1. Quality of Healthcare in Europe Royal College of Physicians London Council Chamber 19 January 2009 Robert Madelin Director General for Health and Consumers European Commission

2. 2 of 26 Quality challenges Multitude of definitions Differences in scope of quality action across Europe Different levels of political commitment Significant disparities in quality strategies Lack of clear and transparent information Lack of comparable process and outcome data

3. 3 of 26 European Union today 27 countries 493 million citizens Health sector: Total expenditure on health: 8.2% of GDP (OECD 2006) Employer for 10% of the EU workforce (with 70% of budget allocated to salaries and other charges)

4. 4 of 26 But European Union today = major differences between MS … … in health status All the data 2006 except IT and EU-25 2005

5. 5 of 26 But European Union today = major differences between MS … … in health status Source: EUROSTAT Standardised death rate by 100 000 inhabitants

6. 6 of 26 But European Union today = major differences between MS … Cervix uteri cancer Adults diagnosed 1990-1994. Source: EUROCARE-3 Breast cancer … in effectiveness of healthcare systems

7. 7 of 26 But European Union today = major differences between MS … … in effectiveness of healthcare systems Source: EC Report on Implementation of the Council Recommendation of 2 December 2003 on cancer screening

8. 8 of 26 Role of the EU: Improving public health Community action in the field of public health shall fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care. The Community shall encourage cooperation between the Member States ---- and ---- lend support to their action.

9. 9 of 26 Role of the EU: Abolition of obstacles to the free movement of goods, persons, services and capital In the health area: Free movement of goods (pharmaceutical products) Free movement of health profesionals Free movement of patients

10. 10 of 26 Role of the EU: Contributing to the economic development and sustainability of health systems (Lisbon Strategy for Growth and Jobs) Sustainability of health systems is one of three priorities of the current Czech Presidency

11. 11 of 26 Common values and principles of EU Member States (2006) universality access to good quality healthcare equity solidarity

12. 12 of 26 Together for Health (2007) Strategic objective 3: Supporting dynamic health systems and new technologies Commission action : Community framework for safe, high quality and efficient health services

13. 13 of 26 Patient- centered care Good quality healthcare for patients Coordination and continuity of care Comparable health data Safety and quality standards Information for patients Well trained professionals Attention to natural caregivers Research Geographica l and financial access to care Effective healthcare system

14. 14 of 26 Europe for Patients to inform what is done to improve healthcare for all in Europe to encourage sharing information by opening the webpage to citizen contribution

15. 15 of 26 Current initiatives I Proposal for a Directive on the application of patients' rights in the cross-border healthcare. (Adopted 2 July 2008) Commission Communication and Council Recommendation on a European action in the field of rare diseases (Adopted 11 November 2008) Green paper on the European Workforce for Health (adopted 10 Dec 08) Action against cancer: European Platform and Report on implementation of the Cancer Screening Recommendation of 2003 (Done 22 December 2008)

16. 16 of 26 Current initiatives II Commission Communication and Council Recommendation on patient safety including the prevention and control of HCAI (adopted 15 Dec 08) Proposal for a directive setting standards of quality and safety of human organs intended for transplantation (adopted 8 Dec 2008) Council recommendation on cross-border aspects of childhood immunisation (due 2009) Prudent use of antibiotics 2 nd report from the Commission on the implementation of the Council recommendation. (Due 2009) European Antibiotic Awareness Day, 18 November 2008. Managed by ECDC

17. 17 of 26 Patients' Rights I Aims of proposed directive: Helping patients to exercise their right to access cross-border healthcare and to be reimbursed. Ensuring safe and high quality cross-border healthcare. Fostering cooperation between EU healthcare systems where useful.

18. 18 of 26 Patients' Rights II Major improvement for individual patients No significant impact on national healthcare systems A number of safeguards to ensure fair, equitable and sustainable system European cooperation helping to improve quality and safety for all in the long-term

19. 19 of 26 Challenges facing European health & care systems – ageing population; ageing workforce; Threats to health New technology Ever-rising expectations and rising costs Health services labour intensive – regional shortages of personnel Responding to challenges requires high- quality health workforce throughout EU without impacting on developing countries Workforce I

20. 20 of 26 Green Paper published on 10 December 2008 Public consultation until end March 2009 Responses will inform consideration of what EU can do to support Member States in tackling the health workforce challenges facing European health systems now and in the future Workforce II

21. 21 of 26 Overarching approach to patient safety: Communication and proposal for a Council Recommendation on patient safety, including prevention and control of healthcare-associated infections. Patient Safety I

22. 22 of 26 Develop national patient safety policies and programmes. Empower and inform citizens and patients. Establish or strengthen reporting and learning systems on adverse events. Include patient safety in the education and training of health professionals. Develop and promote research on patient safety. Classify, codify and measure patient safety. Share knowledge, experience and best practice at European level. Patient Safety II

23. 23 of 26 What next? The proposal for a Council Recommendation is transmitted to the Council for discussion in CZ Presidency. Adoption 2009 Member States to report within 2 years to the Commission on how they implement the Council Recommendation. One year later, the Commission will produce an implementation report to the Council. On HCAI, the ECDC will assist Member States, e.g. by developing guidance, by helping to set up or further strengthen surveillance systems. Patient Safety III

24. 24 of 26 Other EC initiatives Standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components Standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells OECD project, co-funded by EU, on quality indicators of health care The Open Method of Coordination Pharmaceuticals package

25. 25 of 26 Working Party on Public Health at Senior Level met on 9 December to discuss added value of possible EU action in healthcare quality Member States agree: that quality is an important wide-ranging issue; key to improving health systems, linked to patient safety, technology assessment to take forward work at EU level e.g. to exchange good practice/set indicators to compare and measure progress to develop specific action using Commission’s working group on patient safety and quality Common reflection of MS and EC

26. 26 of 26 Thank You!