Thursday, 28th May 2020  
A crash test for Europe
The lifting of lockdown measures in most EU Member States, does not signal the end of COVID-19 even though we can generally observe a significant reduction in the number of confirmed cases while MS gradually return to «normality».
However, the political consequences may last longer and run deeper than the medical problem itself. We witnessed during these difficult times the implosion of European regulatory mechanisms: borders were closed, competition among Member States was fierce for Personal Protective Equipment (PPE). The principle of further cooperation was enhanced by the Commission, but isolated solutions came from local application.
The “day after” will be hard too! New rules for a renewed trust will take efforts and time. We are, at the moment, skeptical about a rapid coordination of actions and cooperative programs in health.
Private Hospitals were fully engaged in this fight and we are not expecting any reward but at least respect and consideration. We want to be a partner in change, in a collaborative EU respecting trust and solidarity.
Dr Paul Garassus
President of UEHP
COVID-19: The European Institutions reply to UEHP
Last 20th April, UEHP President, Dr Garassus, wrote 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.
In the letter, UEHP reminded 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…
We asked 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.
On 30th April, UEHP received the replies to its letters from the President of the European Parliament, Mr David Sassoli, and the President of the European Commission, Mrs Ursula Von der Leyen, briefly summarized below:
Reply of the President of the European Parliament, Mr David Sassoli
The European Parliament, in a resolution adopted on April 17, expressed its awe and admiration to all those that stand in the frontline of the fight against the virus. The European Parliament considers that Member States have initially acted unilaterally at the beginning of the crisis but have now recognised that cooperation, confidence and solidarity and the only way to overcome this unprecedented challenge.
There have also been great signs of European solidarity in action shown by Member States in their treating of patients from other Member States, supplying healthcare equipment, and by the EU through joint procurement and the newly created strategic stockpile under RescEU. The Parliament calls for the creation of a European Health Response Mechanism to better prepare and respond in a common and coordinated way to any type of health or sanitary crisis that emerges at EU level. The European Parliament also believes a Health Autonomy Action Plan should be established in strategic areas such as active pharmaceutical ingredients essential for the manufacture of medicines, and thus reduce its dependence on third countries.
Many major initiatives have already been presented by the European institutions, including direct support to the healthcare systems and funds redirected to the research area.
Reply of the President of the European Commission, Mrs Ursula Von der Leyen
The European Commission is working on all fronts to support in Member States reacting to the COVID-19 outbreak.
This includes weekly coordination in the Health Security Committee of which the minutes are publicly available: https://ec.europa.eu/health/hsc_covid19_en
The European Commission launched four procedures for joint procurement of personal protective equipment, ventilators and laboratory material that proved successful: https://ec.europa.eu/commission/presscorner/detail/en/ip_20_523
In addition we have now also a central stockpiling mechanism via rescEU: https://ec.europa.eu/commission/presscorner/detail/en/ip_20_476
We have also issued guidelines on cross-border health care in the COVID-19 crisis: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52020XC0403(02)
In addition we issues guidelines on the optimal and rational supply of medicines to avoid shortages during the COVID-19 outbreak: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv:OJ.CI.2020.116.01.0001.01.ENG&toc=OJ:C:2020:116I:TOC
Also the European Medicines Agency and its partners in the European medicines regulatory network are putting measures in place to help prevent and mitigate possible disruptions to the supply of medicines in the European Union (EU) during the COVID-19 pandemic: https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/availability-medicines-during-covid-19-pandemi
In terms of research coordination, I can inform you that the European Commission recently put in place an online platform to enable the rapid collection and sharing of available research data: https://ec.europa.eu/commission/presscorner/detail/en/IP_20_680
UEHP thanks the EU institutions and confirms its commitment to support new strategic objectives and to propose relevant initiative, proud of recent engagement for a new common ambition with the European Commission and the European Parliament.
EU Health Coalition - Health is and should be at the core of the Recovery Plan for Europe
The EU Health Coalition calls for Health Ministers to keep a pivotal role in the EU Recovery Instrument negotiations | Health is and should be at the core of the Recovery Plan for Europe
COVID-19 has shown the devastating impact that serious health threats can have not only on the health and well-being of our citizens, but also on our economies. The current crisis clearly demonstrates that healthy populations and economic growth are interdependent and mutually reinforcing.
Health is now at the top of the European political agenda – and this momentum must not be lost. Investments in public health and healthcare systems will not only ensure that a similar health crisis never again impacts European countries in such a profound way, but can also play an important role in the economic recovery of Europe.
As a Coalition of 34 organisations working on health, the EU Health Coalition warmly welcomes the European Commission’s proposal for a Recovery Instrument, to be adopted on the 27th of May to mitigate the severity of the economic and social impacts of the crisis. An ambitious investment in European health systems, including in a European health data, in a strong health research ecosystem and digital health infrastructure, should be a key part of the Recovery Instrument as it would both foster future European research and innovation and improve the responsiveness and resilience of health systems.
We want to stress the crucial role that the Employment, Social Policy, Health and Consumer Affairs Council (EPSCO) should play in the negotiations of the new plan. Recognising not only the importance of a healthy population to a healthy economy in the recovery period and beyond, but also the importance of the health sector for the European economy, Health Ministers should be involved also in monitoring and coordinating the implementation phase of the plan. Echoing the recently issued Commission Country Specific Recommendations, which for the first time proposed health recommendations to all Member States, strengthening healthcare systems will be crucial in the wake of the ongoing COVID-19 crisis and in the aftermath. It is therefore crucial that Health and Economy Ministers work together in the negotiation and implementation of the Recovery Plan.
