy and it began with a consultation for stakeholders in January 2011 to which HFE contributed. As the partnership evolves with a Steering Committee and a strategic implementation plan, Health First Europe will participate in the process by sharing our ideas about how to utilise innovative programmes and technologies to increase healthy living years for European citizens.

Our four themes for this year highlight the type of work Health First Europe has pursued every year since we were established in 2004. We regard investment in health as the cornerstone of a sustainable Europe and we look for ways to assist policymakers in achieving that goal. Afterall, the “wealth” Europe wants to achieve as a society, can only be attained with the advent of “health” for those assisting in that achievement. Health truly does equal wealth.

EDITORIAL: Europe gets serious about minimizing needlestick injuries

More than one million needlestick injuries are suffered in Europe each year. New legislation was recently passed by the EU to protect Europe’s healthcare workers from potentially fatal blood-borne infections such as HIV and hepatitis B and C, resulting from injuries with used needles. Here, John Bowis, Health First Europe (HFE) Honorary President and former UK Minister of Health and MEP, comments on the new directive and its significance to paramedic practice.

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EDITORIAL: HFE Statement on the Seventh Framework Programme (FP7)

HFE welcomed the Commission’s points to:

  • Increase co-operation between Member States to promote research excellence
  • Augment investment in the EU budget allocated to health
  • Use of open method of co-ordination as a mean to maximise the practical benefits, good ideas and innovation across the EU.

Nevertheless, HFE stressed that the research, development and provision of innovative medical technology solutions can play a critical role in meeting the competitiveness goals of the Lisbon agenda, and therefore should not be sidelined when discussing the details of the Commission’s Programme. Thus, HFE called for further focus on medical technology innovation as a policy objective.

Moreover, the letter to the Rapporteur highlighted the support for education and training of healthcare workers, and tackling of administrative barriers with respect to proposal evaluation, training and funding opportunities currently hindering medical innovation and research.

EDITORIAL: International Day of Disabled Persons – Health First Europe urges the EU to speed up integration for disabled people!

For over a decade now, the 3rd of December, the “International Day of Disabled Persons” has served as a reminder of the challenges on the way towards full integration of persons with disabilities, in a political as well as social and economic context. The Day also offers an opportunity to consider progress in terms of political participation, socio-economic integration, access to treatments and assistive technologies as well as general awareness of disability issues.

According to the European Commission, approximately 38 million people in Europe today have a disability, representing some 10% of the total EU population. Among the working-age population (those aged between 16 and 64) in the EU, 16.4% – one in every six – report a long standing health problem or disability. Moreover, labour force participation is particularly low for the severely disabled persons: 78% of the very severely disabled, and 49% of the severely disabled persons in the EU were inactive in 2002, against 27% for the non-disabled. Yet, the European Commission estimates that between 2 and 3.5 million people with disabilities could be (re)-integrated into the EU workforce.

As these figures clearly demonstrate, the inclusion of people with disabilities is an issue of concern for the whole of society. Health First Europe (HFE) agrees with the European Commission that eliminating barriers to the labour market and providing disabled persons with equal opportunities has an important untapped potential for economic growth. HFE calls on EU Member States to support the European Commission in creating the necessary conditions for equal participation, referring in particular to the UN’s Standard Rules on Equalization of Opportunities for Persons with Disabilities that offer guidelines for a broad, inclusive policy agenda. According to these Standard Rules, necessary preconditions of equal participation require awareness-raising in society, the provision of effective medical care and of rehabilitation services and the development and supply of support services, including assistive devices.

Health First Europe (HFE) generally shares and welcomes the European Commission’s participative approach to dealing with disability issues taken in its 2003 Action Plan, published at the close of the European Year of People with Disabilities . With the view of providing a framework for the mainstreaming of disability rights and issues into relevant Community policies in an enlarged Europe, the European Commission proposes an action plan that foresees the involvement of stakeholders and focuses on employment as a critical factor for social inclusion. HFE warns that major disparities still exist between Member States and even within individual Member States and urges European policymakers to continue their co-operation to ensure broad public awareness of disability issues, the consideration of disability requirements in the development of products and services and equitable access for each European citizen to the best treatment appropriate to his or her medical condition.

“We agree with the vast majority of Europeans who think that more should be done to integrate people with disabilities into society. It is the responsibility of each of our governments to ensure that persons with disabilities may exercise the same rights and obligations as others and it is the task of the European Commission to provide the necessary regulatory framework. Equitable and timely access to treatments and appropriate technologies certainly can reduce or prevent disabilities and help people with disabilities to live and work on an equal footing with the non-disabled. But full integration of disabled persons in every aspect of social, economic, political and cultural life is only possible through a change in attitudes, consultation with disabled persons’ organisations and putting in place stronger anti-discrimination legislation”, said Imelda Read, Honorary Chairperson of Health First Europe.