Newsletter UEHP - Monday, 27th April 2020

Where is the EU?

During these difficult times, we were all expecting a high level of coordination to limit risks in Europe. Former engagements and programs developed with EU support were supposed to boost cooperation. Emerge and ERINHA, for example, represented a constructive strategy to face epidemic threats. But alas, we surprisingly observed a stand back position and an intellectual lockdown at regional or national level. Too many local uncoordinated responses deserved efficiency. The question now is TRUST. European politics failed to diffuse scientific and medical responses, with the late reaction by WHO declaring the outbreak a pandemic. But we are nonetheless proud of the clear engagement articulated by all European Hospitals. UEHP is in constant contact with its member hospitals and national federations to share best practices and relevant solutions. Engaged in the front line, our hospitals provide protection and treatment for COVID-19 patients, in close coordination with all medical actors. It is an encouraging example of engagement and cooperation which should be followed.

UEHP wants to express its profound gratitude to the workforce and the management of all European Private Hospitals for their full implication and extraordinary response.

Dr Paul Garassus
President of UEHP

LATEST NEWS

SPAIN

Spanish private healthcare in times of pandemic

Carlos Rus, President of the Alliance of Spanish Private Healthcare (ASPE)

We are living in difficult times… The pressure of Spanish health has started to drop, but the daily fight against COVID-19 continues. Our hospitals experience critical situations on a daily basis and health professionals work on the “frontline of war” during marathon days of extensive emotional exhaustion. There is no doubt that we are facing the greatest challenge that the international scientific community has ever experienced in the last century.

Since the beginning of the crisis, in Spain there has been close collaboration with the public sector to combat the pandemic. We have always been at the disposal of the health authorities and since the State of Emergency was decreed in our country, we deprogrammed the regular medical activity to attend to the health emergency, and, since then, all our hospitals have been subject to the indications and protocols of public health, under a single national command but territorially organized in each region, according to the country's administrative structure.

The important thing and what we are concerned with is caring for patients under the sole command of Public Health in each of the autonomous communities, who have asked us for resources and coordination.

There is no doubt that Private Healthcare, which regularly serves more than 12 million Spaniards, is part of the stronghold of National Health and performs a social function of prime necessity. We are an integral part of that shield that stands before the greatest health crisis in our modern history.

For this reason, we must not forget that we are prepared and committed in the role that is ours to play and I am absolutely convinced that we will only succeed if we continue to be united as a country, but also through the European ties that we represent for the global defeat of COVID-19.

FRANCE

An unprecedented cooperation between public and private hospitals

Lamine Gharbi, President of the French Federation of Private Hospitals (FHP)

On 13 April, French President Emmanuel Macron, speaking in front of a record 36.7 million TV audience, paid tribute to "the unprecedented cooperation between public and private hospitals". This official recognition made during a solemn speech, is as important as it is deserved. The French President also praised caregivers and all those who keep the country standing and deserve consideration and recognition.

This cooperation between hospital sectors should not be a flash in the pan, merely fuelled by the urgency of the situation, but a sustainable organisation. The citizens, who are in favour of this cohesive management, would not understand a step backwards. Thanks to this crisis, we have established in the minds of the population that a more mature organisation between health actors was possible: we have no right to disappoint them.

In addition, our country was not sufficiently prepared for such a pandemic phenomenon, particularly with regard to protective equipment. We condemned this harmful situation from the start; it has now improved even if it is not fully satisfactory yet.

The private sector has made a major contribution to the management of the COVID-19 outbreak in recent weeks. At the government's request, we have, as of 13 March, deprogrammed all non-urgent surgical and medical activity to allow the health system to fully adapt. We have freed up to 4,000 ICU beds nationwide. In the Paris - Île-de-France region, one of the two main regions impacted by COVID-19, clinics created 300 new ICU beds in 48 hours to cope with the epidemic peak. 3,500 COVID patients are being treated in follow-up care and rehabilitation clinics.

Moreover, this unused availability obviously led to major economic difficulties for our establishments and the private practitioners who work there. A draft decree is currently being finalised by the Ministry to provide health establishments, be they public or private, with a guarantee of annual funding. We have requested that an identical mechanism be proposed to liberal health professionals (i.e. all doctors) in private hospitals as soon as possible.

Coronavirus is not the only disease!

Since mid-April, FHP has been alerting the French public authorities about the growing number of people who are neglecting their health during the pandemic. Health professionals have noticed a significant decrease in care services in medical practices and care institutions: the number of visits to doctors' practices has fallen by 40% and that of hospital emergencies by 70%. This abnormal situation is worrying caregivers and those in charge of patients' associations, who want to reassure and encourage sick people who need to seek care. Health professionals are mobilized in the fight against COVID-19 but also remain mobilized for public health.