Collaboration between all sectors and actors is even more imperative now to ensure our healthcare systems can function to their best ability in saving human lives. We must not let the weight of COVID-19 dissipate without positive change – health must be firmly preserved as a key priority also in the aftermath of the crisis and beyond.
Background information:
The EU Health Coalition was created after the first ever EU Health Summit, which took place in November 2018, in order to promote a shared vision of health in Europe, based on jointly developed recommendations. The purpose is to ensure health remains high on Europe’s political agenda and bring the necessary changes to address the unprecedented challenges driven by an ageing population and the increased prevalence of chronic diseases that healthcare systems and citizens across Europe are facing. The EU Health Coalition is composed of patient organisations, EU research-oriented medical societies, industry organisations, providers, regional and local health authorities and other relevant stakeholders that share a common vision for health. To find out more about the work of the EU Health Coalition please visit our website here.
Recommendations to strengthen the resilience of healthcare systems
On 20th May, the European Commission published its country-specific recommendations, asking all Member States to strengthen the resilience of their national healthcare systems. For the very first time from the beginning of the COVID-19 pandemic, the European Commission proposes health recommendations to all Member States.
The ongoing health crisis has shown the need to ensure and strengthen the resilience of the EU's national health systems, i.e. their capacity to efficiently tackle shocks, such as the COVID-19 epidemic, as well as longer-term structural changes in order to be able to react against any potential future crises.
In fact, the COVID-19 outbreak has worsen the performance of many countries that were already experiencing structural and long-term challenges related to the resilience, accessibility and efficiency of their health systems. 
The Commission's proposals for health recommendations take into account specific structural challenges related not just to the short-term resilience of the respective health system (e.g. to ensure the availability of intensive care beds and of critical medical products such as personal protective equipment and ventilators), but also to the access to and the effectiveness of healthcare.
Among the longer-term issues highlighted in the current COVID-19 crisis are the working conditions of doctors and nurses and shortages of health workers, as well as the insufficient financing of certain health system segments. High out-of-pocket payments and unmet needs for medical care for patients are also an issue. In some Member States the crisis has shown an insufficient capacity of the primary care sector.
The crisis also brought to the fore the untapped potential for the deployment and use of e-Health services, with insufficient coordination and cooperation between health care providers, and a limited integration of health and social care services, in particular in elderly care.
The country-specific recommendations on health are the following:
Improve the resilience of the health system by strengthening public health and primary care.
Reinforce the overall resilience of the health system and ensure the supply of critical medical products.
Mobilise adequate financial resources to strengthen the resilience, accessibility and capacity of the health system, and ensure a balanced geographical distribution of health workers.
Enhance the resilience of the health system. Promote balanced geographical distribution of health workers and facilities, closer cooperation between all levels of administration and investments in e-Health.
Strengthen the resilience and capacity of the health system to ensure quality and affordable services, including by improving health workers' working conditions.
Ensure the resilience of the health system, strengthen the availability of health workers, primary care and the integration of care, and deployment of e-Health services.
Enhance the resilience of the health system, including by ensuring sufficient critical medical products and addressing the shortage of health workers.
Improve the accessibility and resilience of the health system, including by addressing the shortages of health workers, strengthening primary care and ensuring the supply of critical medical products.
Address shortages of health workers to strengthen the resilience of the health system and improve access to social and health services.
Strengthen the resilience of the health system by ensuring adequate supplies of critical medical products and a balanced distribution of health workers, and by investing in e-Health.
Mobilise adequate resources and strengthen the resilience of the health system, including by deploying e-Health services.
Strengthen the resilience of the health system and ensure adequate and equal access to healthcare.
Address shortages of health workers and ensure an adequate supply of critical medical products and infrastructure to increase the resilience of the health system. Improve access to quality preventive and primary care services.
Improve accessibility of the health system and strengthen its resilience, including by responding to health workforce's needs and ensuring universal coverage to primary care.
Strengthen the resilience and capacity of the health system, in the areas of health workers, critical medical products and infrastructure. Enhance coordination between national and regional authorities.
Strengthen the resilience and accessibility of the health system including by providing additional human and financial resources.
Strengthen the resilience of the health system, including by mobilising adequate funding and addressing shortages in the health workforce and of critical medical products. Improve the accessibility and quality of health services.
Improve the resilience of the health system by ensuring appropriate availability of health workers. Accelerate reforms to improve the governance of the health system and e-Health.
Strengthen the resilience of the health system with regard to the health workforce, critical medical products and primary care.
Strengthen the resilience of the health system, including by tackling the existing shortages of health workers and stepping up the deployment of relevant e-Health tools.
Improve resilience, accessibility and effectiveness of the health system, including by providing sufficient resources and accelerating the deployment of e-Health services.
Strengthen the resilience of the health system and ensure equal access to quality health and long-term care.
Strengthen the resilience of the health system,  including in the areas of health workers and  medical products, and improve access to health services.
Strengthen the resilience of the health system in the areas of health workforce, critical medical   products and infrastructure. Improve primary   care provision and coordination between types of care.
Ensure the resilience of the health and long-term care system, including by providing the adequate supply of critical medical products and addressing the shortage of health workers.
Strengthen the health system's resilience and capacity, as regards health workers, critical medical products and infrastructure.
Ensure the resilience of the health system, including through adequate supplies of critical medical products, infrastructure and workforce.
United Kingdom
Strengthen the resilience of the health system.
The proposed recommendations for each country will be discussed in the Council, where Member States will discuss and vote on their final adoption. After their adoption, the Commission will monitor the implementation of the recommendations.
