When health systems are saturated, categories are forgotten: all public and private actors answered the call and threw themselves into the battle.

The impact of the epidemic is not ubiquitous
Some areas are more affected by the virus without anyone being able to explain why. In France during the first wave, the Ile-de-France and the Grand Est region were on the front line, and on the contrary, Occitanie or Normandy were spared. Today, all our attention is focused on the South East quarter of our country. Similarly, southern Italy was preserved, as was Austria on the plains, or Portugal, even though Spain was heavily impacted.
What is certain, however, is that the heterogeneity of health systems cannot intrinsically explain these differences. Why is it, for example, that the epidemic per capita ratio varies currently from 1 to 10 in Scandinavian countries with very similar health systems? The severity of the pandemic does not depend exclusively on the organization of care.

Responses to the crisis are exclusively regional
Many federal countries, such as Germany but also Italy or Spain, have autonomous regional health systems. In Germany, each Land has a health minister. Crisis management was done at the regional level with central coordination. However, when the health system was strained, the inter-regional transport of patients was activated. Nowhere has this really been modelled. No one had foreseen the cascade of events that health professionals had to face but they adapted.
A few international patient transfers occurred. From this point of view, Germany has shown great generosity welcoming French and Italian patients.
Similarly, care teams moved between the public and the private sector and between regions but also between countries, for example between Romania and Italy. In general, solidarity emerged between most-affected areas.

A Europe at work but inaudible
A European epidemic crisis cell sits in Brussels. It was very active throughout the first wave and, even today, the cell continues to issue recommendations, publishes synthesis and analysis but it is inaudible. European health ministers have met on numerous occasions without any apparent effect in our respective countries.
The crisis has revealed that health remains ultimately a national prerogative.
For the first time since the European Treaty in 1957, borders between Member States were closed, stopping free movement between countries was symbolically very strong. We closed those borders but not those between regions, but the geography of the crisis is not that of the States. We observe that the crisis has reinforced the notion of nationalism and national security: the other is seen as a foreigner and in fact, we have lost certain values of open-mindedness and exchange. Scientific speech, for example, carried and still carries weight at the national level: everyone listened to their own experts but not to those of their neighbors. The city of Marseille even wanted to have a scientific committee in Marseille! As if the scientific word carried no weight if it came from elsewhere. Despite all goodwill towards cooperation, the identity reflex of self-withdrawal prevails. We are interested in the neighbor's numbers, but not in his methods. Local authorities try to impose themselves when dealing with the concerns of the population which can hardly understand the possible involvement of a supranational regulator.

Competing Member States
The severe global shortage of personal protective equipment showed Europe in a situation of competition within its borders, and even direct competition between Member States. Everyone is trying to have a competitive advantage in terms of materials or molecules. The same situation will happen again regarding access to vaccines. As an economist, I find very intriguing the undisclosed contracts between pharmaceutical companies and the States. Europe hastened to declare that it would pay for all its citizens, and then each State declared the same... However, we could learn from the first wave the necessity to improve coordination between European actors while still preserving the decision-making competence of each country. Autonomy within each country borders but nevertheless a necessary responsibility in terms of health cooperation.

Are our institutions ready?
We need to reintroduce a “Risk Management" strategy to deal with the health crisis or with any other future danger, whatever the cause, and to establish operational bodies with European competences like economic regulation.
The urgency today is to ensure continuity of care in conjunction with the management of the Coronavirus. A recent paper in the scientific journal BMJ shows that a one-month delay in cancer management increases the risk of death by 10%.
No one had foreseen a crisis of this magnitude and leaders have shown a major commitment to find the best solutions and adapt. However, we need to improve the necessary resilience of our health systems, and what we have just experienced must be a lasting lesson. We have to find the critical "nodes" in the network structure and find a way to prevent their blocking.

Read the interview in French : here

Article in the November release of Global Salud from the Spanish Alliance of Private Hospitals.

Ilaria Giannico, Secretary General of UEHP, gives a first-hand account of how the pandemic has been experienced in other European countries and how they can serve as an example to Spain.

The Europe's Beating Cancer Plan aims to establish common standards in Europe to fight cancer. Which priorities have been identified by the BECA commission that you chair?

Our working document is a first step for the European Parliament and its objective is to have an impact on the proposal which will be presented by the European Commission. This proposal will then be discussed between the European Parliament, the European Commission and above all the Member States, which have a very important voice at the discussion table. Europe's Beating Cancer Plan must above all make it possible to reduce health inequalities in Europe, despite the fact that the organization of health systems remains the prerogative of each Member State. A common policy at European level should however make it possible to achieve progress. For my part, I am pleased that cancer has been placed at the top of the EU agenda.

One of the most important domains of action we have identified is prevention, simply because more than 40% of all cancers are preventable through coordinated actions on individual, social, environmental and commercial health determinants. Fight against tobacco, harmful alcohol consumption, sedentary lifestyle, unhealthy nutritional habits, exposure especially to chemicals, vaccination campaigns, etc., the areas of action are multiple. Prevention is therefore a major component, offering a broad field of action in which health care institutions and healthcare prescribers have a key role to play, in order to change behaviours, promote good health practices, and reach populations that are most at risk or socially excluded.

