Political Hub

Drug Pricing

Also at the same meeting the Pharmaceutical Industry came up for scrutiny. At the meeting Health Minsters from the largest European countries pledge to work together to tackle rising drug prices. Member called for grater encouragement for tackling innovation in areas of greatest need, citing dementia and new antimicrobials.

The French Minster was more confrontational calling on countries to stand up to the Pharmaceutical Industry threatening to use new legal tools to bring down prices of inflated medicines.

(Politico 18^th January 2017)

 

State of a Nation’s Nutrition

Nutrition was in the headlights in France as The National Agency for Food, Environmental and Occupational Health Safety (ANSES) resented the main results of the updating of the nutritional benchmarks of the National Nutrition Health Program (PNNS), which aims to improve the state of health of the population by acting on food. "Let food be your first medicine," said Hippocrates.

This information will serve to develop new recommendations for the general public. The last were dated 2002 and referred to at least 5 fruits and vegetables per day and to limit consumption of salt. It is no surprise to see the recommendation to eat less meat and "significantly reduce" the deli meats which is based on the report of IARC, the WHO Cancer Agency.

The risk of chronic disease increases by 10% to 20% for each increase in daily intake of 100 grams of meat (excluding poultry) and even 50% for a 50 g / day increase in processed meats, including deli meats. This is the first time specific reference has been made to quantities. Drinking one drink per day of sweetened drinks (soda, fruit juice, nectar ...) is associated with an increased risk of type 2 diabetes and cardiovascular disease by 20% compared to zero consumption. Pure water is recommended as a preference.

The positive effects of ‘5 a day’ on health are proven: they bring fiber, vitamins and minerals in to the body," insists Professor Margaritis one of the authors of the report.

https://www.anses.fr/en/content/anses-updates-its-food-consumption-guidelines-french-population

 

European Cancer Leagues (ECL) Launch Task for Equal Access to Cancer Medicines

Concern that increased cancer incidence in the population and new technological advances in medicines could result in a situation where unprecedented pressure is added to health budgets so making the medicine unaffordable or unavailable for many cancer patients. With this in mind the ECL are recommending that a political and social discussion to develop suitable policies to ensure equal and affordable access to cancer medicines.

Improvements are being made in many countries in Europe partly as a result of medicines and partly as a result of better health practices. This situation needs to continue and not be hampered by cost of medicines or new technologies. The ultimate goal is to achieve access to medicines for all cancer patients in Europe.

The first meeting, under the chair of the Dutch Cancer League will take place on 23^rd February in Amsterdam. For more information contact EScheres@kwf.nl

 

Polio Might Return to Romania

Facebook is becoming the means of communication adopted by governments across the world. In Romania, Raed Arafat, Secretary of State and head of the Department for Emergency Situations, called on parents to vaccinate their children, and warned that polio had started to reappear in Romania. He commented that he was aware of the debate about vaccinating children but warned that this was a disease almost completely eradicated until recently. It was returning because parents decided not to vaccinate their children and this was a mistake.

http://www.romania-insider.com/polio-may-reappear-in-romania-due-to-anti-vaccination-campaigns/

 

European Report on Slovakian Health System

The European Observatory on Health Systems and Policies completed as they concluded their Presidency of the Council of Ministers last year was not very complementary siting a number of areas that could be improved.

The Slovak health system is based on universal coverage, compulsory health insurance, a basic benefit package and a competitive insurance model with selective contracting of health care providers. However, 14 years after the introduction of a competitive insurance model, some health indicators, such as life expectancy, healthy life years and avoidable deaths, are troubling. This hints at persistent room for improvement in the delivery of care, especially primary and long-term care. Additionally, inequity in the distribution of health providers, resulting in lengthy travelling distances and waiting times for patients, needs to be addressed, especially as, given the ageing workforce, this trend is likely to continue.