Some patients no longer dare to go to a health establishment or call their doctor for reasons other than symptoms related to the coronavirus. Such abandonment of care can cause serious harm, particularly for chronic or acute pathologies.

The only concern of all healthcare professionals remains the health of all. Health establishments and doctors’ practices welcome patients who must take care of their chronic pathologies or need urgent care, every day, in all territories, without financial exclusion and in compliance with safety requirements (in particular strict separation of COVID and non COVID patient flows). The use of teleconsultation and telecare is also possible and is covered by the Health Insurance.

The gradual lifting of confinement measures in our country will begin on 11 May. Private health establishments are reorganizing once again to be able to cope with a second wave of the epidemic and to resume their activity in this environment still threatened by COVID-19 until an effective therapy and a vaccine is available.

PORTUGAL

A challenge in line with our responsibilities

How Health will evolve following COVID-19

Oscar Gaspar, President of the Portuguese Association of Private Hospitals (APHP)

COVID-19 had the effect of a meteor that invaded our atmosphere and left us in a state of shock. Suddenly, we all went into emergency mode: health services totally focused on fighting the invader, families in isolation, the economy (almost) at a halt.

As we conclude the second month after the outbreak of the crisis in Europe, we begin to have the (first wave) of the pandemic under control and it is time to draw conclusions, learn from what happened, put health systems back into operation and restart economic activity as quickly as possible (and safe).

With regard to health, we can already anticipate some of the impacts of this traumatic period, some of as a direct effect of what we are experiencing and others of a more structural nature. This reasoning is valid for Portugal, but it must also be considered in European and worldwide terms.

Changing trends

It must be said that, even before COVID-19, there was a wide debate about the new trends in health and the truth is that these seem no less current now. Thus, we are at a stage in history when the involvement of the citizen / patient has never been more determinant and necessary and when the demographic dynamics make it inevitable that we pay special attention to active aging. On the other hand, the provision of services is also marked by technological advances, digitalization, precision medicine and a focus on “value-based healthcare”. Along these lines, there is, on one hand, a clear perception of the rising health costs in modern societies, the need for large investments in R&D and on the other the search for the best efficiency solutions.

Return to normality. Launch of an emergency plan for the recovery of health activity

To the pandemic, we must add all these challenges to assess the dimension of our work. I would say that, in Portugal and in the short term, what we have to do is not to slow down the fight against COVID-19, return to normal life safely and recover activity. At this point, it is already clear that we have entered another phase in which, having guaranteed all the safety conditions for patients and health professionals, activity must be resumed, albeit gradually. We cannot forget, for example, citizens with chronic diseases such as cardiovascular diseases, diabetes or cancer, and many others, whose adequate response and immediate treatment cannot be postponed. It is of utmost necessity to proceed to an emergency recovery assistance plan. We have to catch up on operation waiting lists, to recover what was not done in March and April and reassure citizens that it is safe to seek treatment in health establishments. Private hospitals are ready and available to fulfil this mission and to collaborate with the NHS, if deemed necessary.

Structural health changes in Portugal

The starting situation of Health in Portugal already presented several vulnerabilities. Even on the 6th of April, with regard to World Health Day, INE (the National Statistics Institute) stated “Fundamental health indicators point to improvement in recent years, although some maintain levels below the European Union average (EU-28)”, also noting that public health expenditure did not exceed 6% of GDP.

We will see how it will evolve, but I believe that this health crisis and the social upheaval caused will make Health a priority. The public divestment made in health in Portugal (the value in GDP fell from 8% in 2009 to 6.3% in 2018) had clear implications on the provision of care, prevention, equipment and access and also had a strong impact on companies related to the NHS (payment delays, administrative prices, discretionary fees, etc.). The sustainability of the health system and the needs of the Portuguese people require an increase in investment in health in Portugal in the coming years. As the National Health Convention has argued, Health must be taken as a national priority and, in particular to face demographic dynamics, it is necessary to evolve to a multi-annual budget and a law of means that endows Health with the necessary resources.

In addition to the appropriate financing of the NHS, a key pillar in the health system, sustainability and citizens' access to innovation and to adequate care must take advantage of all the resources available in the sector, including the investment and the capacity of private operators. One of the lessons of this crisis should be that neither part is expendable when it comes to health, and examples like the German system prove that complementarity between public and private is a wealth that we should not give up. As someone would say: "It should not take another crisis for citizens to benefit from this reality".

On the other hand, it is evident for citizens, authorities and providers that digital has enormous potential and should be exploited for health. From teleconsultations and home monitoring to decisive advances in terms of data collection and management (e.g. national registries of diseases and associated therapies, electronic health registries, integrated plan for chronic diseases), including the development of new applications for diagnosis and therapy.