Another central aspect is screening and early detection, an area with significant disparities between European countries, to the extent that some of them do not have standardized cancer screening procedures. Beyond setting up programs, we want to encourage the use of new technologies and innovations: biology (genomic signatures), scanner imaging for lung cancer detection, etc.

Then we have the more complex aspect of access to patient-oriented treatments. This issue at the European level is currently dominated by that of medicines, partly due to certain shortages, but mainly because the European Union has a strong competence in the matter, guided by axes included in the European Commission's Pharmaceutical Strategy: equitable access to cutting-edge medicines and treatments, at an affordable price, fight against shortages, access to innovation, etc.

In the field, many cancer patients in Europe simply encounter difficulties in accessing protocolized treatments, and we see strong disparities between European regions, in terms of the quality of treatments and access to surgery and radiotherapy for example. We therefore believe it is essential to formalize and standardize quality assurance, on the basis of authorization criteria, as it is done in France and in other countries, for performing cancer surgery, radiotherapy and chemotherapy. I have also proposed that the Organisation of European Cancer Institutes, chaired by Prof. Thierry Philip and which certifies cancer reference centres, could be activated to ensure that there is at least one accredited reference centre in each European country, which is responsible for innovation, primary treatments and a certain form of organisation of clinical research. These centres could operate as a network. This could be a line of approach that would allow us to move forward on common bases.

Then there is the post-cancer period, a component which is well developed in the French cancer plan, which includes psychosocial, socio-aesthetic and financial aspects among others. I am campaigning for the generalization of the right to oblivion, which is currently deployed in only 4 European countries and which I would like to see generalized in all the countries of the Union.

What actions can be taken?

A central lever for action is the sharing of knowledge and data. Data collection is extremely uneven and heterogeneous from one European country to another and information is only partially centralized. The idea would be to deploy cancer registers, to make them communicate and link them to one or more big data platforms, which would collect both clinical and biological hospital data, data from the National Health Insurance, but also "real life" data that provide social, environmental information, etc. in order to improve the understanding of the disease and to contribute to personalized medicine. In addition, there are already networks that help pool knowledge, such as the European Reference Networks, which bring together healthcare professionals from all over Europe to share their expertise on complex diseases, such as paediatric cancers. Two of these networks are dedicated to rare cancers.

The pooling of knowledge also underlies research: fundamental, translational, interventional, clinical, but also research in social sciences and humanities, and in particular research on health inequalities and environmental and social determinants. The Horizon Europe funding program will include a significant cancer component.

There is also, very strongly supported by the commission, the will to set up common training programs in close connection with European learned institutions. Training health professionals better and more regularly, in a multidisciplinary manner, training them in new professions (genomic medicine, artificial intelligence) is a priority, as is therapeutic education and the training of patients and their families, and in particular young people.

What do you believe will be the main obstacles to a uniform implementation of a cancer plan in Europe?

Some points of the plan will be put into legislative terms, binding for the Member States, such as the tobacco directive or the regulations on medicines, but many points will be recommendations and each State will decide how to transpose them in its country. There are many levers that can be operated but the systems are not equal... so not everything is going to be fixed only with legislative measures. In any case, such a plan will bring major advances for all the countries.

A large part of the proposal, in order to be effective, relies upon the good will of governments, their ability to act collectively, but also on the agility of actors in the countries, such as health institutions, including private health establishments, members of UEHP. The hardest part of the battle will be to demonstrate to the Member States, by referring to examples from other Member States, the benefits and opportunities brought by cooperation, interpenetration, strong and lasting commitment to quality assurance, registers, screening, etc. This could be considered within the framework of a European Cancer Institute.

The European Commission began to lay out precisely what it would do with more power over health policy, by publishing yesterday the Factsheet "A European Health Union: tackling health crises together - Coronavirus impact and response".

The Commission is proposing to:

• declare emergency situations at EU-level to ensure EU measures
• take risk management decisions at EU level
• harmonise EU, national and regional preparedness plans
• regularly audit and stress-test preparedness plans
• monitor supply of medicines and medical devices and mitigate shortages.

The Factsheet is available at the following link in 23 languages: here

As first steps, the following activities starting in 2021 will pave the way for better data-driven health care in Europe:

• The Commission proposes a European Health Data Space in 2021;
• A Joint Action with 22 Member States to propose options on governance, infrastructure, data quality and data solidarity and empowering citizens with regards to secondary health data use in the EU;
• Investments to support the European Health Data Space under the EU4Health programme, as well as common data spaces and digital health related innovation under Horizon Europe and the Digital Europe programmes;
• Engagement with relevant actors to develop targeted Codes of Conduct for secondary health data use;
• A pilot project, to demonstrate the feasibility of cross border analysis for healthcare improvement, regulation and innovation;
• Other EU funding opportunities for digital transformation of health and care will be available for Member States as of 2021 under Recovery and Resilience Facility, European Regional Development Fund, European Social Fund+, InvestEU.