On the one hand, there is a strong will to improve the Slovak health system, for example the current strategic documents and reform efforts by the Ministry of Health aim at a complete overhaul of enduring inefficiencies in the Slovak health system.

For EuropaColon we cannot help add to this report that the absence of formal population screening in the country with the highest colorectal cancer mortality is of considerable concern and an areas we believe needs to be urgently addressed.

More up-to-date information on many countries is available from the Observatory.

http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/slovakia-hit-2016

OECD Meeting of Health Ministers in Paris

In a new report Managing Access, Value and Sustainability, published on January 16, 2017, the OECD. The authors concluded that the proliferation of high-cost medicines and rising drug prices are increasing pressures on public health spending and called into question the pharmaceutical industry’s pricing strategies. The report added that governments need to work with the industry and regulators to define a new approach to the development and use of new health technologies that encourages innovation while also delivering more affordable and value for money treatments.

The report recommended that prices paid for technologies must reflect their real-world health benefits compared to alternatives and be adjusted based on evidence about their actual impact. Payers must be equipped with the necessary powers to adjust prices and withdraw payment for ineffective technologies.

More efforts are also needed to harness the potential of health data more effectively. Use of personal health data creates major opportunities for health system improvement, research and disease surveillance, but requires the right governance frameworks to realise these benefits while managing the privacy risks.

 (http://www.oecd.org/health/managing-new-technologies-in-health-care-9789264266438-en.htm)

CanCon

The European CanCer Organisation, ECCO, recently completed the first of two cancer reviews put together by members from 25 clinical societies in Europe. These publications state the requirements for essential care for colorectal cancer bone Sarcoma. These are not a set of guidelines but instead a complement to existing treatment guidelines that aim to clarify aspects of the pathway for clinicians, laypersons and patients. The report covers the patient pathway from diagnosis to palliative care. The colorectal cancer report can be viewed:  http://www.sciencedirect.com/science/article/pii/S1040842816303547

Cost of medicines was one of the chosen topics by the Maltese Government to be looked at during their presidency this year. One of these areas is a recommendation for collaboration between countries in the Mediterranean basin, similar to the one agreed by the Benelux countries a while ago. Also on the table were HTAs, (Health Technology Appraisals) and were subject of a presentation at a meeting of senior health officials in Malta during the Presidency of the EU. Not surprisingly there was call for flexibility when discussing proposals to set up a EU wide system for HTA. The wide range of health systems in the EU require a system that will allow countries to collaborate but also maintain individual differences so that they can maintain their own health systems.

CanCon, as previously stated the Joint Action on Cancer ended with its closing meeting in Malta in February. The document setting out the findings and conclusions can be accessed here.

Also available is link to more information about CanCon. http://www.cancercontrol.eu/who-we-are/

Health System Challenges

The demands placed on EU health systems and discussion about their ability to cope with increasing pressures is an on going topic that repeats every year. 2017 started with some harrowing descriptions of life within UK hospitals, including over crowding, delays in essential treatment and operations. This brought leading institutions such as the Royal College of Physicians to comment that vital services are “struggling or failing to cope” and the Red Cross to conclude that the NHS was suffering a humanitarian crisis.

However, while Brexit remains the main topic of general and political interest it is unlikely that these stories will generate much anti-government feeling. However it does present Mrs May with an opportunity that will be of considerable benefit is she can manage it alongside her other challenges. (Politico 12^th January 2017)

In the Republic of Ireland the situation seems to be similarly grave with the Health Minister apologising for failings in the system as 600 patients waited for a hospital bed. The numbers later eased to 190 the Irish Independent reported. Also in January the Irish hospital with the biggest emergency department announced it was cancelling all non-elective surgery. Adding it has experienced a 10% increase in adults attending the emergency department, a large number of these being over 75 years of age. (Politico 9^th January 2017)

May 2017

31st May 2017

Relocating the European Medicines Agency (EMA)

One of the most interesting and hotly debated topics regarding Brexit is the relocation of the EMA. Home to the approval and regulation of all medicines and devices in the EU, this has been a source of considerable income and employment for the UK since it was located in London in 1995.