A word also for the industry. It has long been argued that Portugal should increase its skills in terms of health goods and services. To this end, it must accelerate the attraction of Foreign Direct Investment (from the pharmaceutical industry, medical devices, equipment) while strengthening its position in clinical trials and in the involvement of Portuguese research centres. Furthermore, this crisis brought to light the best of Portuguese entrepreneurship: from the involvement of several universities and technological centres in the development of ventilators to the conversion of companies in the textile, plastics and metalworking sectors to produce medical protective suits, masks, visors, etc; and even developing innovative equipment such as “intubation chambers in an ICU environment”.

The role of Europe

The pandemic crisis also exposed some weaknesses of the European Union in terms of Health. We all know that, under the Treaties, Health is a competence of Member States but at a time that affects everyone (a symmetrical crisis, as they say) it is difficult to explain that there is no capacity for articulation, that people feel that, with honourable exceptions, the status of European citizenship is not perceived and that, worse than anything, there even seems to have been a competition for the purchase of personal protective equipment (PPE) ) etc. In Europe, too, there will be some circumstantial and others more structural discussions, the first of which are not of minor importance.

The European Commission is already mobilized to support the financing of expenses to fight COVID-19 and has also evolved towards the centralized acquisition of ventilators and PPE. I believe that the lessons from this period will lead to:

Identifying the areas in which Europe could reinforce its action (public health, management of strategic medicines and PPE stocks, possible joint purchases, strengthening European capacity in terms of medical equipment, etc.)
Without calling into question the principle that Member States have a specific and predominant competence in terms of defining health systems, consider health as an EU priority and, as such, reflect on some basic rules so that all European citizens have access to health and health innovation ensuring a smooth and adequate functioning of health systems.

As with President Obama's Recovery Act, I believe that Europe's Recovery Plan will take on health as one of the pillars of development, due to its intrinsic value and the enormous potential to leverage economic activity. In this European plan, we do not only need to build roads or bridges. We need to invest in digital infrastructure, in sustainable solutions, we need to invest in health before the next virus, we will need to invest in technology. We need a:

Europe in technological leadership
Europe that retakes smart reindustrialization
Europe that does not depend on third parties for vital products (such as ventilators and others, etc.)
Europe that invests more in health

Conclusions

Michael Porter teaches that the health challenge is to generate value and we also know from the manuals that this requires strategy, investment, human resources, management and leadership. We are at a historic moment in time in which the value of health but also that of health activities is obvious to everyone. In Portugal and in Europe, not failing this historical moment is to invest in health, to prepare ourselves in a resolute manner, to involve citizens, strengthen interconnections with research centres, take advantage of entrepreneurship, seek efficiency and be transparent in the choices that are made. We are all needed. We are all committed to more and better health.

UEHP

Letter to the EU Institutions Presidents on the role of the private sector in the COVID-19 pandemic and the future of health

Today, 20 April 2020, on the initiative of our President and the UEHP Board, we sent a letter on the role of the private sector in the COVID-19 pandemic and the future of health to the President of the European Commission, Mrs Ursula Von der Leyen, the President of the European Parliament, Mr David Sassoli, and to the EU Commissioner for Health & Food Safety, Mrs Stella Kyriakides.

All across Europe, all hospitals, public and private, have joined forces to combat the coronavirus crisis, developing new solutions to cope with the unpredictable number of patients suffering from the virus.
Representing 20% of all hospital beds in Europe, private hospitals (providing acute care, rehabilitation and mental health services) have shown their full engagement in the public health response managed by governments in each Member State. Two key words must be stressed: coordination and cooperation, sometimes managed with a certain delay but always effective and relevant, at regional or national level. UEHP would like to remind the European Commission and the European Parliament of the full involvement of the private health sector in facing this public health threat and engaging all means to succeed.
UEHP believes that the current crisis requires new perspectives for a European Health coordination and a major change in scientific and management cooperation. The lack of European initiative exposes national systems to inadequate responses. Too many contradictory voices disclaimed effective communication and practical solutions. Just to name a few of the problems we faced: ICU beds, ventilators, PPE, drug or devices shortage...
As already expressed by top policy makers, the “day after” will be another day. We are asking the European Commission and the European Parliament to make Health a priority and, as such, define basic rules. Learning from the crisis means to understand that the challenge of the pandemic can only be met by joining all forces in the health care sector.
Private hospitals therefore are an indispensable element, carrying a great share of the burden and thus should be acknowledged as partners with equal rights.

UEHP is ready to support new strategic objective and to propose relevant initiative, proud of recent engagement for a new common ambition with the European Commission and the European Parliament.

European Patients’ Rights Day

In the midst of the pandemic of COVID-19, the European Patients’ Rights Day, each year on the 18th of April, has a particular meaning. This annual celebration aims at enforcing the implementation of patients' rights in Europe to reduce health inequalities. Videos from all over Europe have been posted on the Active Citizenship Network website.