Private hospitals played a major role in the fight against the epidemic
Christine Schibler, General Delegate of the French Federation of Private Hospitals (FHP)
In view of the crisis, private hospitals responded immediately to the government's request to promptly deprogram non-urgent activity. We have postponed more than 500,000 interventions, making it possible to free up a large number of intensive care units to absorb the first epidemic waves.
However, the private sector was initially scarcely solicited even though public hospitals were said to be overloaded. In the Grand Est, one of the most affected regions, clinics rapidly freed 70 beds in ICU high-care. And yet, these beds remained empty for several days even as public hospitals were approaching saturation. FHP made an appeal in the media to expose these dysfunctions. Thereafter, cooperations were established, even though it was not until the increase in the necessary resources could no longer depend on a single healthcare actor. From these early stages, regional health agencies in several regions have drawn lessons to organize the care of patients by relying on establishments of all legal nature.
This was the start of a rebalancing with greater equality of treatment in the referral of Covid-19 patients and a better organization between healthcare actors, regardless of the legal status of the establishments. For example, at the end of March, in Île-de-France, the ARS (The Regional Health Agency) asked all health facilities to double their intensive care capacity in just three days to deal with the epidemic wave. In the end, more than a third of the new intensive care beds were created by the private sector, which received a third of the intensive care patients in Île-de-France.
We hope that this public-private cooperation, which proved its worth during the Covid crisis, will be set in stone, amplified, and taken as a structuring element in health policy.
Guaranteed financing
From the start of the crisis, and this is specific to France, the Minister of Health and the government made a commitment to all hospital sectors - including the private sector - of funding up to 85 % of last year's revenue. A decree to this effect was published early May. This will not be enough, but it will allow us to maintain the teams and protect the sector. Given this funding commitment, establishments have kept their teams working without resorting to a partial reduction in the activity. In addition, a bonus of 1 500 euros is provided for public sector employees who have been in contact with Covid patients and 500 euros in the departments least affected by the health crisis. The government has implemented a principle of transposition in the private sector, but we are still awaiting the terms.
Finally, the Ministry of Health launched a major national concertation which will deliver its conclusions by mid-July to reach a major plan around 4 subjects: human resources, investment, territoriality and the impact of simplification. Massive investments are planned but we do not yet know if these financial packages will be balanced between the sectors. We remain extremely cautious even though the Prime Minister and the Minister of Health repeatedly mentioned the private hospital sector in their speeches. We have called for not confining ourselves to the problems of the public hospital, for what promises to be a profound restructuring of the health system.
Cooperation between different hospital sectors and healthcare actors has enabled our country to absorb the first waves of the epidemic. Let us learn from this crisis to build a balanced health system that is equally supported by all health actors.
A slow recovery
In departments classified red, for example in Île-de-France, activity picked up overall at 30%, and at 40-50% in other regions classified green.
FHP published a quality and safety Charter for patients, to reassure them and prompt them to return to hospitals. Many private establishments have equipped themselves with digital tools, such as remote services. In general, this crisis has accelerated digital development. Here too, we will be able to capitalize on an acceleration of digital uses by patients and healthcare professionals.
Liberal practitioner unions are numerous in France and unfortunately do not always speak with one single voice. The recovery is also complicated for them, they are both impatient and worried.
Moreover, France is still generally experiencing unsatisfactory situations in terms of supplies for certain protective equipment, tests and molecules used in anaesthesia. We have had direct contacts with manufacturers. In several areas, the State has taken on a requisition role - it buys, regulates, and redistributes - but one wonders if it is really its role to make purchases, given the many problems encountered. Here again, we will have to learn from a very centralized management by the State of the supply of protective equipment which has not proved efficient.
A dynamic organization with improvements to be made
At the FHP level, we quickly switched to a “crisis management” mode of operation.
We set up a crisis unit which met daily during the first months of the epidemic, including weekends. This crisis unit brought together 25 people, managers and executives from healthcare groups and independent establishments, representatives of the different branches of FHP. We also had to adapt to the constraints of confinement and install optimal telecommuting methods: everyone's responsiveness was extremely valuable.
In terms of information, we distributed to all our members, every day for a month and a half, a newsletter dedicated to the Covid crisis, "Le 20h". This daily newsletter was widely read by our members, twice as much as our usual communications.
Likewise, we were very present in the media. The president of FHP Lamine Gharbi was interviewed more than 80 times, participated in numerous TV and radio platforms and FHP generated more than 360 articles in the general public and medical print media since the beginning of March.
With the public authorities, information and exchange circuits were gradually put in place. At the beginning of March, hospital actors were not integrated into the ministerial information circuits. But quickly we were receiving internal notes and information from the Ministry and the ARS, with much more fluidity, transparency and speed, but we had to claim it. We were in daily contact with the Ministry of Health. This crisis management has also strengthened relationships between private hospital federations: FHP, and FEHAP (The French Federation of Private Non-Profit Hospitals and Social Care Establishments), Unicancer (umbrella organisation for all the French Comprehensive Cancer Centres) and FNEHAD (The National Federation of Hospital Care at Home), with whom we have a common position concerning, for example, the employee bonus.
In various regions, public authorities have developed expertise in crisis management. On the other hand, national steering, notably inter-ministerial - because the crisis concerned health, work, the economy, etc. -, will have to improve. We must all learn from the crisis.
European Federation of Nurses Associations
COVID-19 shows nurses run the healthcare systems!
