Mary Harney, Ireland’s former Minister for Health, tells us about the need for a sustainable, futureproof healthcare sector.
Mary Harney served as Ireland’s Tánaiste (the deputy Prime Minister) from 1997 to 2006 and Minister for Health and Children from 2004 to 2011. She speaks with Health Europa about cross-border collaboration, digital innovation and the impact of COVID-19 on healthcare infrastructure.
How could the healthcare system benefit from wider international collaboration?
When it comes to health COVID-19 shows that there are no borders – the rapid spread of the virus has highlighted how interdependent and interconnected we all are. Initially, every country decided to fend for itself when the pandemic hit. There was a lack of preparedness at country and regional levels in the EU; this was a great pity – we had all become too complacent about our health. One of the early learnings is that we can only deal robustly with a similar crisis in the future if we prepare regionally. Countries acting alone are not going to be able to deal with pandemics – and there will be more.
The pandemic has brought to light great weaknesses and fragilities in supply chains from the point of view of stockpiling, preparedness and their sustainability. I think we must act together – the experience of COVID-19 should be a wake-up call. By working together we can be more effective; no one country can contain this virus on its own. I think the pandemic is going to force a re-examination of the global health infrastructure with a view to promoting sustainability and increasing investment in emergency preparedness.
There needs to be a greater value placed on data and epidemiological surveillance. The World Economic Forum reported that 97% of hospital data is never used; and that’s a missed opportunity to deliver better care to patients, through better innovation and more effective treatments and, ultimately, better and more financially sustainable outcomes. Healthcare systems around the world are very siloed: the patient has to work around the system, rather than a more holistic approach working for the patient. This pandemic has shown that healthcare professionals were prepared to work together and break down some of those silos.
The digital transformation is now underway: there was a 50% increase in teleconferencing in the US in March; Norway went from around 9% of family doctor consultations taking place online to around 90%. This is something that health systems have been trying to make happen for years and it will lead to more effective care. The use of digital technology can reduce errors, reduce duplication and save time. From the point of view of patients managing and understanding their own health, digital is essential.
The futureproofing initiative that I am involved with is helping to identify what is necessary to ensure healthcare systems are sustainable. It is a data-driven exercise and its importance has been heightened as the social and economic consequences of COVID-19 are becoming apparent. Futureproofing allows us to identify the strengths and weaknesses of healthcare systems. It is a learning tool that facilitates the sharing of best practice. The pandemic has shown in stark terms the link between health and the economy at a national level, at a global level, and on an individual level. If we do not have access to good healthcare, we cannot have a successful economy: we see now so many businesses have been unable to function because of this pandemic.
Should more attention be paid at a policy level to the wider effects of the health system on the economy? How are the two interlinked?
Most health systems in Europe that we thought were robust have shown great weakness. Normal health demand is incremental and the increase in demand created by COVID-19 was exponential; and it’s hard to see how any system could really have been fully prepared – but so many weaknesses have come to light in some of Europe’s biggest health systems, including issues of continuity and coherence between regional and national authorities.
Since the financial crisis in 2008 many health systems have seen some depletion of resources; and that has impacted on their capacity to be agile and respond to major shocks such as the pandemic. It is time to strengthen the global health architecture, including the WHO. Multilateralism is definitely essential when it comes to shocks such as the world is experiencing. I think we do need to strengthen our global organisations. We need to enhance the capacity of health systems to perform, not just to deal with crises like this but to take a larger role in preventing them – disruption of the status quo is a must.
Could standardisation of data be important for strengthening the capacity of healthcare systems?
Interoperability, standardisation and reduced duplication are all important. We must certainly prepare for personalised and precision healthcare systems of the future. Certainly at the EU level, we could better share and use data, both for innovation, in terms of new technologies, therapies, treatments and preventative strategies; but also to deliver better care to people. I think the use of data to improve society is something that the vast majority of citizens would be willing to accept – but we have to find a way to make that happen while respecting and protecting people’s privacy. In many EU countries we haven’t invested sufficiently in ICT to allow data to be gathered and used effectively in real time.
How can digital and technological innovations contribute to shoring up the resilience and sustainability of the healthcare sector?
Real-time information is so important if we want to have resilient, robust systems; and we do not have that at the moment. Specifically in relation to COVID-19, we are still in the learning phase; we’re still gathering data; we still don’t know enough about this disease. One thing we do know is that our healthcare systems were not robust and resilient enough. Countries will emerge from this pandemic with weaker healthcare systems because of the resources which have been consumed in the combating the virus. Economies will be weaker and, in the short term, may not able to provide the kind of resources that are needed to develop robust and resilient healthcare system.
In Ireland, as in other countries, tech companies were able to tell the government whether people in general stayed at home or whether lockdown was being breached. That information was available in real time and was helpful in informing the government response in lifting restrictions: they were able to base their decisions on evidence. We need responsive and strong healthcare systems that are able to deal with crises; and systems that can be improved by providing information and links between healthcare and public technology networks. All of this, of course, presumes that privacy issues can be properly dealt with.
What lessons should health authorities and policymakers take from the COVID-19 pandemic, in terms of futureproofing healthcare?
Public health will need to be much more strategic: generally, the focus has been on treating disease and illness with less emphasis on prevention. I think there will be a greater priority on public health messaging – the way the public in general have responded has been quite remarkable. It demonstrates that people do care about their health, that they heed important messaging, and that they’re interested in evidence.
In most countries, the political system has heeded the expertise and followed the science rather than the politics, and I find that very reassuring. When I became Ireland’s Minister for the Health, 32 hospitals across the country were providing breast cancer surgery, for a population of 4.6 million; and we were getting very poor outcomes. We gathered a group of experts from Ireland and other countries; and they recommended changes such as reducing the number of cancer centres to no more than eight and ensuring every cancer patient has a multidisciplinary assessment of their treatment pathway. There was huge political opposition, but we stuck with it; and the results have been really impressive.
Politics very often says: ‘leave things as they are; do not disrupt anybody or upset the status quo’. Understandably, people have great affinity with their local hospitals, but not every local hospital is capable of providing the acuity of care required for illnesses like cancer. We must be prepared to do the right thing and follow the expert advice, not the political nous which says: ‘this will be unpopular in the short term’. Hopefully, the silver lining of COVID-19 is that there will be greater respect for the clinical and scientific expertise available to governments: if that happens, we will have evidence-based decisions.
What can policymakers do to ensure the formation of health policy is rooted in a strong evidence base?
I hope that patient groups and health experts will see that when they speak up with a united voice, with a clear message, they will be listened to; I hope they will be a bit more vocal and not afraid to speak out. I note with horror what’s happening in some countries, where attempts are being made to drown out expert advice, or confuse people about that advice, for purely political reasons. These are exceptions: in most countries the advice has been followed and I think that is happening generally in the EU and will continue to be the norm. Full independent assessments will be made of the response to COVID-19 and policymakers should use the opportunity of these reports to insist on the use of strong evidence for future health policy.
Mary Harney
Former Tánaiste and former Minister for Health, Ireland
www.maryharney.ie
This article is from issue 15 of Health Europa. Click here to get your free subscription today.