Watch the contribution of Ilaria Giannico, UEHP Secretary General.
https://youtu.be/6GRWNTBTA48

The Member States will be required to use these amounts to speed up their investments under the structural funds. They will use this for the national co-financing they would normally have had to provide themselves in order to receive the next tranches of their structural fund envelopes. In view of the average co-financing rates across Member States, the €7.5 billion will be able to trigger the release and use of some €17.5 - €18 billion of structural funding across the EU.

Read the ACN newsletter
http://www.activecitizenship.net/newsletter/2020_04_17-79/index.html

EU Health Coalition | Statement on COVID-19 online

The EU Health Coalition published its Statement on the COVID-19 crisis and the need for more solidarity and coordinated EU action.

UEHP is member of the EU Health Coalition, an independent coalition gathering 34 European associations working in the healthcare field. The coalition was created in Brussels in 2018 in view of the EU elections with the aim to propose recommendations to the EU institutions and to keep healthcare on top of the EU agenda.

NEW guidelines on cross-border rules on exchange of patients and medical staff to tackle COVID-19 crisis

The European Commission has just published new cross-border rules on exchange of patients and medical staff. The new guidelines on EU emergency assistance for cross-border cooperation in health care suggest that member countries share hospital beds and medical staff when possible.

The Commission said that the coronavirus pandemic had “already placed great stress on healthcare systems,” and that “exceptional emergency situations” warrant “a more coordinated approach” on cross-border health care. The Commission suggested that member countries therefore “make full use” of existing national health structures “to assist patients in need of critical care.” Examples could include offering available hospital beds across borders. Some member countries, including Germany and Luxembourg, have already taken in patients from hard-hit France and Italy.

The Commission also called on national health authorities to help health professionals “share expertise and skills working hand in hand … across borders.”
As for covering costs, the Commission suggested that national authorities issue a general prior authorization “to ensure the coverage of all the expenses incurred by the hosting healthcare provider.”

The Commission also said it is “committed to assisting” the coordination of requests and offers regarding intensive care places through its Health Security Committee and the bloc’s Early Warning and Response System. In addition, it will use the EU Civil Protection Mechanism to co-finance the emergency transport of patients.

The full text of the new guidelines is available here

Blood and Beyond webinar and launch of the report on rethinking blood use in Europe

The results of the project “Blood and Beyond -Rethinking blood use in Europe to improve outcomes for patients” in which UEHP has been involved for the last six months, are available (Final report – Infographic).

After six months of collaborative work, the report outlines the need for a collaborative, patient-centred approach to rethink and optimise blood management in chronic diseases in Europe. With a focus on red blood cell (RBC) transfusions, it contains policy recommendations to safeguard and optimize Europe’s blood supply; to reduce transfusion dependency and to facilitate innovation.

All collaterals including video insights are available on the website of the initiative: www.bloodandbeyond.com

For more information on the Blood and Beyond initiative, please visit: www.bloodandbeyond.com

Read the final report here!

See the infographic here!

MedTech Europe assures industry’s continuous support in accessing medical technologies in times of COVID-19

22 April 2020, Brussels - As the world enters yet another week in the fight against COVID-19, MedTech Europe, the trade association representing the medical technology sector, assures hospitals and the healthcare sector at large that it remains committed in developing, producing and distributing medical technologies to the frontlines for hospitals and other point-of-care areas.

As hospitals become the epicenter in the management of this pandemic, the delivery of new COVID-19 related tests, personal protective equipment, such as masks, gloves and gowns, respiratory equipment such as ventilators as well as many other equipment needed in ‘Intensive Care Units’ have been the sector’s core focus.
Over the past months, medical technology manufacturers have been taken major actions including:

scaling up production as much as possible to meet the demand for medical supplies. Access to (invasive and non-invasive) ventilators is of particularly high importance during this pandemic to support higher acuity patients: manufacturers are putting tremendous efforts to prioritize manufacturing these devices despite significant supply challenges
Supply chains around the globe are being secured and strengthened as much as possible so that all materials, components and accessories are available.
Distribution of equipment via land and air freights is being organised, whilst border restrictions are in place in many areas.
Regulatory and market access challenges in Europe are continuously addressed.

At the same time, medical technologies manufacturers remain fully committed to do the utmost possible to minimise the disruption in the availability and accessibility of all other medical technologies and services, especially those needed by people impacted by acute sicknesses or those with chronic conditions.

In the weeks and months to come the medical technology sector remains fully available to discuss any critical question or need of the hospital community in this acute period of COVID-19. Furthermore, there might be opportunity for valuable exchange about how to come slowly and effectively back to ‘normal’ provision of services in non-COVID-19 related areas whilst addressing potential backlogs that developed during the COVID-19 crisis. We are looking forward for continued dialogue with the community of UEHP!

MEMBER'S CORNER

GERMANY

During the corona pandemic, privately-owned hospitals are trying to create as much capacity as possible for COVID-19 patients.