Prof. Dr. Paul De Raeve, RN, MSc, MStat, PhD, EFN Secretary General
Florence Nightingale influence on healthcare systems is well documented historically, demonstrating change of the policy decisions benefiting patients and nurses. When health crisis occurs, the nursing profession is always at its frontline serving citizens and patients. In times of war and pandemics, when the citizens/patients need frontline support, the nurses are always at the frontline day and night. For that same reason, EU and national leaders take concrete and immediate actions to support frontline nurses.
In these times of pandemic and emergency situations, it is key to reflect on existing EU legislation to strengthen healthcare systems in the EU and importantly, support and protect frontline nurses while doing their job, putting their own lives at risk. The COVID-19 outbreak is having an unforeseen impact across all EU countries, and it is affecting all layers of society. COVID-19 is reshaping the EU political priorities, strategies and budgets to get the European Union acting as ‘one voice’. A new area of cooperation has arisen coordinating actions to tackle future health emergencies within the EU.
The main takeaway of the COVID-19 outbreak is that the European Commission needs to look for formulas to engage frontline into their decision-making processes, going way beyond consultations. This is a need and a demand of nurses at the frontline, as well as of citizens. If the European Commission and Member States fail in this, the whole of the EU institutions risk to be perceived merely as a bureaucratic complex of institutions that are not reliable in the context of health emergencies. The COVID-19 crisis is proving that keeping healthcare governance at the national/regional level creates patchwork, confusing and even upsetting EU citizens, and as such loosing trust in the EU.
The EU institutions should actively co-engage with the nurses, to be better prepared frontline. That way, all EU countries will be much better prepared for the next pandemic/health emergency. This EU Coordination can be done by focusing on the collection at EU level of robust data, from the nursing profession concerned, to assess the impact of not being prepared, to learn and being prepared for the next crisis. The Health Security Council should engage in dialogue to make fit-for-purpose solutions that can be deployed frontline. A frontline approach, supported by the EU institutions, Parliament, Commission and Council, is urgently needed to protect EU citizens and its health workforce in times of emergency and crisis.
The EFN continues being engaged with all interested EU and health stakeholders to do what is best for the frontline nursing profession across the EU and Europe, and in doing so, maximising the health outcomes of patients affected by the COVID-19 disease.
Florence Nightingale challenged the poor working conditions for nurses and set standards for hospital conditions and patient care that became foundational to the development of modern nursing. She advocated to elevate the nursing profession’s reputation with better education standards, which in turn encouraged more women to enter the profession than ever before. EFN encourages EU Institutions to support nurses and nursing with fit-for-purpose policies.
European Working Group of practioners and specialists in Free Practice (EANA)
Practitioners in free practice on the front line during the pandemic
Dr Philippe Boutin, Président
In Europe, practitioners in free practice working in private hospitals have been on the front line, sometimes risking their own lives to face an unprecedented health crisis. Lack of protection, lack of medical information, lack of coordination and resources at the beginning of the crisis, the response of practitioners in free practice was really strong, even though they were sometimes «under-used», which many deplored. Doctors of all status have also demonstrated an extremely rapid adaptability, with organisational changes carried out within 24-48 hours, the management of patients in double rows, etc. and the search for solutions, the increased use of telemedicine, mutual aid, etc. They wanted to be useful above all, to assume their role as caregivers.
The epidemic has not developed equally everywhere in Europe, so that private physicians have suffered in different ways, with strong disparities according to countries, territories, and health policies. Practitioners and specialists in free practice did better in the countries where the pandemic hit the least, in Austria, Switzerland and Germany in particular. Overall, the management of the pandemic has resulted in an abrupt drop of activity due to government decisions to reorganise ICU beds, managing shortages of protective equipment, anaesthetic products and molecules, or simply to the drop of patient numbers seeking medical practices for fear of contamination. Most private physicians have suffered significant economic harm, with little hope of receiving financial compensation from the health system.
How do you foresee the future?
The recovery looks complicated, but it is urgent that the activity resumes. The principle of free medical practice is to be as close as possible to the patient and to anticipate a possible secondary health crisis, due to the lack of diagnosis during the pandemic and follow-up of patients with chronic pathologies. Doctors in free practice are worried because the signals are red with a 40% drop in heart attacks in France for example during the lockdown or the occurrence of very serious pathological cases, pathologies that we no longer saw. We must provide a security response inside our establishments to recover all these patients who are afraid of having contact with others. In medicine it is not only a matter of treating emergencies, we must continue to focus on prevention.
The pandemic has allowed the take-off and acceptance by the population of telemedicine, which is a very good thing for the organization of health in the territories.
Covid-19, an opportunity for the Europe of Health ?
The post-crisis period should not disrupt health systems in the different European countries. The Europe of Health must emerge from the crisis, but this is not a new demand. More than the observance of disparities, we must have a coherence of health systems in Europe, which must be at the centre of all attention: a coherent, unified health system, a common crisis management worthy of the name. This crisis will perhaps make it possible to finally have a European coordination in terms of health crisis and management of health systems.
Private practitioners in Europe all share the same feeling of belonging to a large family. They have the same attachment to their art, the same functioning, and the same objectives. They want to preserve their independence in their work but also provide a social and liberal medicine.
COVID-19 and the use of communication technology
Ivone Werner, UEHP Executive Assistant
Using communication technology to work around the need to meet in person is nothing new and it need not be electronic: regular, reliable mail service supported the introduction of both Mail Order Catalogues and Distance Learning courses as far back as the 1840s.
When the internet exploded into the public consciousness in the late 1990's, the game changed significantly: Online banking, online universities, multiplayer gaming, internet gambling, online dating.