Many EU countries are lobbying hard to host this Agency, recognising the influence this, potentially one of the most important EU Agencies, brings the host country. Affecting not only human health but also animal health, the Agency is urged deliver a smooth transition from one location to the next so as not to affect the approval and regulation of medicines and devices during this time.

EMA Executive Director Guido Rasi has recently said the moves offers the Agency the opportunity to streamline their practices and this could have a bearing on the processes and approval of medicines in the EU.

Watch this space for more news as the saga unfolds.

Digital health – e-health

E-Health is a relatively new term that is used to describe healthcare practises supported by electronic process and or communication. It covers a wide range of options including electronic devices used in clinical practise but also includes the internet. Therefore it has relevance to patients and healthcare professionals and everything/one in between. There is a lot more discussion at- https://en.wikipedia.org/wiki/EHealth

It is perceived that good quality health care will increasingly depend on greater use of information and communication technology for the health and wellbeing of citizens in the EU. For this reason it is one of the pillars of the works of DG SANTE. The first EU eHealth Action Plan 2004-2011 covered electronic prescriptions and health cards to new information systems that reduce waiting times and errors, in order to facilitate a more harmonious and complementary European approach to eHealth.

The second eHealth Action Plan 2012-2020 operates in the context of Article 14 of Directive 2011/24 on the application of patients' rights in cross-border healthcare. It focuses on the following:

• Supporting research, development and innovation;
• Promoting international cooperation;

• Achieving wider interoperability of ehealth services;
• Ensuring wider deployment & facilitating uptake.

During a meeting recently as part of the Malta Presidency, Commissioner Andriukaitis announced that the Commission plans to publish a Communication on digital health by the end of the year, as part of the mid-term review of the Digital Single Market Strategy. This further increases the attention which digital health is getting at the moment, particularly as it will be published during the Estonian Presidency, set to focus on digital issues and ehealth.

The Communication will notably aim to deliver on actions around three themes:

• Giving effect to the right of every citizen to access and share securely their personal health data;
• Supporting the development of a secure data infrastructure for the pooling of health data to advance research, disease prevention and personalised health and care – this will notably be enacted through a strategy for the potential research use of patient data gathered by the European Reference Networks;
• Facilitating feedback and interaction between patients and healthcare providers.

The importance or dependence of health systems on modern technology was highlighted in May when a cyber attack affected 200,000 computer systems worldwide, but mainly in Russia and the UK. In England this resulted in closed units, patients diverted to unaffected hospitals and cancelled operations and procedures leading to considerable confusion and difficulties for patients and families.

Health Technology Assessments

HTAs were recently the subject of an EU Commission public consultation and received favourable results, with 87% of citizens and stakeholders supporting EU cooperation beyond 2020.

The Commission received some 250 replies to the consultation on strengthening EU cooperation on Health Technology Assessment (HTA), 25% of which were from citizens and 75% from stakeholders. Almost all respondents (98%) acknowledge the usefulness of HTA, 81% consider the current EU cooperation on HTA to be useful to some degree, and 87% consider that EU cooperation on HTA should continue beyond 2020. Of those who support sustainable EU cooperation on HTA, 80% think the scope should include pharmaceuticals and 72% consider that medical technologies should also be covered.

Commenting on these results, Vytenis Andriukaitis, Commissioner for Health and Food Safety, said "I am pleased, but not surprised at the overwhelming support for sustainable cooperation on HTA at EU-level. Such cooperation will bring real added value to all countries, through the pooling of resources, exchange of expertise, and the avoidance of duplication. I am keen to finalise a proposal on what form this cooperation will take before the end of the year." 

The results of the public consultation and views expressed by stakeholders in other forums will be summarised in the Synopsis Report which will form part of the Impact Assessment on strengthening EU cooperation on HTA beyond 2020. Read the full report. 

