Hans Kluge: Trends in social and health system reforms in europe

Social and health care at a turning point from Paris to Pelkosenniemi19 November 2015

Social and health care at a turning point from Paris to Pelkosenniemi Helsinki, Finland, 19 November 2015

Trends in social and health system reforms in Europe

Dr Hans KlugeDirector, Division of Health Systems and Public Health


Table of Contents

1. Challenges and opportunities

2. Priorities in Health System Strengthening 2015-2020

3. Health Service Delivery Reforms


Health Security


SDR for NCDs per 1000 000 people aged 30-69 years in the WHO European Region, 1997-2012

Age-standardized death rate per 100,000 in people aged 30-69 for cardiovascular diseases, cancer, diabetes mellitus and chronic respiratory diseases combined.


Life expectancy at birth and overall life satisfaction (2014 data); measuring well-being


Governance

Resourcing

Financing

Services delivery

Health systems: an adaptive platform for new challenges and innovative solutions

CHALLENGES INNOVATIONSEpidemiological

burden

Populationageing

Financial & environmental constraints

Cultural paradigms

Innovative health technologies

Redesignedmodels of care

Repurposed workforce competences

Revised accountability arrangements

Realigned incentives mechanisms


Alma-Ata Declaration; Ljubljana Conference on Reforming Health Care

1978-96

World Health Report – Performance Health Systems

2000

Health in All Policies Prospects and potentials

20062008-2013- 2015

Tallinn Charter:

Oslo conference: Impact of crisis

2009 & 2013

2012

Health 2020

2012Malta:

Public health action plan

2012UNGA resolution on

Universal health coverage

2015

Priorities for health systems strengthening in the WHO

European Region


Transforming our world:The 2030 Agenda for Sustainable Development


People Centred Health systems: starting from the values

Boosting health inform

ation


The Highland Region integrated care project


The Highland Region integrated care projectGoal To strengthen improve health of adults and children through the alignment of social and health care services to better meet

population needs.

Aims

Coordination: strengthening the flow of patient information between social care and health care sectorsComprehensiveness: introduce multi-disciplinary team that provide the patient with needed health and social careQuality: increase the quality of health and social care provided to patientsAvailability/accessibility: stratify population based on age ( e.g. adult and child) rather than by type of care, co-locating social and health services, increasing responsiveness to patient needs

Targets Reduction in the number of unnecessary/duplicated tests

Location Highland region, Scotland, United Kingdom

Target pop Care seeking populations within the region, both adults and children

Leader NHS Highland – Chief Executive Officers

Actors Scottish Government; NHS Highland and Highland Council; Care providers working in both the NHS Highland and the Highland Council

Funding Pooled existing budgets and reallocated for services.

Before After

Model of care Health care services are provided by the NHS while the Highland Council is responsible for social care elements. Health services had been integrated in the 1990s, with an emphasis on shifting services into the community. There is overlap between care being delivered by both the NHS and the Council, often unaware of what interventions patients and finding there was much overlap between social care and health care services.

Health and social care services are now stratified based on age rather than by type of care being provided. Social and health services have now been integrated with the continuum of care now extending to include social sectors. One organization now manages adult care, NHS, with the Highland Council now responsible for the service planning and delivery of children health and social care. Care is still designed using the community model.

Organization of providers All health care providers work in separate organizations from social care workers, regardless of whether they are in acute settings or delivering community care. Information between social care and health settings is often fragmented though it is dependent on individual practices. Both social care and health workers maintain misconceptions about the care delivered by the other profession, often leading to duplications or missing services.

Health and social care providers of adult and child care were brought under one organization. Social care providers have been integrated into traditional health practices both within the community and in acute centres. Professional contracts have been changed between organizations to enable this integration. Providers now possess a better awareness of the other, while reducing overlap and maximizing each other’s scope of practice.

Continuous performance improvement Following the implementation of the Joint Future legislation the government realized that the outcome measurement was important and so began evaluating outcomes and cooperation between the two services.