According to the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), privately owned hospitals have a total of 4,034 intensive care beds. The large hospital groups own 2,915 intensive care beds. There are also a further 944 beds in these houses, which can be converted into intensive beds within 48 hours.

Current figures of the large private hospital associations (AMEOS Group, Asklepios Kliniken, Helios Kliniken, Paracelsus, Sana Kliniken, Schön Klinik). The figures in the table are based on a current association survey (as of April 15, 2020). Cross-agency figures can be found on the DIVI website.

ITALY

The evolution of the situation has reinforced the central role of the Gruppo San Donato in the continuous and daily fight against the virus in its hospitals.

To date, we have 1 943 COVID-19 patients hospitalized in our facilities, including 220 critically ill patients on CPAP and 165 intubated patients in intensive care beds.

This means that Gruppo San Donato, which represents 13% of all beds in the Lombardy Region, cares for 18% of all COVID-19 patients hospitalized throughout the Region.

The effort made by the Group, in each establishment, to go from 350 COVID-19 patients to 2 000 in just 3 weeks was remarkable and deserves consideration.

This effort was necessary to cope with the peak arrivals of more than 250 COVID-19 patients per day during the first week.

The week of March 16 was particularly critical, especially in Bergamo, Brescia and Vigevano, with the arrival of more than 70 patients a day in the emergency departments in these provinces. The establishments resisted and the height of the crisis was managed with dedication and professionalism.

These days, new patients continue to arrive but without the flooding of the emergency departments that we had experienced in the previous weeks.

We currently have an average of 105 new hospitalizations per day at Group level and we can be proud of having already been able to discharge 600 patients, completely cured. A number which is strongly increasing daily.

In order to face this crisis, GSD has put the patients and the needs of the country at the centre of its action.

Significant investments (around 16 million euros) in machinery and construction were necessary to have a capacity of up to 270 CPAP beds and 200 intensive care beds dedicated to COVID-19 patients.

Furthermore, each week, we invest around 3 million euros to cover our weekly PPE needs, including more than 80 000 gowns, 200 000 masks and 1 000 000 disposable gloves, and around 1.2 million euros for the purchase of specific drugs essential for the care of COVID-19 patients.

Our scientific research, leader in Italy, explores various alternatives to bring new effective solutions to the patient's bed in record time.

San Raffaele Hospital in Milan has become the national leader in models of care and in the use of investigational drugs. All the experience of the first Research Hospital in the country was made available to each establishment of the Gruppo San Donato with daily interaction between the chief doctors and the intensive care departments.

Clinical trials and data collection at Group level have started: the only way to rigorously define what really works and in which context. A large observational study is currently underway and includes several hundred patients with COVID-19 already treated in our establishments as well as all those who will be hospitalized in the future. It is a uniform protocol that will systematically collect clinical and biological information and therefore obtain reliable data on the effectiveness of the drugs administered today in Italian hospitals. As part of the study, each patient follows the same therapeutic procedure, even though it can be managed by more than 7 different departments which are today dedicated to emergency COVID-19 at San Raffaele Hospital.

The process begins with the collection of several biological samples, including blood, plasma, urine and viral swabs.

By comparing the information that emerges from the samples with the treatment protocols and the clinical data collected by the patients during the entire hospital stay, the medical researchers at San Raffaele hope to be able to:

Better understand what the most affected patients have in common;
What are the indicators that allow us to predict the course of the disease;
Which drugs work best in different cases.

It is only thanks to high quality studies, carried out on a sufficient number of patients, that we will be able to provide scientifically valid answers to this need for treatments sought by the Italian and international medical community ", declared professor Fabio Ciceri , deputy scientific director for clinical research at San Raffaele Hospital and head of the haematology and bone grafting unit.

"On the contrary, impromptu statements, based on the experimental treatment of a few patients in an emergency context, risk only confusing the public but also the medical profession. This is even more true for a disease which presents a great clinical variability like COVID-19 ".

In nearly 80% of patients, the presence of the virus is not or not very symptomatic and in the remaining 20%, it causes severe pneumonia.

A great variability is also observed in these 20% who are hospitalized patients in serious condition. It is in these patients, in the most critical phase, that we are testing the use of Angiotensin II, a vasoconstrictor already used in intensive care and which could bring them clinical benefit.

As there are no specific drugs yet for the disease, the experimental therapies tested in recent weeks in Italy on patients with COVID-19 are all carried out with off-label drugs.

These are approved drugs, but indicated for other pathologies, or even not yet approved and therefore administered for compassionate purposes after evaluation by the Institutional Ethics Committee.

The first class of drugs are antivirals, which prevent replication of the virus and help the immune system contain the infection.

The most widely used - off-label drug - is chloroquine or hydroxychloroquine, molecules marketed since the first post-war period as medicine against malaria, but also endowed with antiviral and anti-inflammatory properties.

