THE ORGANISATION OF RESILIENT HEALTH AND SOCIAL CARE FOLLOWING THE COVID-19 PANDEMIC Opinion of the Expert Panel on effective ways of investing in Health (EXPH) Health Further information on the Health and Food Safety Directorate-General is available on the internet at: http://ec.europa.eu/dgs/health_food-safety/index_en.htm Neither the European Commission nor any person acting on behalf of the Commission is responsible for the use that might be made of the following information. Luxembourg: Publications Office of the European Union, 2020 © European Union, 2020 Reuse is authorised provided the source is acknowledged. The reuse policy of European Commission documents is regulated by Decision 2011/833/EU (OJ L 330, 14.12.2011, p. 39). For any use or reproduction of photos or other material that is not under the EU copyright, permission must be sought directly from the copyright holders. © Photos : https://www.gettyimages.com/, Health and Food Safety Directorate-General Print ISBN 978-92-76-26123-0 doi:10.2875/158132 EW-06-20-027-EN-C PDF ISBN 978-92-76-26122-3 doi:10.2875/005848 EW-06-20-027-EN-N EXPERT PANEL ON EFFECTIVE WAYS OF INVESTING IN HEALTH (EXPH) Opinion on the organisation of resilient health and social care following the COVID-19 pandemic The EXPH adopted this opinion at the 5th plenary on 25 November 2020 after public hearing on 20 October 2020 The organisation of resilient health and social care following the COVID-19 pandemic About the Expert Panel on effective ways of investing in health (EXPH) Sound and timely scientific advice is an essential requirement for the Commission to pursue modern, responsive and sustainable health systems. To this end, the Commission has set up a multidisciplinary and independent Expert Panel that provides advice on effective ways of investing in health (Commission Decision 2012/C 198/06). The core element of the Expert Panel’s mission is to provide the Commission with sound and independent advice in the form of opinions in response to questions (mandates) submitted by the Commission on matters related to health care modernisation, responsiveness and sustainability. The advice does not bind the Commission. The areas of competence of the Expert Panel include, and are not limited to, primary care, hospital care, pharmaceuticals, research and development, prevention and promotion, links with the social protection sector, cross-border issues, system financing, information systems and patient registers, health inequalities, etc. Expert Panel members De Maeseneer Jan (Chair), De Oliveira Martins Pita Barros Pedro, Garcia-Altes Anna (Vice-Chair), Gruson Damien, Kringos-Pereira Martins Dionne, Lehtonen Lasse, Lionis Christos, McKee Martin, Murauskiene Liubove, Nuti Sabina, Rogers Heather-Lynn, Siciliani Luigi, Stahl Dorothea, Wieczorowska-Tobis Katarzyna, Zacharov Sergej, Zaletel Jelka Contact European Commission DG Health & Food Safety Directorate B: Health Systems, medical products and innovation Unit B1 – Performance of national health systems Office: B232 B-1049 Brussels [email protected] The opinions of the Expert Panel present the views of the independent scientists who are members of the Expert Panel. They do not necessarily reflect the views of the European Commission nor its services. The opinions are published by the European Union in their original language only. 2 The organisation of resilient health and social care following the COVID-19 pandemic ACKNOWLEDGMENTS Members of the Drafting Group are acknowledged for their valuable contribution to this opinion. The members of the Drafting Group are: Expert Panel members Professor Jan De Maeseneer Chair Dr Dionne Kringos Rapporteur Professor Christos Lionis Rapporteur Dr Heather-Lynn Rogers Rapporteur Dr Anna Garcia-Altes Professor Damien Gruson Professor Lasse Lehtonen Professor Martin McKee Dr Liubove Murauskiene Professor Sabina Nuti Professor Pedro Pita Barros Professor Luigi Siciliani Dr Dorothea Stahl Professor Katarzyna Wieczorowska-Tobis Dr Sergej Zacharov Dr Jelka Zaletel The declarations of the Drafting Group members are available at: https://ec.europa.eu/transparency/regexpert/index.cfm?do=groupDetail.groupDetail&gro upID=2847 3 The organisation of resilient health and social care following the COVID-19 pandemic ABSTRACT The COVID-19 pandemic has raised questions about the resilience of health systems across the globe. Many analyses of its impact and the responses adopted have already been published. The Panel received a mandate to look beyond the current crisis and consider how health systems can prepare better for future threats. Specifically, the mandate requested a new framework for the organisation of health and social care following the COVID-19 pandemic. This Opinion (1) identifies the building blocks of resilient health and social care systems, (2) explores the elements and conditions for capacity building to strengthen health system resilience, (3) addresses healthcare provision for vulnerable patient groups and how to sustain such provision in a system under stress, and (4) sets out an approach to develop and implement “resilience tests” of Member State’s health systems. The recommendations target a number of key areas, including: enhancing workforce training and resilience, reviewing research and development and procurement (especially for innovative medicines), identifying and reducing disinformation, fostering inter- professional and inter-sectoral collaboration with community health workers and informal care givers for example, integrating information and communication technologies across care levels and public health, strengthening primary and mental health care, increasing public health focus on psychological distress, debating methods for Member States to collect and share aggregate health data on ethnicity and socioeconomic status, developing and deploying online trainings for frontline health and social care professionals regarding care provision to vulnerable groups, and finally investing from the European Commission in the development and implementation of (a) comprehensive resilience testing of health systems that use qualitative and quantitative data collection methodologies to generate meaningful, actionable results for health system transformation, and (b) corresponding learning communities within and across Member States to share lessons learned through this process. Keywords: care organisation, health care, social care, building blocks, capacity building, vulnerable groups, health systems resilience, resilience-testing, ‘SARS-CoV-2’, COVID-19 Opinion to be cited as: Expert Panel on effective ways of investing in health (EXPH), The organisation of resilient health and social care following the COVID-19 pandemic, 25 November 2020 © European Union, 2020 ISSN 2315-1404 ISBN doi:xxxx ND-xxx https://ec.europa.eu/health/exph/overview_en 4 The organisation of resilient health and social care following the COVID-19 pandemic TABLE OF CONTENTS ACKNOWLEDGMENTS ...................................................................................................................................... 3 ABSTRACT ........................................................................................................................................................ 4 EXECUTIVE SUMMARY ..................................................................................................................................... 7 BACKGROUND .................................................................................................................................................. 9 THE RESILIENCE OF HEALTH SYSTEMS IN THE SPOTLIGHT .................................................................................................. 10 QUESTIONS FOR THE EXPERT PANEL .............................................................................................................. 13 1. OPINION ................................................................................................................................................. 15 1.1. COVID-19 AND THE RESILIENCE OF HEALTH SYSTEMS ........................................................................................ 15 1.1.1. Building blocks to improve the care organisation ......................................................................... 15 1.1.2. A multidimensional conceptual framework .................................................................................. 18 1.1.3. Assessing the resilience of health systems .................................................................................... 19 1.1.4. European initiatives on resilience of health systems ..................................................................... 20 1.2. CONDITIONS FOR CAPACITY BUILDING OF RESILIENT HEALTH AND SOCIAL CARE ........................................................ 22 1.2.1. Responding to unintended consequences ..................................................................................... 22 1.2.2. Integrating and using different forms of information for actionable decision-making ................. 24 1.2.3. Disseminating knowledge and good practice ................................................................................ 29 1.2.4. Anticipating and coping with uncertainties and unplanned events .............................................. 31 1.2.5. Managing interdependence and cooperation of different actors ................................................. 34 1.2.6. Building or developing legitimate institutions, measures and norms