Good health of all citizens is essential for the economy:

Health ministers from the world’s largest economies yesterday issued a declaration pledging to tackle issues such as epidemic response, antimicrobial resistance and support for health systems.

 “Health is one of the most valuable resources for building a sustainable future,” the ministers noted. They made special reference to the importance of strong and resilient health systems, calling them the “the basis for a prosperous and stable society.”

Sometimes the importance of a healthy work population seems to be forgotten as Health Ministries impose cuts to budgets and impose restrictions on medicines and health care.

8th May 2017

PRESS RELEASE - What next for health? Click here to read.  

EuropaColon Launches European Colorectal Cancer Awareness Month

European Parliment - March 2017

European Colorectal Cancer Awareness Month hosted by Dr Alfred Sant MEP Malta was launched in European Parliment on 1st March. The audience comprised MEPs, health care professionals, patient advocates and pharmacetical companies.

Click here view agenda.

Presentations were made by: Professors Eric Van Cutsem and Stephen Halloran, Dr Santiago Gonzalez Moreno, Professor Peter Nardei and Mr Geoffrey Henning (highlights of their message were captured on video and can be accessed by clicking on their names).

July 2017

Value Based Care

Health systems are under threat the world over, with more and more people being diagnosed with diseases that are costly to treat. As a result payers, governments, hospitals etc, are all looking at ways to make sure the money spent has the greatest impact.

One of these routes is value based care. This is a change from the traditional means whereby services have been reimbursed by a single/standard fee, paid when delivering a service or a number of services and has little to do with whether the patients’ health improves.

Value based care is a new approach and offers a possible solution to greater health costs, clinical inefficiency and duplication of services. The aim is to make it easier for people to get and benefit from the care they need. Doctors and health services will be reimbursed for keeping people healthy and for improving the health of people with a chronic disease in a cost-efficient manner.

In the NHS in the UK, a specific department is committed to reducing variation in peoples’ health and to help deliver a sustainable health system, called NHS Rightcare. It is focused on three strategic pillars:

• Intelligence - Using data and evidence to highlight variation and identify the areas of greatest opportunity to support quality improvement.

• Innovation - Working in partnership with a wide range of organisations, national programmes and patient groups to develop and test new concepts and influence policy.

• Implementation - Supporting local health economies to implement sustainable change that improves population health and increases value.

This new approach opens up a number of opportunities for cancer care that EuropaColon has been calling for over the years:

• It is likely that more governments will subscribe to the need for accurate and linked data registries that will enable them to deliver this new approach ore efficiently. This will bring multiple benefits in helping to understand variations in treatment, care and outcomes across Europe.
• It will give the patient voice more traction as reported outcomes are seen as a means of validating this payment method and the system delivering the service. PROMS (Patient Reported Outcome Methods) are an important tool to validate the care received.
• All patients can look forward to a time when more attention is paid to them as individuals rather than being merely a number that requires a specific treatment.
• Finally it is likely to reduce variations in care as there is more focus on what is happening across all regions within countries.

August 2017

How Much to Spend on Health?

Per capita health spend in the UK is a subject of constant reproach by opposition parties who rail against the current government. But new data suggests that current spend (public and private) is higher than previously reported.

Spend is traditionally measured as a percentage of gross domestic product (GDP).  New data, shows that spend was not 8.7% as previously reported (2014), but 9.9%, raising the UK up to 9^th position when compared with the rest of Europe. The latest data recently published by the Office for National Statistics (ONS) for the UK¹ and the Organisation for Economic Cooperation and Development (OECD) for other countries², implies that previous figures have underestimated the sums spent in the UK on healthcare.

While this takes the pressure of the government somewhat, it does not suggest that the correct amount of money is necessarily being spent on delivering healthcare in the UK. The new figures include spend, on health related social and long-term care. This was previously not included and accounts for much of the increase.