Telework and Telecommuting, terms coined in 1974, went from novelties in the 90s to commonplace in the early 2000s. This is particularly noticeable in industries like software: Automattic, the company behind more public websites than any other in the world, has over 1000 employees, working almost entirely from home since 2005 - there are many more like it.
While remote work is not an option for everyone, remote services are much more accessible. In most European nations, online tax return submission has been a reality since the turn of the century.
So, what has changed?
Well, everything has changed. (In case you had not noticed). If necessity is the mother of invention, then, Covid-19 is the mother of all necessities. Teleworking flipped overnight from being a perk of the tech-savvy to an economic imperative. In March of 2019, teleworking was a privilege enjoyed by around 3% of the workforce in western democracies. In March of 2020, many of the governments of these same democracies decreed that their citizens must telework beginning immediately.
Applications like Zoom, already widely used by teleworkers and teenagers, have become household words.
Online communication is no longer the sole domain of the enterprise and the socially active teenager: your grandparents are forced to adapt to WhatsApp, Facebook or Apple's Facetime, your 8-year-old is required to use Zoom or Microsoft Teams or Google Meet.
But what about Health?
Telemedicine, another term coined in the 1970s, has similarly seen an overnight transition from a useful complement to traditional "hands-on" healthcare to urgent requirement.
A 2018 report on E-Prescription by the Health Information and Quality Authority of Ireland noted that electronic drug prescription had been available in some Nordic countries since the 1990s and was ubiquitous across European member states by 2012. In all such services, a prescription might be provided digitally - more recently via smartphone - but rarely without an in-person consultation with a doctor. More generally, Telemedicine was reported to have rapid uptake in upper-income nations in a World Health Organization report back in 2010. That report describes the major success of telemedicine being limited to specific areas, with radiology far ahead, pathology, dermatology, and psychology to a lesser extent, and very little else available. 
Not so today! Realizing that a visit to the doctor, is not only avoidable but potentially more dangerous for the patient than whatever else affects them, doctors are adopting virtual consultations and e-prescriptions en masse.
It is necessary to take a beat here and recognize that technology is not a cure-all. There is no robot to attach your loved-ones to ventilators if they are unfortunate enough to end up in the intensive care unit with a severe case of Covid-19: we have to depend on hands-on care and attention from heroic doctors and nurses for that. And there will never be a technology to replace the personal attention of a dedicated primary school teacher, or a hug from grandma. 
But you knew that too. What you may not have known, what many of us - like-it-or-not - coming to learn, is that there is a lot that we always assumed we had to be present for, which we can perfectly well achieve remotely.
The lesson here is that none of the underlying technologies here is new. The concepts behind these remote alternatives to traditionally in-person interactions have been around for a while, and the technologies have been relatively successful for some years, even decades.
But the general awareness and the assimilation into the daily lives of every patient, school student, grandparent and worker on the planet, near simultaneously, is both astounding and life changing.
One day soon, doctors will start receiving patients with minor complaints; life will return to mostly normal. But something will have changed forever. It will not be technology itself, though, it will be the awareness of what technology can do to enable many of us to more or less continue our lives from the safety of our own homes. An awareness that was imposed upon the entire world pretty much overnight. An awareness that will affect everything we do from now on.
Restarting the activity after the lockdown
Grigoris Sarafianos, President of the Panhellenic Union of Private Hospitals
How has the private healthcare sector been affected by the pandemic in Greece?
The private sector operated in unprecedented conditions during the months of the pandemic.
On the one hand, the Ministry of Health had agreed not to treat COVID 19 patients in private hospitals, and on the other hand, it had to take measures to deal with cases that would occur in private hospitals.
This meant a change in the way we operate, increased security measures for patients, relatives, working doctors, nursing and administrative staff as well as for our partners.
The drop in turnover for the months of March, April, May 2020 was 70-80% due to the ban on regular surgeries, the operation of outpatient clinics and the conduct of diagnostic tests and the fear of citizens entering health facilities due to fear of the virus.
Even pathological hospitalizations were drastically reduced due to the need to perform tests for COVID 19 before their introduction, which had to be covered by private payment.
As a result, the number of patients admitted to the Psychiatric Clinics has decreased, for the same reasons. The implementation of dialysis in the Artificial Kidney Units of Private Hospitals remained unaffected but with increased operating costs.
Today we are facing the problem of the survival of our health units. In collaboration with the Ministry of Finance, we have taken some measures to financially support the Private Hospitals, but it is uncertain whether they are sufficient to continue the operation of all.
How has the private healthcare sector in your country been included into the national emergency plan to face the epidemic?
The Ministry of Health's plan from the outset was to treat COVID patients in state hospitals and non-COVID patients in private hospitals.
At the same time, with a decision of the Government, the Private Hospitals were ordered for the needs of the health system for fear of a sudden escalation of the cases and in agreement with the Ministry we offered the beds of the Private Intensive Care Units at the disposal of the Ministry.
This meant increased operating costs of Private Hospitals, increased vigilance and permission from patients in Private Hospitals due to the satisfactory management of cases by State Hospitals thanks to Lock down.
This leads to a negative economic result for the Private Sector.
Today we will be called to participate in the plans for dealing with a possible second case next October.
What will remain after the crisis for the private healthcare sector?
We continue our operation, which was not interrupted for a single day and from 11/5 it was allowed to carry out 50%, compared to 2019, of regular surgeries, outpatient clinics and diagnostic laboratories.
However, the attendance is not the expected one due to the phobia of our fellow citizens to enter health care facilities for fear of transmitting the virus.
We believe that in order to return to the pre-COVID era, there will be a transitional period of a few months, provided that the number of cases decreases continuously and that a second wave does not occur in September.