According to the first studies carried out in China, the use of chloroquine improves patients' symptoms and reduces the length of hospital stay.

Other antiviral drugs used in patients with COVID-19 are Kaletra, generally used for HIV, and Remdesivir, originally developed for Ebola, but which, in early laboratory tests, had also been shown to be effective on a coronavirus. (different from SARS-Cov-2).

Unlike the others, having never been commercially approved, Remdesivir is currently administered for compassionate purposes in intensive care.

However, we should soon enter the first clinical trials with patients in less advanced stages of the disease.

One of the consequences of COVID-19 is the extreme pulmonary inflammation, which in some cases contributes to severe pneumonia and respiratory failure, often requiring admission to intensive care.

Therefore, it was decided to use molecules capable of deactivating the extreme immune response and thus contributing to the functional recovery of the lungs. In this case, the most used molecule is Tocilizumab, a monoclonal antibody already on the market for the treatment of rheumatoid arthritis which acts by blocking the production of interleukin-6 (IL-6), an inflammatory molecule produced by the immune system in response to viral infections.

There are others in experimentation, such as Anakinra, which acts on Interleukin-1 (IL-1), or Sarilumab, which also works on IL-6.

We are also carrying out experiments on the blood serum of people who have already developed immunity to COVID19 as well as on therapies involving the use of stem cells.

The GSD Crisis Management Team

ITALY - Emilia Romagna

The 44 private hospitals of Emilia Romagna are ready to deal with the Covid19 emergency and all the immediate after effects. AIOP Emilia Romagna is working alongside the Region, with whom it has signed an agreement of total collaboration.

“Ours are public structures governed by private law and as such belong to the accredited hospital network, which is dedicated to coping in the best possible way with the Covid19 emergency”.

Alberto Breschi, lawyer and consultant, AIOP Emilia Romagna

AIOP ER is facing this struggle with all the means at its disposal. What is the overall evaluation at this moment in time of this “ synergy between AIOP ER and the SSR ( regional health system)”?

The evaluation is positive. Our Region has reacted promptly through the head of the Health Department, Raffaele Donini and, with the representation of accredited private hospitals (AIOP Emilia Romagna), an agreement has been put in place with the conditions and the prerequisites to take on as early as possible the synergy of publically administered hospital beds and those privately managed ( 5,000 out of a total of 20,000). There are 3 possible ways of collaborating: Type A hospital beds) to ensure the resources, in terms of hospital beds and operating rooms, to allow the public health system to make use of the private network for non COVID cases, that anyway continue to exist and for those cases that require urgent treatment; Type B hospital beds) for Covid cases that require total isolation; Type C hospital beds) for Covid patients in later stages of illness, allowing for a quicker rotation of beds for Type B acute cases.

What is the key role of AIOP at this point in time?

The role of AIOP has been focussed on both the actual cases of the epidemic and the taking care of the most urgent cases amongst those not infected. In the first case the role of AIOP has been to make available their network , both intensive therapy resources and normal. The structures given over to Covid cases have been examined by the public hygiene services, that in almost every situation were involved in reorganising the space (all rooms reduced to 1 bed, with a halving of capacity as the vast majority of rooms normally have 2 beds), filters, changing rooms, safety equipment and filters for personnel. In the second case the private structure is available to carry out their own urgent programmed cases ( up to a 30 day wait) and those of the public system, in some cases hosting surgeons from public hospitals that operate in the private sector.

Yet again the the private sector doesn’t hold back and supports the public sector. Public- private is the present and will it be the future ?

This experience demonstrates that the future lies in this synergy: neither sector would be able to manage without the other, even if the predominant role lies with the public sector considering the numbers and the characteristics of our system. Over and above some pointless controversies, the virus has impacted on areas that, up to a point, define the boundaries and peculiarities of this collaboration. Overall the synergy has been strong and each has counted on the presence of the other, depending on a personnel that has shown almost heroic dedication. The presence of the private sector has made it possible to make use of a group of organisations that in terms of people, capital and technology are something the public sector would never have been able to put together. Those who contemplate a future without this integration are denying the evidence.

Bruno Biagi – Managing Director of the Maria Cecilia Hospital of Cotignola (RA)

All AIOP structures in Romagna have been made available to face the COVID emergency. In respect to other areas, which have been worse hit by the pandemic, in Romagna it has not got out of control. All intensive therapy beds have been made availabl,e as well as beds for COVID patients, both of type B and C, in a number of structures in Romagna.

From the outset the structures have given their maximum collaboration to the requests of AUSL ( the public health system) in Romagna. The support continues in this second phase where there is a slight decrease in infections. The health structures in Romagna are also looking after recovering Covid patients that need care and assistance in order to regain their self sufficiency.

