Polityka zdrowotna na poziomie Unii Europejskiej Agnieszka Daval-Cichon Health Strategy and Health Systems Unit Bruksela, 28 marca 2011

Dzisiejsza Unia Europejska 27 krajów ~500 milionów obywateli 27 systemów ochrony zdrowia

Strategia dla Europy: wyzwania Przeszczepianie narządów, krew, tkanki i komórki Farmaceutyki Urządzenia medyczne Bezpieczeństwo żywności Inwestycje zdrowotne poprzez fundusze strukturalne Finansowanie projektów Działania międzysektorowe Powiększanie EU Zwiększające się różnice zdrowotne Starzejące się społeczeństwo Zmiany klimatu, zagrożenie pandemiami i bioterroryzmem Choroby związane z trybem życia Migracje& Transgraniczna opieka zdrowotna Nowe technologie i innowacyjność Globalizacja Bezpieczeństwo Obywatele pragnący większej kontroli Informacja zdrowotna i Portal zdrowotny ECDC Współpraca z WHO In order to implement the health article, we have set out an overall Community health strategy ”Together for Health” (COM(2007)630 of 23 October 2007). This slide sets out some of the key issues – and then outside those, some of the elements of Community action in response. The strategy aims to bring all of these elements together into a coherent structure. Biała księga żywienia Komunikat w sprawie alkoholu Strategia kontroli palenia tytoniu Forum farmaceutyczne Prawa pacjenta w transgranicznej opiece medycznej

Polityka zdrowotna w traktatach unijnych Traktat z Maastricht podpisany w lutym 1992 r. podkreślił znaczenie zdrowia publicznego w UE Art. 152 (129): Przy określaniu i urzeczywistnianiu wszystkich polityk i działań Wspólnoty zapewnia się wysoki poziom ochrony zdrowia ludzkiego

Nowe elementy w Traktacie Lizbońskim (Art. 168)‏ Możliwość ustalania standardów dla produktów leczniczych i wyrobów medycznych Wzmocniona koordynacja działań na rzecz zdrowia: ustanawianie wytycznych, wskaźników, ułatwianie wymiany doświadczeń, również w dziedzinie monitorowania i oceny Zachęta do ścisłej współpracy między Państwami Członkowskimi w dziedzinie usług zdrowotnych w celu zwiększenia ich komplementarności w regionach przygranicznych Działanie na rzecz ochrony zdrowia publicznego w związku z tytoniem i nadużywaniem alkoholu

Wspólne wartości, wspólna strategia Konkluzje Rady w sprawie wspólnych wartości i zasad systemów opieki zdrowotnej Unii Europejskiej (2006/C 146/01): powszechność, dostęp do wysokiej jakości opieki, sprawiedliwość oraz solidarność Razem na rzecz zdrowia: strategiczne podejście dla UE na lata 2008-2013

Europejska Strategia dla Zdrowia 2008-2013 Cztery zasady działania: Strategia oparta na wspólnych wartościach « Zdrowie – nasz największy skarb » Zdrowie we wszystkich obszarach polityki Ochrona zdrowia w skali światowej Trzy cele strategiczne: Propagowanie zdrowia w starzejącej się Europie Ochrona obywateli przed zagrożeniami Wspieranie dynamicznych systemów zdrowotnych i nowych technologii

Europa dla Pacjentów Kampania informacyjna wylansowa we wrześniu 2008 Dostępna w 22 jezykach Obecnie 12 inicjatyw

Inicjatywy Transgraniczna opieka zdrowotna Choroby rzadkie Pracownicy sektora opieki zdrowotnej Bezpieczeństwo pacjentów Dawstwo i przeszczepy organów Partnerstwo europejskie na rzecz walki z rakiem Szczepienie przeciwko grypie Racjonalne stosowanie antybiotyków Zdrowie psychiczne Szczepienia w dzieciństwie Choroba Alzheimera i inne odmiany demencji Produkty farmaceutyczne

Dlaczego bezpieczenstwo pacjentow?

