Wojciech Dziworski

Senior Economist and Political Analyst, Innovation and Healthy

Ageing, DG Health and Consumers, European Commission

Transforming Long Term Care in Europe : Improving Quality and Ensuring Access

Transforming care in Europe

Wojciech Dziworski

Innovation for Health and Consumers UnitDG SANCO

European Commission

Ageing and care challenges

Chronic conditions

Workforce shortage

Financial unsustainability

Health inequalities

HLY vs LE

Ageing society

Age dependency ratio Age-related total spending in % of GDP

Ageing – global challenge

Source: Ageing Report 2009, OECD*data for 2000 and 2050

EU27

Japan

US

2010 205023,2

13,711,1

27,8

16,7 16,6

Number of working age population for one older person (+65)

New paradigm of ageingfrom to

societal challenge major opportunity

burden asset

passive care pro-active care

curing diseases improved functioning

Social protection - contributions from Europe

• Europe 2020 / European Semester (Country Specific Recommendations – CSRs)

• Social Investment Package

• Employment Package – Towards a job rich recovery

• European Year 2012 on Active Ageing and Solidarity between Generations: pillar on independent living

• Open Method of Coordination – Social Protection Committee

• European Innovation Partnership on Active & Healthy Ageing

• Funding (ESF)

• RTD research projects

• Ageing Report

• Pilot project on elder abuse 6

Europe 2020 – priority areas for action at EU level

Single Market ActTrade and

external policiesStructural Funds

Modernised EU levers for growth and jobs

Europe 2020 flagships for smart, sustainable and inclusive growth

Strengthened EU economic governance

Macro-economic & fiscal surveillance

Regulation of financial services

Targets and guidance for structural reforms

Innovation Union

New Skills and new Jobs

Digital Agenda

Youth on the Move

New Industrial Policy

Platform against Poverty

ResourceEfficiency

7

5 EU objectives and 7 flagship initiatives

8

2013 CSRs on long-term care

• European Council issued CSRs on LTC to seven Member States (AT, BE, DE, FI, LU, NL, SI)

• CSRs based on fiscal sustainability considerations calling for improved cost-effectiveness

• 5 CSRs recommend stronger focus on prevention, rehabilitation and independent living

AT: The issue of the fiscal sustainability of the health care and long-term care system has to be addressed, also in view of the increasing need and demand for long-term care provision. (…) There is scope to enhance prevention, rehabilitation and independent living to contain future costs of long-term care.

BE: In long-term care, improved cost-efficiency of public spending on long-term care services and cost-saving measures of health prevention and rehabilitation, and for the creation of better conditions for independent living should be explored in the light of the relatively high cost of institutional care in Belgium.

Social Investment Package - functions

10

Three functions of social policies:

•Investing in human capital, strengthening people's current and future capacities

•Protecting against life's risks, ensuring adequate livelihoods and preserving previous investments in human capital

•Stabilising the economy by consumption smoothing, cushioning the impact of economic shocks

Social Investment Package - framework

11

1. Social investment throughout the individual's life

• Investing as early as needed to allow people to prevent disadvantage from compounding

• Investing throughout life to allow people to adapt to changing circumstances (Work/life reconciliation measures, Lifelong learning, Active ageing, Long term care (LTC))

2. Activating and enabling policies through targeted and more effective support

3. Increase the sustainability and adequacy of social systems through simplification of administration and delivery of services and benefits

Investing in Health

Commission Staff Working Document adopted on 20 February 2013 as part of the "Social Investment Package"

Key Messages:

extends the Health Strategy establishes the role of health as part of Europe 2020

health is a value in itself and also a growth-friendly type of expenditure

a healthy population and sustainable health systems are decisive for economic growth and social cohesion

12

Open Method of Coordination

Guarantee access for all to adequate long-term care and ensure that the need for care does not lead to poverty and financial dependency

Promote quality in LTC, notably by establishing quality standards

Ensure that adequate and high-quality LTC remains affordable and sustainable

Large diversity in supply of LTC in EU

• Informal care provided by family carers versus formal care in institutions or provided by home care services

• Formal care is organised by public, for-profit or NGO providers

• Financing from general taxation, obligatory insurance, private insurance or private spending

• Services in kind, allowances paid to the family carer or cash benefits for the recipient of the care

• Legal obligations on family members

Similar public budgets for social protection lead to very different outcomes

• Demography: tripling of people in age groups at particular risk of developing LTC needs

• LTC needs likely to rise dramatically over the next decades even if incidence of disablility reduces

• In its present organisation both informal & formal care provision will be overwhelmed

• Ressources will not increase = How to do better with less

Increasing gap in LTC

16

17

Immense differences: Expenditure in the base scenario, EU27, % of GDP

Source: Commission Services , EPC

How to close the gap?

