draft INVITATION Working Group on the Quality of Childhood at the European Parliament (QoC) MEP Anna Hedh MEP Kostas Chrysogonos MEP Deirdre Clune MEP Arne Gericke MEP Nathalie Griesbeck MEP Karin Kadenbach MEP József Nagy MEP Evelyn Regner MEP Julie Ward This QoC Talk will be hosted by: MEP Hannu Takkula (Group of the Alliance of Liberals and Democrats for Europe, Finland) 64th QoC Talk: Primary Health Care for Children in Europe. Similarities and Differences between Countries - what do they Mean? Interim findings of the Models Of Child Health Appraised (MOCHA) Horizon 2020 Project The presentation will be given by Professor Michael Rigby and Dr. Denise Alexander, respectively the Deputy Leader and Research Coordinator of the MOCHA Project and both of Imperial College London, UK. Time: Tuesday 11 April 2017 from 15.00 until 17.00 hours Location: European Parliament, Rue Wiertz 60, Brussels, Room number A8F388. Entrance: We will gather at the Entrance at Place Luxembourg at 14.30 hours. Please be in time. It is obligatory to take your passport and/or ID Card with you. 2 MOCHA is a comparative study into the Primary Health Care for Children in Europe The Horizon 2020 funded Models Of Child Health Appraised (MOCHA) Project (www.childhealthservicemodels.eu) runs from 2015 to 2018, and is assessing the different ways in which the 30 countries of the EU and EEA provide primary care for children. Children are a key sector of Europe's population, and the health of children determines the future health of Europe’s population. However, children seldom feature directly in policies for health or in health analyses. Yet, apart from their vulnerability, children are totally dependent on the adult population creating the right kind of effective services for them, but children rarely figure directly in policy considerations. Children’s primary care services: some underlying assumptions are seriously flawed by being naively optimistic. Primary care is particularly important in healthcare provision – not least for children’s health. Having readily accessible first points of contact services is essential, whether for the young infant suddenly developing a fever, or for a teenager concerned about anxiety or depression. Some underlying assumptions in setting child health policy are seriously flawed by being naively optimistic. One is that families are all equally benevolent and supportive, and that parents will know when and where to present a child for prevention and treatment. In fact, many families have problems, including parental illness, poverty, domestic tension and even violence, and absence of one or both parents. Children’s primary care services therefore need to be proactive, accessible and well-informed. A second assumption is that all primary health care professionals are equally competent within their field in diagnosing and treating children. However, knowledge of childhood conditions, and skills in working with children, are specific, yet are required and taught very differently across European countries. There are in Europe two different national models of primary care professional service for children: (a) the specialist paediatrician and (b) the generalist family practitioner Central to the initial focus of MOCHA is that there are two different national models of primary care professional service for children. Most countries have adopted through tradition one model or the other. One serves children through specialist primary care paediatricians, who treat only children and pass on their care to different doctors as adulthood is reached. The other model is of the generalist family practitioner, who treats all ages and thus usually the whole of one family. Each model is based on strong convictions, and the dichotomy has been described several times, but there is so far little empirical outcome evidence to justify one model over the other. Until that is resolved, in theory many countries’ children are getting less effective care. Other themes studied in the MOCHA Project: School health service However, in the process of addressing the assessment of models of children’s primary care in Europe, the MOCHA project has identified and studied many other differences. These include: School Health: Some countries have a very strong school health service, with health professionals closely linked with schools and able to provide advice and guidance; other countries focus strongly on the formal educational role of schools and the taught curriculum, and consider health as a personal and family matter. Adolescent Health Services Older children may find it difficult to discuss personal health issues, not least mental health and reproductive health, with doctors who also know their parents, and indeed may require the parent to be aware of the consultation and possibly also present. Some countries provide confidential 3 direct access services for adolescents, others do not. What is the outcomes evidence in support of either approach? Complex Care Most countries are good at providing specialist care for children with conditions such a traumatic brain injury, or long term ventilation, but often the focus on the special condition leaves a gap regarding other health needs including preventive health. The project will assess what systems best consider the child holistically, and ensure the avoidance of a gap. Professional Staffing Apart from different types of primary care doctor, different countries have different training requirements for providing primary care for children, different balances between doctors and nurses, and different relationships and record keeping. The objective will be to find which patterns have the greatest strengths, within the bounds of affordability. Funding and Payment Patterns Europe has a broad split between publicly funded health systems, and insurance-based systems. This is a good example of policy being developed with adults in mind, with rational adult choices. But what are the effects on children, and are all systems equally effective at providing effective care for children? And within either funding model, what are the effects of co- payments, such as prescription charges? Equity of Service Equal health for all is a key WHO principle. In practice, equity is compromised in two ways. Demographic effects mean that some children are less likely to receive preventive or therapeutic services, particularly children from lower socio-economic groups, those with less well educated mothers, and those from mobile families or population minorities. System effects may result in service provision which is not equal, such as lower service levels in rural or inner city areas. Which models of provision are most effective at addressing equity challenges? E-Health There is a strong drive across Europe to introduce electronic health records and other e-health support. This too is usually based on treatment patterns for adults. The MOCHA project is finding that in many cases record content, record functionality, and e-health plans and infrastructures are not designed to meet the needs of children. Also, overall e-health provision varies widely across Europe. What is the effect on children’s health outcomes, and what is the best pattern? The MOCHA project is now reaching its mid-point: a good moment for stakeholders to give their input It has identified many of the differences and disparities in children’s primary care provision across Europe, and is moving to analysing what this means in terms of indicating optimum provision patterns. This presentation will highlight the results of the first 12 months analysis within the project; the disparities between countries and models of provision; and the ethical dilemmas identified. It will also identify the issues the project will address in its next phase as it seeks to identify best practice within national contexts. It will be an important opportunity for organisational stakeholders, and European policy makers, to hear and react to a selection of interim findings, so as to inform the project on factors to consider in addressing their second phase of work in moving towards evidence-based recommendations. 4 Overall objectives of the QoC Talks: To gain a better understanding of the Quality of Childhood in the EU Member States. This time we will focus on ' Primary Health Care for Children in Europe. Similarities and Differences between Countries - what do they Mean? Interim findings of the Models Of Child Health Appraised (MOCHA) Horizon 2020 Project'. To reflect on the role that the European institutions can play to improve the situation. To get to grips with the values, principles and approaches that could lead to improvements for children both in Europe and around the world. To form an effective working group and to get a sense of how to move on. We take pleasure in inviting you for the 64th session on 11 April 2017. With best regards, Michiel Matthes Chairman Alliance for Childhood European Network Group Programme Outline for Tuesday 11 April 2017 Time Subject Speaker / facilitator 15.00 Opening MEP Hannu Takkula 15.07 A reflection about the theme from the Shanti George from the Learning point of view of the Learning for Well- for Well-being Community being community 15.13 A reflection about the theme from the Christopher Clouder, one of the point of view from the Alliance for co-founders of the Alliance for Childhood Childhood 15.18 Primary Health Care for Children in Professor Michael Rigby and Dr. Europe. Similarities and Differences Denise Alexander, respectively between Countries - what do they Mean? the Deputy Leader and Research Interim findings of the Models Of Child Coordinator of the MOCHA Health Appraised (MOCHA) Horizon Project and both of Imperial 2020 Project College London 16.15 Discussion Michiel Matthes, Chairman of the Alliance for Childhood European Network Group 16.50-17.00 Closing remarks MEP Hannu Takkula Disclaimer: The organisers organise this session on a best effort basis. However changes in parts of the programme or in the entire programme may occur due to unforeseen circumstances and the organisers cannot be held liable for that.