Evidence 8 - 12% of patients admitted to hospital in the EU suffer from adverse events whilst receiving healthcare; much of the harm to patients is preventable Healthcare associated infections Medication-related errors Surgical errors Medical devices failures Errors in diagnoses Failure to act on the results of tests Source: European Commission

Patients’ experience 25% of respondents to EU survey say they or their family experienced an adverse event with healthcare Source: Special Eurobarometer 327

Citizens’ perception Half of respondents to EU survey feel they could be harmed while receiving healthcare 69 i 67 % w Polsce Source: Special Eurobarometer 327

What EU response?

Collective work Setting up a working group on patient safety; 3-4 meetings a year Role in preparation of the recommendations Composition of the working group : EU Member States EFTA Council of Europe, WHO, OECD European associations of patients, doctors, pharmacists, nurses, managers

EU policy Commission Communication (2008) and Council Recommendation on patient safety, including the prevention and control of HCAI (2009)

Financing EU co-funded European network on patient safety 2007-2010 Aim: to establish an umbrella network of EU Member States and EU stakeholders to encourage collaboration in the field of patient safety

Financing Network of National PS Platforms Good Medication Safety Practices in Europe Guidelines on Patient Safety Education and Training Compendium of good practices in patient safety http://www.eunetpas.eu/

Financing 38 research projects focused on patient safety and quality of healthcare recently co-funded http://cordis.europa.eu/home_en.html

Council Recommendation on patient safety What’s in it?

Council Recommendation Composed of two parts: General patient safety issues (seven recommendations) Prevention and control of healthcare associated infections (two recommendations) http://ec.europa.eu/health/patient_safety/policy/index_en.htm

General patient safety issues: Action for Member States Support the development of 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

General patient safety issues: Action for the EU Classify, codify and measure patient safety Share knowledge, experience and best practice at European level Develop and promote research on patient safety

Prevention and control of healthcare associated infections Adopt and implement a strategy at the appropriate level for the prevention and control of healthcare associated infections (six objectives) Consider setting up an inter-sectoral mechanism for the coordinated implementation of the strategy Implementation by the ECDC

Implementation Progress report from Member States - June 2011 Report by the Commission – due in June 2012 Further steps after 2012 if necessary 25

What next? ?

From patient safety to wider quality of healthcare Main discussion points: What has been already done at EU level in the field? Which dimensions of quality should and could be addressed at EU level? How to ensure patient empowerment and professional involvement? MSs will face different challenges when attempting to implement the Recommendation. The WG can be a good forum for exchange on those challenges and how some MSs have overcome them. For some MSs, this will mean new financial pressures. I would encouarge MSs to look to the possibility of using EU structual funds in some cases. I know that Paul and the EFN have already been giving this much thought and have been engaging with their members on possible uses of structural funds for pateint safety. The WG will have a key role to play in the implementation of the EU level actions of course. To test citizens’ perception of patient safety in their MS, we are shortly going to launch a Eurobarometer survey which will capture public opinion those aspects of the recent Recommendation that are patient-facing. It is intended to run a similar survey after the implementation deadline has passed to test if things have changed for citizens. The Commission will continue to engage in and monitor EU and international work in relation to patient safety taxonomies and indicator sets, by organisations such as WHO and OECD, and bring those issues back to future meetings of the WG. EUNetPaS will finish its work next year too. How can we sustain EU joint efforts at the more technical and delivery-focussed levels, to complement the work of this WG? EUNetPaS II? A joint Action between the Commission and MSs like is being set up for HTA? There are a number of options open. Indeed we had some very preliminary informal discussions about a possible joint action with Jean earlier today.