Promises made to junior doctors, for example, during their dispute last year are still not in place and most hospitals treat them as though they were expendable. Furthermore, the debate continues to rage about the cap on pay increases in the public sector also affecting spend in the long run. If nothing else this latter issue will keep up the pressure on the government.

For the UK to match the EU average spend on healthcare, the government could reduce spend by £2bn. To match spend of Sweden, they would need to increase spend by £24bn which is very unlikely.

1. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2015#main-points
2. http://www.oecd.org/els/health-systems/health-data.htm

September 2017

Total Diet Replacements the Controversy Continues

The current EU standards for Total Diet Replacements, very low calorie diets (under 800 calories per day) used for weight control in the obese (BMI over 30) have been in place for 30 years and appear to have provided safe standards throughout this period.  The proposed EU changes were criticised in March by the European Very Low Calorie Diet Industry Group.  If the changes are implemented, the product category will likely disappear from the market, as it would no longer be neither feasible or commercially viable for operators to deliver a range of products to the levels of nutrients suggested.

British MEP Julie Girling, the health spokeswoman for the European Conservatives and Reformists in Parliament has campaigned for the changes to not be introduced.  Mrs Girling has said of the proposals

“ … this legislation is ill-considered and could have deeply damaging consequences if it is not reconsidered. It is not putting it too strongly to say this will cost lives.”

September has seen the socialist groupings within the European Parliament oppose Mrs Girling’s resolution to enable the current regulations to remain in force.

November 2017

Battle for the Heart of Medicines

After months of strategic positioning and hype the decision of the new home for the European Medicines Agency EMA was decided with the successful candidate being drawn from a plastic bowl. The Member State voting had resulted in a tie with Milan and Amsterdam each with 13 votes in the third round.

The EMA is the agency responsible for approving all medicines and devices used in health systems throughout the EU. Until the Brexit vote the agency was hosted in London by the UK. Faced with the need to relocate all EU agencies from the UK the positioning began. This ended on 20^th November 2017 when the results of the voting and then ballot were announced.

The politics of the EU were exposed in this process lasting 18 months from start to finish. 19 countries in Europe applied to host the agency though three withdrew before the vote took place. The EMA is perceived to be one of the most lucrative agencies guaranteed to bring considerable income to the host country from the regular stream of visitors. The agency has nearly 900 well-paid employees and around 36,000 visitors each year. Milan was the long running favourite.

Halbe Zijlstra, the new Dutch foreign affairs minister, told Politico Playbook: “Amsterdam is ready to receive the staff of EMA, all 900 of them and their families. They are very welcome in the Netherlands,” a pointed reference to concerns of some LGBT EMA staff that other candidate cities would not be as welcoming as Amsterdam. (Politico Brussels Playbook, 21 November 2017)

A Look Behind Could Save Your Life

Thousands of men are unnecessarily at risk of dying from bowel cancer because they are too embarrassed to provide a stool sample. Public Health England (PHE) said the situation is so grave it is calling on all men and women, aged over 60, to get screened for bowel cancer after the latest figures show over 40 per cent are not getting tested.

A new plan is to encourage wives, partners and daughters to encourage the older men in the family – as well as the women – to overcome any embarrassment and ensure they send in a sample to be tested. “Men in particular are less likely to send in a sample, so we’re asking their partners, children and grandchildren to encourage them to do so.” Professor Anne Mackie, Director of Screening, Public Health England

A new report, Screening Programmes in England 2016-17, shows that despite a 3 per cent increase on the previous year, the take-up for bowel cancer screening (59 per cent) is still significantly lower compared to other cancer screening programmes – breast screening (76 per cent) and cervical screening (72 per cent). Bowel cancer screening is offered to all men and women aged 60-74, who are sent a home test kit to provide stool samples.

In 2016-7 over 3,000 bowel cancers diagnosed through screening. In over 90 per cent of these cases, cancers were found at an early stage, where treatment is more likely to be successful.