At the core is the synergy with the Emilia Romagna Region which was confirmed at the height of the emergency, with a quick and effective agreement as possible, that sees private hospitals increasingly allied with the SSR and SSN ( regional and national health services ).

I’m Managing Director of the Maria Cecilia Hospital which is a highly specialised hospital accredited with the National Health system. We have transformed a part of the Intensive Therapy ward into an area for COVID-19 patients from other hospitals in the region. It consists of 8 separate isolated beds in the Intensive therapy unit complete with the latest technology .

In an attempt to decongest urgent and undeferrable interventions we are putting together a possible organisational agreement with the Romagna health authority, so that urgent and undeferrable surgical activity in public hospitals will be transfered together, with medical staff and patients, to the operating rooms of the Cotignola hospital.

Walther Domeniconi, executive director of Villa Laura

From the very beginning we have made ourselves available to the health authorities in Bologna. Despite some initial difficulties we eventually succeeded in transforming the hospital to be completely dedicated to COVID patients.

Villa Laura made available 100 beds as well as creating the possibility for 8 intensive therapy beds.

The medical team, led by the Health and Medical Director Doctor Luca Arfilli and by the Anaesthetic service coordinator Doctor Stefano Maltoni, is made up of highly experienced professionals with the contribution of younger personnel.

Nurses and social health workers have modified their shifts and also their daily habits to give life and soul to dealing with this emergency.

Cardiologists and other medical staff, such as imaging specialists of Villa Laura Nursing Home have given everything to face this situation. We have initiated a system of checking the condition of all operators which helps to create a serene working environment.

Mario Sanna – Health Director of the S. Antonio Nursing home in Piacenza and AIOP President for the province of Piacenza.

From the outset we have made available all our services to face together the epidemiological outbreak of COVID-19.

We have completely converted the Sant’Antonio Nursing Home into a COVID structure, with 80 available COVID beds and stopped all outpatient services. But in particular by sanitizing the entrance to the rooms of each patient.

In the Piacenza nursing home there are 90 beds for COVID pateints and 40 for emergency orthopedic, trauma and breast cancer cases. There are separate entrances for COVID and non COVID patients.

The two structures have made available 170 beds overall, maintaining places for urgent and undeferrable cases.

Prof. Mario Sanna, AIOP President of the province, communicated that the multispecialist San Giacomo Nursing Home in Piacenza has made an important contribution in offering 40 beds.

In general all the AIOP structures in Piacenza are fully participating in dealing with the emergency alongside the public hospital of Piacenza, preparing for the successive phases and supplying all healthworkers with PPE ( personal protection equipment).

SPAIN

The Spanish private health sector asks the Spanish Government to maintain these measures for two months

The Spanish Private Health Alliance (ASPE) has proposed to the Government 10 measures to ensure the economic viability of the private health sector, which is currently collaborating with public health authorities in the fight against the COVID-19 pandemic.

Under the State of Emergency, the Spanish Government has ordered the deprogramming of all non-urgent-elective health activity, reducing it approximately by 80 %, making the resources of the sector available to the Health Councils in all parts of Spain and especially in the COVID-19's areas of greatest spread, where private hospitals operate in an integrated manner with public systems. The private healthcare sector is treating 19 percent of hospitalized patients and 10 percent of ICU cases. At this time, 100% of the structures remain in operation, but without main income activity, which can have repercussions on their present and future sustainability in many cases. "

Given this situation, ASPE, which represents more than 80 % of Spain's private hospitals (468) and up to 925 outpatient centres, has asked the Government through the Ministry of Industry for urgent measures to be able to face the enormous waste in resources.

For Carlos Rus, president of ASPE, “we support the preservation of employment and the full productive capacity in the fight against COVID-19 but we need urgent measures that allow the financial viability of hospitals and private clinics which are facing a serious crisis of liquidity, jeopardizing the continuity of many hospitals. "

ASPE proposes a package of economic-financial measures to make health establishments viable under the current circumstances:

1. In relation to taxes and fees:

a. Exemption from Social Security fees for the duration of the State of Emergency.
b. Exemption from the payment of taxes and withholdings of personal income tax during the same period.
c. Deferrals and / or bonuses in Social Security.
d. Deferrals and / or discounts in Corporate Tax and IBI and Tax credits for increased health workforce.