Private clinics innovate during Corona
New service schedules, establishment of infection wards, procurement of protective equipment - the clinics have adapted to the coronavirus at lightning speed and in a variety of ways. In the process, they have developed various particularly creative ideas.
The list seems endless: capacity expansions, procurement of respiratory equipment, fever measuring stations, telephone hotlines, staff training. In an unprecedented effort, the clinics throughout Germany have countered the consequences of the corona virus and developed and implemented a variety of measures under high pressure. The daily routine was turned upside down from one day to the next. Despite the enormous burdens, some clinics have even managed to develop special therapeutic and practical offers for dealing with Corona and its consequences. Here are some examples from the clinics in private ownership:
Online to the doctor  
The Helios clinics set up a video consultation at the beginning of April to secure outpatient treatment options during the corona pandemic. The offer can be used by patients regardless of their place of residence or state of health. One of the places where it was launched was the Helios Klinikum in Berlin-Buch, where patients can reach a team of 70 specialists via video consultation. All you need for the consultation is a device with a front camera, display and connection to the Internet, as well as a health insurance card or identity card with private health insurance. Prescriptions and sick notes, which are issued during the video consultation, then reach the patients by post. Unnecessary journeys and especially waiting times for check-ups can be avoided. The video consultation is a great relief especially for the oncological center of the clinic. Immuno-weak patients can be better protected against infection, but still receive the necessary care and treatment.  
Digital home visit  
It is not a substitute for rehabilitation, but it is a valuable aid for all patients who were unable to start their rehabilitation or had to stop it early due to the corona pandemic: The digital "Dr. Becker home visit" has been coming to the house six days a week since the beginning of April, completely in line with the rhythm of inpatient rehab. In the form of a patient newsletter, the Dr. Becker clinic group sends out impulses on sports exercises, mindfulness training, relaxation techniques or healthy nutrition. The concentrated knowledge comes from all indication areas that the clinic group offers: psychosomatics, neurology, orthopaedics as well as cardio- and psychocardiology. The focus is on psychosomatic content. Originally, the digital home visit was only designed for patients of the Dr. Becker clinics who were not allowed to come to rehab due to the corona pandemic. However, due to the many positive feedback from its own patients, the clinic company decided after a short time to make the offer public.  
Two special corona rehabilitation concepts  
A rehabilitation measure was also developed by the Dr. Becker Clinic Group to alleviate the expected psychological and social effects of the corona crisis. The doctors of the Dr. Becker Clinics are thus taking up a recommendation of the German Academy of Natural Scientists Leopoldina, published in mid-April. The experts pointed out that corona threatens not only the respiratory tract but also the human psyche. Loss of control, social isolation and traumatic experiences such as domestic violence or the death of a loved one through Corona can trigger mental illnesses or intensify existing disorders. With their new range of services, the Dr. Becker Hospitals are focusing entirely on the performance elements of psychosomatic rehabilitation in order to support the patients' personal responsibility and provide guidance for this. In developing the concept, the physicians were able to draw on their experience with the "Corona Care Telephone", which the Dr. Becker Hospital Group had already set up for its employees at the beginning of the crisis.  
The chief physicians of the median clinics have developed a rehabilitation measure for corona patients and started it at the end of March. Patients with a severe course of Covid-19 disease and a significantly weakened condition, but who do not require isolation, are treated. The therapy takes particular account of the pneumological functional limitations to be expected in the course of the disease and is suitable both as a follow-up treatment immediately after hospitalisation and as a curative procedure. Guided by physiotherapists and occupational therapists, patients are slowly re-mobilized, their muscles are strengthened, endurance and circulation are trained and practical skills for everyday life are practiced. The rehabilitation concept takes into account in particular the pneumological functional restrictions expected in the context of the disease - with the aim of restoring and normalising respiratory function. In addition to the benefits for corona patients, the Median Clinics also offer relief for acute hospitals by admitting patients earlier.  
Online courses and communication aids  
Since the end of March, the Asklepios clinics have been offering self-help training on stress management, mindfulness and relaxation via the Internet due to the Corona crisis. The free e-health modules are intended to act as "digital companions" for help functions that are currently not possible due to the restrictions in personal contact. The offers can be used around the clock via PC or as an app with a smartphone. Interested parties can access the modules via the Internet address www.asklepios.com/coronavirus/selbsthilfe or, after registering on the Internet for the first time, via the app with the smartphone. The small audio-visual courses take ten to fifteen minutes each - some units can accompany the users for four to five weeks, for example to repeat mindfulness exercises regularly.  
The clinic company wants to offer uncomplicated help for the mental challenges people face in this difficult situation with the online self-help courses tailored to the psychological needs. Because the drastic measures, such as the ban on contact, can cause anxiety and lead to isolation for many people. The e-health modules help to relax or even reduce negative thoughts. The programs are practice-oriented and created by experts and offer guidance and support on "Mindfulness", "More relaxation", "Less ruminating", "Gratitude" and "What is stress?", "To stay active at home" and "Daily plan for the state of emergency".  
The Asklepios-Westklinikum Hamburg also responded with a special service to the visiting bans and restrictions that have applied to all hospitals since mid-March. Especially for patients who cannot access Skype, Whatsapp and Co and are therefore "cut off from the outside world", the hospital offers a service telephone number through which relatives and friends can send their greetings, photos, videos and (voice) messages can send to loved ones in the hospital. The clinic then takes on the task of forwarding the messages to the patients.  
Restarting the activity after the lockdown
In Austria the resumption of activity is ongoing and private clinics choose different strategies to renew with a normal operating mode.