More here

• Preventing transmission
• Ensuring sufficient workforce capacity
• Providing health services effectively
• Paying for services
• Governance

Find here the registration links to the upcoming webinars of the European Observatory on Health Systems and Policies available. 

Those 11 associations today form the European Alliance for Value in Health in order to CONNECT different stakeholders to CREATE conditions and INSPIRE others. The vision of the Alliance for a value-based, sustainable and patient-centred health system is one where:

1. Outcomes that matter to people and patients, as well as benefits valued by health systems and societies, are at the centre of decision-making;
2. Interventions and services addressing prevention, social care and healthcare are organized in an integrated way around people and patients;
3. Resources are allocated towards high value care and prevention, with outcomes and costs of care measured holistically;
4. Continuous learning, education and healthcare improvement is based on evidence, and supported by data and insights;
5. Innovative ways of care delivery are fostered;
6. Financing models and payments reward value and outcomes.

The Alliance will work together towards this goal through building a common understanding of the enablers and barriers to transforming health systems in this direction, through sharing and spreading knowledge and best practices and through engaging with policy makers and stakeholders at European, regional and local levels. Among other things, the Alliance will:

• Issue joint opinions on current health policy topics or the specific elements and enablers of a value-based system;
• Bring together the members of our organisations to network and exchange views;
• Connect with other actors at European, national or local level that work towards the same goals;
• Provide a hub for news and knowledge.

Read the full press release here

Last 17th November, UEHP was invited to speak to the launch event of the Health first Europe Report "Identifying the gaps between evidence and practice in the prevention of surgical site infections". The report shows a striking gaps between evidence-based measures suggested by official guidelines and medical practices in European hospitals which represent a serious concern for the safety of European patients. Surgical Site Infections (SSIs) are infections that occur within 30 days following a surgical procedure and affect either the incision or deep tissue at the site of the operation. Their costs in Europe is up to 19 billion euros per year. We all need to play our role to protect and promote patient safety while decreasing the rate and burden of infections, especially in relation to AMR bacteria. SSIs are largely avoidable and up to 50% can generally be prevented through the successful implementation of clinical practice guidelines. 

The report includes a paragraph written by our President, Dr Garassus, on the current challenges to implement an infection prevention approach on European healthcare systems and how to overcome them on short and long term. 

Health First Europe Webinar Tuesday 17 November 2020 was dedicated to Surgical Site Infection. UEHP presentation: be simple, make it clear and transparent “Collect and Correct”! (to collect information and to correct malpractices)

Extract from Dr Paul Garassus’ presentation

Surgical site infections are caused by bacteria that get in through incisions made during surgery. WHO recommends 29 ways to stop surgical infections and avoid superbugs. Hygiene in hospital starts with simple process as “Hand drying in hospitals” (cf. European Tissue Symposium, Professor Marc Van Ranst). The key success is not to have big ideas, but to implement them. A collaborative process is required among hospital staff. Why international working groups are useful? For a positive strategy to improve quality and to limit severe adverse events SAE. The goal is not to determine standards on a mean value, but to propose incentives to reach best practices.

Challenges and Solutions “Primum non nocere” et “Si vis pacem, para bellum” (against infection)

With general data coming from a wide European hospital range, all professionals could easily know their individual performance. A positive attitude can emerge from European data. Europe for Health is a chance. That is the only one way considered as an international benchmark to impose a quality culture in hospitals and to compete all together to the same goal, a high-quality level, limiting patient harm and extra-cost related to adverse events. All information is collected and analysed by medical staff and quality managers. The full implication is required for the key success process. Then based on results, comparison by year and hospital categories, all professionals are informed on their position. Based on these data, then have to develop their own strategy to reach the top level on quality results. Where to invest? In prevention including initial formation for MD, standards and process, SAE reporting using specific codes, and peer review developing a collaborative process.

During the launch event of the report, our President was invited to present the UEHP position on SSI, how private hospitals are trying to prevent hospital infections in the surgical care, with some case studies from our member hospitals.

The full report is available here

About the 2020 edition: The 2020 edition of Health at a Glance: Europe focuses on the impact of the COVID‑19 crisis. Chapter 1 provides an initial assessment of the resilience of European health systems to the COVID-19 pandemic and their ability to contain and respond to the worst pandemic in the past century. Chapter 2 reviews the huge health and welfare burden of air pollution as another major public health issue in European countries, and highlights the need for sustained efforts to reduce air pollution to mitigate its impact on health and mortality. The five other chapters provide an overview of key indicators of health and health systems across the 27 EU member states, 5 EU candidate countries, 3 European Free Trade Association countries and the United Kingdom. Health at a Glance: Europe is the first step in the State of Health in the EU cycle.

You can find the publication here