• Reducing the incidence of frailty and disability through prevention and rehabilitation strategies

• Enabling elderly people to continue to live independently (adapted housing, use of ICT)

• Improving efficiency of care delivery through better care coordination, organisation and quality control

European Innovation Partnership on Active & Healthy Ageing

+2 HLY by 2020Triple win for Europe

Specific Actions

crosscutting, connecting & engaging stakeholdersstakeholders across sectors, from private & public sector

Implementation of the EIP on AHA actions

• national, regional and local level

• bottom-up approach

• creating critical mass and scale

• mobilisation of efforts, resources

• leveraging funding opportunities

• tangible outcomes – benefits for citizens, care systems and economy and society

•All 28 EU MSs

•Health providers in 271 commitments

•Public authorities from all levels in 170 commitments

•SMEs in 130 commitments

•Large industry in 79 commitments

2nd Invitation for commitments(310 Commitments)

1st Invitation for commitments(261 Commitments)

Examples of commitment/action

Prevention of functional decline & frailty

Commitment

•Developing, assessing and implementing technologies (built and ICT) infrastructure and related services that promote clients' abilities to live independently and self-manage

•Supporting healthcare professionals in the development and application of efficient and suitable care in or close to the home and the daily life context

CCTR-Centre for Care Technology ResearchInternationally accredited Innovative Medical Devices

Initiative in the Netherlands

A1. Prescriptions and adherence

to treatment

A2. Preventing falls

A3. Preventing functional decline

& frailty

B3. Integrated care incl. remote

monitoring

C2. Independent Living

D4. Age-friendly cities and

environments

Mapping of innovative practices

PracticalToolkits

More integrated, more efficient services

Implementation on large scale

provide input and expertise through an open collaboration

Commitments of the partners

Better professional cooperation: standards, guidelines

Preliminary achievements• mapping the good practices in the EU and beyond (over 300

examples)

• identification of benchmarks on physical and cognitive decline;

• testing of protocols on frailty in larger cohorts;

• improvement of screening methods for detecting early dementia;

• building of international networks for innovation and evidence

development;

• mapping the risk stratification tools for targeted care

• matrix of necessary ICT services for integrated care

• replication of best practices in new regions and scaling-up existing

innovative solutions for healthy ageing.

Region Skane

University Hospital Olomouc

City of Oulu

Coimbra

Southern Denmark

Collage (3)

Saxony

Ile-de-France Pays de la Loire

Lower-Rhine Council Languedoc-Roussillon

Liguria Campania

Friuli Venezia Giulia Emilia-Romagna

Piemonte

Northern NetherlandsTwente

Province of Gelderland and Overjssel

South Holland Province Noord-Brabant:

Slimmer Leven

GaliciaBasque Country

MadridCataloniaValencia

Andalusia

LiverpoolScotland

Northern Ireland Wales

Yorkshire

32 RSs =>12 MSs

selected for self-assessment and peer-review

(innovation, scalability, outcomes)

71 good practices of innovation-based integrated care models with sound impact on the ground

1 July 2013 – Star Ceremony

announcement of best RSs with stars, ready for replication and coaching

13 Reference Sites

12 Reference Sites

7 Reference Sites

Reference Sites - coverage

Concrete examples of innovative services

With proven added value to citizensand care systems in EU regions.

With evidence of contribution to growth and job creation in their settings

With evidence of transferability from local to regional or national level.

The first signs that such innovations meet the ambitions of the triple win of the EIP-AHA:-quality of life -sustainable care -economic growth

-HOW Guide to support scale up -published

Reference Sites –showcasing impact on the ground

develop policy on active & healthy ageing

Political added value of the EIP

EC: facilitator & supporter

align policy priorities with funding

support from the ground

mobilise efforts & resources

inspire for policy action

identify good practices working in real life

High level conferences (e-health, Gastein

Forum, Conference of Partners, Frailty

and Adherence Conferences, EUPHA-

polipharmacy)

Alignment of priorities in Horizon 2020,

CIP 2013, PHP 2013 etc.

Joint Action on Chronic Diseases and

Healthy Ageing (28 countries + 5

networks)

Reflection process of the MS: Towards

modern, responsive and sustainable

health systems

Funding

7th Framework Programme (FP7) Competitiveness and Innovation Framework Programme (CIP)

Public Health ProgrammeStructural

Funds(2007-2013)

(2014-2020)

•Good practices exchange•Clusters internationalisation

(2014-2020)

• INTERREG V• Possibility of co-investments• Possibility of 15% spent outside your

area• ESF – Targeted mobility schemes

TODAY

FUTURE

€ 446 million (2014-2020)

Health Programme

€ 9 billion (original proposal) for

Health, Demographic Change and Well Being

KIC - Innovation for healthy living and active ageing,

Societal Challenge 1-Health, Demographic Change & Wellbeing

Personalising Health and Care (PHC)•understanding of the causes and mechanisms of ageing/diseases;

•Improve monitoring health and to prevent, detect, treat and manage disease;

•support older persons to remain active and healthy;

•test and demonstrate new models and tools for health and care delivery.

Health Co-ordination (HCO)•1 dedicated support to the EIP on AHA (communication, identifying new priorities, improved framework)

Other Activities (not in the Work programme)Innovative Medicines Initiative, the European and Developing Countries Clinical Trials Partnership (EDCTP), and the Active and Assisted Living Programme.

http://ec.europa.eu/programmes/horizon2020/en/h2020-section/health-demographic-change-and-wellbeing

Horizon 2020 – 1st Work Programme 2014-15

WP '1

4/'1

5: €

1,2

000 m

Health Programme 2014-2020

• 3rd Union action programme in the field of health 2014-2020

EUR 449,4 million

Links:

Reference Site guidehttps://webgate.ec.europa.eu/eipaha/library/index/show/id/688

Action group flyerhttp://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/achievements_2013.pdf

Planned SPC report on LTC

� How to define adequate social protection against the risk of dependency in old age?

� How to fill the data gap (MISSOC, OECD, ESTAT)

� Discuss the potential costs of meeting/not meeting needs for a better social protection

� Discuss various ways for closing the gap between care needs and supply

� Identify priorities for the exchange of experiences and mutual learning

� Identify priorities for EU policies

� Present country fiches

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Joint Reports EC/OECD

Thank you for your attention!