Private clinics have been affected by the crisis in very different ways. Some establishments have been involved in the national emergency plan and have played a key role in it, like the PemiQaMed hospitals in Vienna.
Public hospitals of the Vienna Hospital Association (KAV) and the Viennese clinics of the PremiQaMed Group have joined forces during the Corona crisis, securing together the medical care of the inhabitants of the City of Vienna. “Keeping the health system efficient in the fight against the corona pandemic must remain a top priority. However, we should not forget that there are also patients with other acute conditions that need to be treated. We are part of the health care system of the Viennese population - we face up to this responsibility even in these challenging times and make an important contribution with our cooperation", emphasized Julian Hadschieff, CEO of the PemiQaMed Group during a press conference on 18 April 2020 .
The PremiQaMed Group has provided capacities to relieve the KAV hospitals and the private hospitals Döbling, Confraternität and Goldenes Kreuz have taken over urgently needed operations from the KAV hospitals. “The KAV is currently pooling all its resources to deal with the corona crisis. However, this should not be at the expense of the entire health system in the long run," said Vienna's City Councilor Peter Hacker,"therefore, in the future there will be the possibility to refer patients from the municipal hospitals to private hospitals for treatment."
Cooperation enables faster OP appointments for necessary operations
"We will treat patients from the KAV hospitals who are not infected with COVID-19 and who require urgent surgery” informed Werner Fischl, Managing Director of the PremiQaMed private clinics, “together we are taking the important step to relieve the KAV hospitals and to reduce the increasing waiting times for pain patients due to the corona-related capacity bottlenecks. Patients will be treated in the general fee class, so they do not need supplementary health insurance."
Translation of a press release sent out on 18 April.2020 via APA OTS
Restarting the activity after the lockdown
Niccolò de Arcayne, Head of Institutional and International Affairs at AIOP
From the 4th of May, less restrictive measures adopted by the Italian Government, allowed the citizens to put their lives back together, in a very slow and controlled way.
All these new measures brought the Country to the end of the lockdown situation, and the population is now gradually re-starting its daily activities, with the situation that seems under control, and the Covid-19 related contagion that in the center-south regions reached its minimal values - in terms of new infections - from the beginning of the emergency situation. This brought Mr. Brusaferro, President of the National Institute of Health, to declare that “the number of cases is coming down to a low level in all of Italy's regions, including Lombardy”.
As everybody knows, from the first days of March 2020, each Italian region, with and official ruling of their own President, followed the Ministry of Health’ indications and decided to stop the ordinary and non-urgent activities of the public and private hospitals, in order to make them ready in case of necessity of supplementary beds and medical staff. These decisions negatively affected the activity and the economic sustainability of a significant number of private hospitals, especially in certain southern regions (for example: Calabria) where the contagion has spread below the initial expectations. Despite the end of the “critical” Phase 1, not all the Regions yet authorized the recovery of the ordinary and non-urgent activity, and for this reason, the Italian Association of Private Hospitals addressed a letter to the Ministry of Health, Mr. Roberto Speranza, and to the President of the State-Regions Conference, Mr. Stefano Bonaccini, asking for a concrete intervention in favour of a complete re-start of the listed above activities. The Italian Association of Private Hospitals is also conducting several government affairs activities, in order to favour the communication with the Government, and explain to the Minister of Health and the Minister of Economy what is the real economic situation of a big part of private hospitals, that definitely deserves to be recipients of economic aid. These activities are also aimed to favour the total inclusion of physicians and health professionals of private hospitals in the serological screening activities launched and covered by the competent territorial health authority, that in certain Regions/Provinces, have been addressed only to the personnel of public hospitals, leaving to private hospitals the economic and organisational burden of and independent organisation.
The role of the Italian private hospitals, during the Phase 1 of the emergency, has been crucial in all the 20 Regions, with a massive contribution in terms of ICU beds. In fact, the private hospitals sector, during the Covid-19 emergency made available 958 ICU and Sub-Intensive Covid-19 beds, 9.401 long-term Covid-19 beds and 25.103 no-Covid beds. These numbers testifies the important part played by private hospitals during the hardest part of the emergency, in Regions like Lombardy, where we assisted everyday to a huge number (hundreds) of contagion.
In Lazio Region, for example, the contagion are now growing very slowly, with an average of 20 daily cases for the entire Region, half of whom are detected and distributed in the territory of the city of Rome.
In general, life in Italy is trying to re-start, with a general re-opening of the largest part of our commercial activities, even if, a significant part of big companies (multinationals and consultancies) announced that they will not re-open their offices before the next September, in order to proceed in the most safe way possible.
Restarting the activity after the lockdown
What is the impact of the crisis on the current hospital activity in your country?
The Spanish private health sector has lived through three very different scenarios:
First, we have the facilities which have lived the pandemic at 150% of their capacity, then, in other areas, those which have been used as a clean circuit (for non-Covid patients) for the public network so that it could focus on infected patients; and finally, in those territories where the incidence of infected people has been very low, private health centers only treated Covid patients sent by referral from mutuals and insurers without the need for referral by public centers. However, they all have a common denominator: the deprogramming of non-urgent or elective care, thereby causing a reduction of their revenue by more than 85% during the dominant months of the crisis.
As for the return to activity, most autonomous communities have resumed their outpatient activity and scheduled surgeries, although their overall activity does not exceed 30-40% in the bulk of the territories because of the uncertainty of patients rescheduling their consultation. However, specific circuits have been implemented to ensure safe spaces that limits crowds and facilitate the recommended distancing. Most private hospitals are currently without Covid patients.
