1 Structural Funds and h ealth an evolving focus for EUREGIO III Professor Jonathan Watson Brussels 22 September 2011 HCN Executive Director; EUREGIO III Project lead; Special Professor of Health & Public Policy, University of Nottingham; External Partner to European Masters degree in Sustainable Regional Health Systems (Deusto, Vilnius, Corvinus, Verona)

2 WHAT IS EUREGIO III Generate practical knowledge (examine SF management; collect case examples of projects; consider needs your needs; identify directions for capacity building) Share practical knowledge (training workshops; master classes; inventory of case examples; inventory of stakeholders, expertise and resources; publications; website; conference; stakeholder events; external events) Inform improvements in the SF process and regional development (management, delivery, planning for )

3 challenges for regions Demographic and epidemiological trends The explosion in new clinical and ICT technologies Patient safety and quality The need for economic sustainability

EU wide convergence on common issues Change – known, unknown and the unpredictable Resources – the impact of the credit crisis and beyond Investing for future health gain (direct and indirect) The underpinning principle of health equity as a core element of social cohesion

5 national response: hard choices learning from regions 1. Rationing services and cutting health care spending – will make the position worse 2. Raising additional revenue – does not look possible 3. Implementing structural reforms that improve the health sector’s productivity, responsiveness and economic sustainability 1 & 2 have been tried within the 15 and 12 and usually fail or prove unsustainable. The current crisis will create the climate and opportunity for change The EU wide trend is now in the direction of (3) – structural reform, but It will require significant strategic vision from the bottom-up PPPs may offer a way forward as an alternative – in part, but --- SF investment may assume more critical importance: transformational change; demonstration projects.

6 lessons learned Case studies Interviews Events Stakeholder assessment Surveys

7 practical knowledge: EUREGIO III case studies TypeFocusSF period Comparator non- SF project High technology facilities Cancer centres (1) (1) Yes High technology equipment Major diagnostic technologies (1)No General health infrastructure Major hospital reconfiguration (1) Yes eHealth Patient support Public health (2) (2) (1) Yes No Mental healthCommunity care (1) No Master plans Regional and national planning for SF (1) (2) Yes

8 Findings 1: the SF process

Findings II - the usual suspects? Process bureaucracy is process bureaucracy Decisions without accountability - & uncertainty over ROI Often ad-hoc and opportunistic basis for SF proposals Strong tendency towards tactical, as opposed to strategic, investment Scale of legacies can create overwhelming problems:

Findings III - the usual suspects redux Lack of / poor integration of projects and programmes – masterplanning weaknesses and implementation problems Weak financial realism & some evidence of over-expectation spirals In comparison with non-sf and ‘progressive’ health systems – a weakness in visioning, innovation and transformational change Under-estimation/under- exploitation of the dramatic changes underway in healthcare

Findings IV: gaps… Delivery of SF Project development Real-time knowledge exchange during implementation Mentoring & Peer review Good practice clearing house Management of SF Communication Conditionality Health Equity Impact Assessment Comparable monitoring and evaluation

12 approach to health post 2013 Alignment with the Europe 2020 strategy Focus on main bottlenecks constraining growth in lagging Member States and regions Foster structural change in health systems Increase the quality of public expenditure Demonstrable medium and long-term impacts Show the added value of health systems reform Facilitate future proofing of health systems

13 towards modern, responsive & sustainable health systems “Investments in health should be acknowledged as a contributor to economic growth European Structural Funds resources can be used in complementing the financing of health sector development of eligible regions of Member States, Recognising the importance of evidence- based policy-making and decision-making processes supported by adequate health information systems; Recognising that there is a need for sharing evidence on health systems’ modernisation and of new healthcare approaches; Moving away from hospital-centred systems towards integrated care systems; Make smarter use of EU Structural Funds which can contribute to health systems innovation.

Next steps: changing model of care 14

15 Next steps: critical success factors Population health status, Health outcomes, Economic outcomes 3 integrated elements of health care delivery: service delivery models, Workforce, Capital (infrastructure; technology; ICT)

16 Next steps: technical support

closing the loop Guide to the negotiation of health infrastructure and health service priorities in the post 2013 programming period in convergence regions (commissioned by DG REGIO targeting their desk officers) Development of integrated care strategies as a contribution to improving the quality and effectiveness of managing chronic disease and implementing healthy ageing programmes (requested by IP AHA targeting regions and MS) Technical Assistance in framing regional health development priorities for next programe cycle in line with Europe 2020 (commissioned by Italian MoH PTOA) 17 EU MSRegion s

summary MACRO - the relationship between Europe 2020, health, structural funds and national reform programmes MESO - conditionality; stakeholder engagement; interregional knowledge sharing; developing high impact projects MICRO – capacity building and technical assistance

19 thank you