2. Access to lines of financing to be able to access sufficient financial resources to meet current spending.
3. Access to guarantees established in RD 8/2020 or to the ICO lines of working capital financing to allow coverage of the working capital deficit.
4. Liquidity lines by banks guaranteed by the State to face cash payments required by health providers (for example, EPIs).
5. Soft loans for investment in essential material in COVID-19.
6. In order to ensure that credit reaches the sector, access to a specific financing line for the sector, amounting to 75% of the hospital sector revenue for 2 months.
6. In order to ensure that credit reaches the sector, access to a specific financing line for the sector, amounting to 75% of the hospital sector revenue for 2 months.
7. Reduction of health VAT at a super-reduced rate to facilitate the purchase of materials and equipment for health care.
8. Subsidies for purchases due to the high increase in the prices of medical supplies: masks, gloves, gowns, medicines.
9. Direct aid to establishments involved in the care of patients with coronavirus.
10. Approval of exceptional payment rules:

a. That private establishments under public contracts, which charge a fixed part of the contract, continue receiving this part
b. Payment periods not greater than 60 days by insurers and by the State

PORTUGAL

In its usual publication on the World Health Day (April 7), the Portuguese Statistics Institute (INE) published the most up-to-date data on the established capacity and the activity carried out by the country's health system. Information from the INE reveals that there is a greater number of private hospitals and there is an increase in the activity of private hospitals in all areas.

INE says that “it was in the private hospital sector that this production increased the most in relation to the previous year, with 12.5% more surgeries, 10.4% more activity in emergency care, 6.9% more medical consultations and 4.3% more hospitalisations.”

Private hospitals were responsible for more than 1.3 million emergency episodes.
Private hospitals carried out more than 7.3 million specialty consultations.
Private hospitals performed more than 290,000 “medium and large surgeries”

In 2018, there were 119 private hospitals (5 more than in 2017), increasing the predominance of the number of private hospitals which started in 2016. The predominance of private hospitals was comprehensive to the mainland and the Autonomous Regions (Azores and Madeira).

35,400 beds were available for immediate hospitalisation of patients (68.1% in public hospitals or in a public-private partnership and 31.9% in private hospitals).

ITALY - Lombardy

The Italian Association of Private Hospitals (Lombardy regional office) in cooperation with Confindustria Lombardy (the regional office of the Italian Manufacturer's Federation), Aris (Italian Association of Religious social-health institutes) and Lombardy Region, recently promoted the publication, on the most known Italian newspapers (Lombardy Region editions), of the following advertising.

As you can see, the info-graphic shows the important results of the cooperation between public and private healthcare sector before and during the COVID-19 emergency, in terms of ICU and acute beds made available within the public and the private accredited hospitals of Lombardy Region.
The main purpose of the advertising, that during the past week have reached the attention of a significant number of readers, is to show the utmost contribution of the private healthcare sector during the COVID-19 emergency, with its 484 ICU beds made totally available to the Region, in order to face in the best way the constantly growing number of cases in the Region.

FRANCE

In Bordeaux, the situation is incomparable to that of the East of France or Paris. We had time to get organized. The Health Agency in our region has set up a collaborative approach that works: the military hospital, public, private and private non profit establishments are brought together in a telephone crisis unit every day at 11am. Each one specifies its flows and the regulation of patients is done naturally. We also discuss our needs in terms of equipment, molecules and human resources and even share best practices. We also discover together new problems as we go along and solutions are found: prior agreements, bed occupancy in gerontology, home health care delivery, psychiatric patients, etc.

Even the Bordeaux University Hospital, the most important in France, is asking for help. A huge network has then been created and is operating with the modern means of communication initiated by the regional Health Agency. Directors and ICU medical doctors participate in this crisis cell. At the same time, the physicians have created whatsApp groups to exchange on their practices. We had time to learn from the mistakes of the first two affected regions. Together, with the regional Health Agency, the care offer is globally balanced, graduated and united. We have been able to welcome about a hundred patients from other regions to our ICU and resuscitation units, across all establishments, regardless of status.

How to restart the business?

In the absence of clarity, insurance risks worry liberal physicians working in private hospitas, who manage their individual responsibility. On the resumption of activity, we see two philosophies pointing: resumption of activity according to the usual protocols and known recommendations, for example for tuberculosis, which the private sector will probably choose, or maintaining two COVID + and COVID - flows that the public sector will be able to organise better thanks to endowments. The immunity of the population is very far from being acquired, and we have started a second wave. It is illusory to think that in June or July normal activity will be able to restart.

For the first time in 2020, thanks to the planned allocations, we know in advance that our turnover will be the same as last year. Let's use this time to structure ourselves internally in the private sector. We are going to have to build on the collaboration between our institutions, and not fall back too quickly into our competitive shortcomings. The war against COVID-19 is not over, but the war after the epidemic peak, that of communication, authorizations and patient care, has already started.

GERMANY

The hospital group Helios belonging to Fresenius sent a team of doctors and nurses as well as 30 ventilators to Spain to support the containment of the corona pandemic at the beginning of April. More than 200 volunteers have contacted the company to help in Spain, which is particularly affected by the coronavirus.

Fresenius Helios is Europe’s leading private hospital operator, with more than 110,000 employees and the largest private hospital operator in Spain with its subsidiary Quironsalud.

AGENDA

26 June

Brussels

Brussels, UEHP Council Meeting

1-2 October

Salzburg

VPKA Annual Congress & UEHP Council Meeting