Although during the months of confinement care processes have been reinforced via telematics or via teleconsultations, in recent weeks, in line with the de-escalation process, face-to-face care has been incorporated through new protocols which are likely to remain permanent.
The new processes generally integrate measures that are applied both in outpatient consultation and in emergency and operating rooms:
  • A separation has been put in place in covid-19 clean and safe circuits for patients and healthcare personnel.
  • Hygiene and disinfection measures have been increased, with the frequent use of disinfectant for both hands and surfaces, and the obligation to use masks and gloves for doctors.
  • Diagnostic tests are carried out in a generalized way to all the patients who are going to be operated on or are in the delivery rooms.
  • Patients consultations are scheduled further apart to avoid crowds in the waiting rooms.
  • New spaces have been created to promote greater social distancing.
  • Visits to inpatients are limited.
  • Whenever possible physical examination will be carried out at a safe distance.
  • General recommendation to patients, except when strictly necessary, to arrive at consultations without companions and with greater punctuality to limit contact with other patients.
  • And even preventive quarantines are assessed in necessary cases.
It is necessary to convey a sense of trust to the population, for patients to know that they can go again to their doctors, specialists and usual health centers. It is safe since numerous, precautionary and preventive measures were taken against the coronavirus.
Has this health crisis brought about changes in the role of the private hospital sector within the National Health System?
All health centres in Spain have cancelled ordinary medical activity to deal with the health emergency and all are subject to public health indications and protocols. It should therefore be noted that the private health sector has been providing a public service since the State of Emergency was declared with full dedication and responsibility towards Spanish society.
More specifically, private healthcare has cared for more than 25,000 hospitalized Covid-19 patients and has treated about 1,200 patients in ICU, sometimes reaching double of these units in areas such as Madrid and Barcelona. And all this with full and absolute collaboration, always at the full disposal of both the Ministry of Health and the Autonomous Communities.
However, now we advocate the maintenance of employment and full productive capacity in the fight against COVID-19, and we need urgent measures to enable the financial viability of private hospitals and clinics in the face of the serious liquidity crisis that we are experiencing.
Restarting the activity after the lockdown
What is the impact of the crisis on the current hospital activity in your country?
The impact was and is brutal. From the beginning, private hospitals took part in the national fight against COVID-19 and in that sense, all non-urgent surgeries and scheduled consultations were cancelled, in compliance with the rules set by health authorities.
Activity then fell to around 20% in March and April. Measures of social distancing and confinement rules have also led citizens to avoid leaving home, even to carry out their necessary health treatments. Portuguese private hospitals have quickly adapted to this new reality and are hard at work to increase patients´ safety and trust. Activity is currently at 70%.
In the case of the Portuguese NHS, the Minister of Health has already recognized that, after 2 months, 51 000 surgeries remained to be performed, 540 000 hospital specialty consultations and there were 400 000 fewer emergency episodes compared to the same period in 2019. In terms of primary care, about 840 000 consultations and 990 000 nurse consultations had not been carried out until April compared to the same period last year.
On the other hand, there is a “new normal” in the provision of care, which requires different procedures and practices (COVID-19 tests prior to surgery, use of personal protective equipment, rules of social distancing, space disinfection, etc. ) and the capacity of existing resources was also affected. These new rules and their consequences apply in the same way to hospitals, regardless of whether they are public, private, or social.
Did this health crisis bring changes to the role of the private hospital sector within your national health system?
The COVID-19 crisis brought health to the centre of the political discussion. In Portugal, the health system had a good assistance performance and the NHS is unanimously praised. Whoever ideologically had prejudices against private health activity is now seizing the opportunity to try to reinforce the idea that it was the public base of the system that enabled this positive response, forgetting that the impact of the crisis did not choose countries for their health system nor is there any proof that countries with a greater participation of the private sector have performed worse (see for example the case of Germany or Austria).
Private hospitals have always been available to participate in the national fight against COVID-19, whether treating infected patients or making beds available for other non-COVID patients. Until mid-April, the collaboration of private hospitals was very harmonious, but from then on the authorities understood that the (public) NHS would be sufficient to respond to the crisis and the private sector was left behind, except in the case of citizens with health insurance, in which insurance companies entered into a partnership with hospitals.
In this phase of recovery of health activity, the Minister of Health has already stated that there may be a need to resort more to private hospitals to reduce waiting lists and private hospitals have already confirmed their availability.
FHP Charter of Commitment “Caring for you, reassuring you”
The French Federation of Private Hospitals and the Conference of the Presidents of the Medical Boards of Private Hospitals have co-signed a Charter of Commitment entitled "Caring for you, reassuring you", built around 10 axes aimed at reassuring and securing patients regarding their conditions of care in hospitals and private clinics in this epidemic context.
“The Covid-19 epidemic has disrupted the activities of our institutions and health professionals, who have been able to adapt and mobilize fully to meet the challenges of the health emergency. Although still committed to the fight against the pandemic, our institutions must now focus on reassuring our fellow citizens for whom a return to care has become essential.
For several weeks now, we have been alerting people to the importance of returning patients to doctors' offices and healthcare institutions to alleviate the risks inherent in giving up healthcare. Containment measures and the fear of contamination have led many patients to postpone their care. In order to ensure that care can be resumed under the best conditions, it is essential to communicate with patients by reminding them of the measures implemented in our facilities to ensure the safety of patient care.”
Lamine Gharbi, President of The French Federation of Private Hospitals Dr Marie-Paule Chariot, President of the Conference of the Presidents of the Medical Boards of Private Hospitals
25-30 May
Digital Health Online Summit
26 June
Brussels, UEHP Council Meeting