How? Joint Action on Patient Safety and Quality of Healthcare Joint Action means a collaboration between the Commission and Member States under co-financing by the Health Programme

Main objectives of the Joint Action To contribute to the implementation of the Council Recommendation on patient safety To establish collaboration among Member States on aspects of quality of healthcare To promote collaboration among Member States on patient involvement/empowerment, including sharing information on patients’ rights and the role of the patient in safety and quality improvement

Joint Action - process Two preparatory meetings held by the Commission in 2010 to define both content and structure (MS, stakeholders, international organisations) Coordination: France (HAS) Project submission: May 2011 Joint action: 2011-2014 Sustained collaboration thereafter

Objective: to implement EU Health Strategy by Improving citizens' health security • Promoting health for prosperity and solidarity • Generating and disseminate health knowledge Total budget 321,5 mio, Jan 2008 to Dec 2013

Specificities of the Health Programme Co-finances institutional networks, public health capacity building projects, etc. Supports EU initiatives on health Aims at raising awareness about public health at political level

Work Plan 2011 Adopted 22 February 2011 Total budget: € 49 751 348 Five main priorities: Health Information and advice; Cancer and rare diseases; Health determinants: nutrition and physical activity, and alcohol and tobacco; Health systems: ensuring high-quality, safe and efficient cross-border healthcare; Legislation on quality and safety of human substances

Financing mechanisms (1/2) Project grants Indicative amount: € 4.650.000. Maximum EU co-financing rate: 60% Operating grants Indicative amount: € 4.000.000. Maximum EU co- financing rate: 60% Grants for joint actions Indicative amount: € 17.040.000. Maximum EU co-financing rate in 2011: 60% (exception: HTA 70%) Conference grants Indicative amount: € 800.000. Maximum EU co-financing rate: 50%

Financing mechanisms (2/2) Direct grant agreements with international organisations Indicative amount: € 3.200.000. Maximum EU co-financing rate: 60% Procurement (call for tenders) Indicative amount: € 17.753.028. Maximum EU co- financing rate: 60% Other actions Indicative amount: € 870.000.

Unijne Fundusze Strukturalne dla Zdrowia Fundusz strukturalny Cele Możliwa alokacja na potrzeby zdrowia EFRR (REGIO)‏ Spójność Konkurencyjność Inwestycje w infrastrukturę zdrowotną wspierające rozwój regionalny i jakość życia; innowacyjność Europejska współpraca terytorialna Rozwój współpracy i możliwości/zdolności; infrastruktura EFS (EMPL)‏ Konkurencyjność regionalna i zatrudnienie Bezpieczeństwo w pracy w celu promocji bardziej produktywnych form organizacji pracy; prewencja i programy promujące zdrowie The EU Cohesion guidelines 2007-2013 include health as a priority for investment. Efficient health investments are essential to maximise health gains and to achieve sustainability, especially in time of crises

Unijne Fundusze Strukturalne dla Zdrowia 5 miliardów € przeznaczone w ramach programów operacyjnych na wspieranie infrastruktury zdrowotnej (aktywa trwałe) + 6 miliardów € na priorytety: kwestie zw. z problemem starzenia się społeczeństwa i e-usługi (łącznie z e-zdrowiem) + € X z EFS (z € 349 miliardów łącznie przeznaczonych na politykę spójności)‏ 0 % <1% 1-2% 2-3% 3-4% 4-5% >5% Structural funds: €5 billion earmarked for health (1,5% of the overall envelope for 2007-2013, a small slice of the cake….)‏ Additional funds have been earmarked for other health-related areas, such as e-health and active ageing. Other funds are also available under the ESF but are not earmarked for health. It’s the role of the SANCO network to investigate how much is spent and for what purpose. Abreviations: OP: Operational Program Infrastruktura zdrowotna: Procent planowanych inwestycji w infrastrukturę zdrowotną w odniesieniu do całkowitej sumy funduszy strukturalnych przyznanych krajom członkowskim w latach 2007- 13. Źródło:Komisja Europejska, DG SANCO 2007

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