A needs assessment to better understand future care demands allowed for the creation of these services. Training was provided informally through the dissemination of information and shadow learning, and reporting on leadership lessons and evaluations was against set performance indicators.

Management of services delivery

Management of health care services was the responsibility of the Highland NHS and social care the Highland Council. Individual budgets for each are allocated from central government funds each organization for which they are responsible for spending.

Management over adult care is provided by the NHS and children’s care provided by the Council. These two organizations receive funding from the Government to provide care.


Prudent health care in Wales

“You can think of the NHS as an escalator, on which we are always pushing people up the levels of intervention and somehow the higher up you go, the more prestigious it becomes and the more you feel you’ve gotten something good out of the health service. Prudent medicine is all about reversing that escalator. It is about saying the more we can do at a primary care level, the more we can do at the population level and the more we can do at the citizen level, the better service we can provide to our patients.” Professor Mark Drakeford, Minister for Health and Social Services


Acute care services:

from hospitals to homes in Ireland

Advanced nursing roles for disease prevention services in

Samara, Russia

Healthy lifestyle clinics in Lithuania,

Norway & Malta

Multi-professional

group practices in France

Integrating nutrition

programmes in primary care in Kyrgyzstan

Tele-homecare for COPD services in Denmark

Transforming services delivery: initiatives from

across the Region

Acute care services:

from hospitals to homes in Ireland

Advanced nursing roles

for chronic care , Finland

Healthy lifestyle clinics in Lithuania,

Norway & Malta

Multi-professional

group practices in France

Integrating nutrition

programmes in primary care in Kyrgyzstan

Tele-homecare for COPD services in Denmark


Rolling-out programmes beyond

their original sites

Over-coming professional

hierarchies for coordinated practices

“Getting others on board took longer than we originally

expected”

Payment of providers

incentivizing old model of care

Time and capacity to tailor guidelines and

protocols to individual needs

Passive culture to informing patients and engaging in

decisions

Managerial authority and capacity sub-

nationally to oversee implementation

Out-dated protocols and clinical guidelines

Time constraints and resources to inform the public

Institutional arrangements incongruent to changes put

in place

Sub-optimal access

to essential medicines

for selected services

Measuring performance:

“To win an enemy we have to know him

first”

Lack of mechanisms for measuring and

reporting on performance

Sustaining new health workforce

competencies overtime

Ad-hoc Provider

trainings

Lack of long term funding

to for up-keep of new technology

Reporting on impact

and feeding back on results for

scale-up

Incongruent information systems restricting the flow of

information

What are the challenges to transform services?

Rolling-out programmes beyond their original sites

Sustaining new health workforce

competencies overtime

Measuring performance:

“To win an enemy, we

have to know him first”

Managerial authority and capacity sub-nationally to

oversee implementation

“Getting others on board took longer than we

originally expected”


PeopleThe population and individual health needs the health system aims to serve.

A framework for transforming services delivery: four principle domains

Health services delivery Transforming the processes of services delivery to respond to priority health needs. Health system Aligning health system functions of governing, financing and resourcing with services delivery transformations.

ChangeManaging the process for sustainable changes at scale.

PEOPLE


3 2

1

Sequencing transformations: phases and areas for action

Strategizing change with

people at the centre

Piloting transformations

Scaling-up system wide

change


Source: WHO Regional Office for Europe. (2013). Strengthening people-centred health systems in the WHO European Region: a roadmap

EvidenceDescribing and documenting first-hand experiences from across all Member States

NetworksDeveloping a network of Member State focal

points, experts, associations on integrated health services across the Region

Capacity building Courses, conferences, tools, for putting findings into practice

Concepts Consolidating and aligning existing concepts on health services delivery applyingsystems-thinking

Response of the Regional Office: launch of Roadmap to developing a Framework for Action


PHAME Project

Hans Kluge: Trends in social and health system reforms in europe

Health & Medicine

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