Bowel cancer is the fourth most common cancer in England, but the second leading cause of cancer deaths, with around 13,000 people dying from it every year. If detected early bowel cancer is highly treatable, which is why screening is vital and it has been shown to reduce the risk of dying from bowel cancer by 16 per cent. Thousands more lives could be saved if more people, particularly men, returned their stool samples to be tested.

Home test Improvements are being simplified and next year there will be a new home test, the faecal immunochemical test (FIT), which requires just one sample rather than the current three, and will detect bowel cancer more accurately. In addition to the home test, a one-off test called bowel scope screening is offered to men and women at the age of 55. Professor Anne Mackie, PHE’s director of screening, said: “It’s of great concern that 4 out of every 10 over 60 year olds are not taking up the offer of getting tested for bowel cancer. Men in particular are less likely to send in a sample, so we’re asking their partners, children and grandchildren to encourage them to do so.

Read more at: https://inews.co.uk/essentials/news/health/stool-samples-bowel-cancer-men-public-health/

December 2017

Food and healthy eating

Food and its effect on the health of people is in the news in a number of countries this month.

In Bulgaria, as President of the EU Council, is launching its health agenda for its term with a conference on healthy nutrition for children. Experts will be looking at the links between health and nutrition, although not specifically stated one hopes this will include obesity.

The meeting coincides with the Bulgarian plans to influence the role of traditional diets and the Common Agricultural Policy to be more responsive to the need for nutritious and affordable food. Bulgaria is hoping to use the meeting to affect the draft Council conclusions on these issues while also hoping to help countries exchange best practice.

It is also on the agenda in Spain where the Health Ministry has announced a deal with 500 food companies to reformulate 3500 food products to reduce salt, sugar and fat content by around 10% by 2020. Included are companies who cater for schools and hospitals where meals are likely to include Grilled dishes and lean meats will increase as will vegetables, fruits and fish in season, with pre-cooked and fried products reduced.

Abortion tops the agenda in Ireland

One of the last bastions to abortion is Southern Ireland but this looks to be changing as the general public seem to be moving towards a change of policy. The Eighth Amendment current gives mother and child equal rights to life.

A pole last week has indicated that 64% back a rule change that will allow a woman to get an abortion if she decides. At present the rule only allows for an abortion if the mothers life is at stake. As a result the following day the Irish Prime Minister, Leo Varadkar, finally acknowledged his support for liberalizing Irelands abortion law. “These terms pro-life and pro-choice don’t really comprehend the complexity of this issue, which is a very private and personal one and one, I think, that contains a lot of gray areas,” Varadkar said.

A referendum is likely although the final decision will only be taken in March. While it looks like the result will be positive for change previous referenda in recent Irish history haven’t always followed the trend and cant be determined by surveys as these have misled in the past.

Alcohol not far behind in Ireland politics

One of the most draconian pieces of legislation in the EU regarding alcohol consumption was due for debate in the lower house of the Irish Parliament , the Dáil, on 6^th February.

The Public Health Alcohol Bill has been lingering for some time and aims to crack down on heavy drinking by 2020 by the introduction of minimum unit pricing, separating of alcohol products from other products in supermarkets, and introducing health warnings and advertising restrictions.

The legislation was passed in the upper house in 2017. The Health Minister, Simon Harris referred to it as a landmark piece of public health legislation.

Wine uproar in France

In France the French National Association of Prevention in Alcohol Addition (ANPAA) is up in arms because of wine producers in the country are been given a say in the French Health Strategy after a former wine lobbyist became an agriculture adviser to President Macron last year.

A more laid back approach is being adopted by the Presidents officer where the view is that all stakeholders should be involved in the development of a national strategy. The wine producers were previously categorised alongside tobacco and illicit drugs as harmful substances for discussion in the French health strategy for the period 2018 – 2022. They are now recognised as legitimate actors in the development of the strategy.