What can we learn from the Danish healthcare system and what can we learn from each other?

My name is Meg Hillier and until recently I was an ambassador for Healthcare Denmark, which allowed me the great privilege of learning about the Danish healthcare system, and meeting so many people, dedicated and passionate about improving healthcare.

This summer I was elected to chair the powerful Public Accounts Committee in the UK Parliament. This is the public spending watchdog. It has been sitting since 1861.

Our job, twice a week, is to hold senior public officials to account for how they are spending taxpayers' money.

Of course that includes the 96 billion pounds we spend annually on the National Health Service, which I am reliably informed is the equivalent to 960 billion Danish Krona.

I am delighted to be here in Odense to address the question of 'what can we learn from the Danish healthcare system and what can we learn from each other?'

You will be relieved to hear that the simple, and quick, answer is 'a lot'.

As we have heard today, so many of the issues being faced in Danish healthcare are no different from those we are grappling with in the UK, and in many other advanced economies.

The Danish and British healthcare systems are close cousins - the most similar out of the whole of Europe.

May I illustrate that point with a few figures:

Total expenditure on health as a percentage of GDP is 10.6% in Denmark, and 9.1% in the UK.

In both countries health expenditure as a percentage of GDP decreased from 2012. In Denmark it was 11%, and in the UK it is 9.3%.

Public sector spending on health accounted for 85.4% of total health expenditure in Denmark and 83.5% of total health expenditure in the UK in 2013.

Between 2012 and 2013, private sector spending increased by 3% in both Denmark and the UK, accounting for 14.6% of total health expenditure in Denmark in 2013 and 16.5% of total health expenditure in the UK in 2013.

So you can see that despite the big difference in population size - more people live in London than in Denmark – there are real similarities between our two systems.

Real challenges too.

Our respective healthcare systems are both products of the post-war 'golden age' of social democracy.

They were both born out of the same egalitarian impulses that disease, injury and ill-health should be banished in a civilised society, for everyone, regardless of their social standing.

But our systems reflect the society and economy of the time.

And as societies and economies change, so the healthcare system must change too.

Our populations are working differently - fewer jobs in traditional manufacturing and heavy industries; more jobs in digital industries and the service sector.

Women's roles are changing fast, with more women in the workforce than before.

The health challenges are different: obesity, cancer, a growing awareness of mental illness, sexual health, drug and alcohol addiction.

Our populations are less trusting of authority, more sceptical and questioning, have more access to medical information, studies and journals.

Patients are more likely to have read up on the latest research, drugs or treatments online before meeting with a doctor.

But most importantly of all, our populations are getting older. The generation born this year can confidently expect to live to 100. Many will live to 110, or 120.

In the UK for very day longer that a middle aged man lives, life expectancy goes up by an hour (the equivalent of a year for every five years of life). The bad news is that by end of life he'll have at least two morbidities.

The solution to life without a morbidity is about well being rather than health.

The Marmot Review – a study commissioned by the UK Government to investigate public health – of 2010 points out that most of the determinants of ill health are social - unemployment and quality of housing being particularly important.

In the UK the poor relation is mental health. Yet we know that poor mental health can lead to serious health problems more widely. So tackling social needs and wellness are important to improve health and save the health services money.

But even if we tackle wellness there are still the questions of who will care for this larger, older population, how will healthcare systems meet growing demand, and how we need to work to prevent ill health rather than just rely on health systems to provide a cure.

We also need to make sure that our health systems are

equipped to deal with the conditions of an older population, especially dementia and social isolation, and decide who will pay for it all?

A bigger, older population; changing patterns of work and recreation; new drugs and technologies; growing demands and changing social attitudes - this is the 'perfect storm' of pressures on the healthcare system in Britain and Denmark.

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In the UK, reform of the healthcare system is fraught with political peril.

A British government minister once said that our National Health Service (NHS), founded in 1948, is the closest thing the British come to a national religion.

The NHS remains, whatever its mistakes and set-backs, a remarkably durable social institution, founded on the principle that healthcare should be free at the point of need, regardless of your ability to pay.

The Economist Intelligence Unit pointed out this year, Britain has an incredibly lean and efficient health service compared with just about every other industrialised country.

The British National Health Service is the fifth biggest employer in the world.

That means that politicians must tread very carefully when it comes to health reform. If you want a thousand people at a protest meeting, the surest way is to threaten to close a local hospital, even if the alternatives - primary care, local clinics, health prevention - deliver a better service and better health outcomes.

We have had our successes. For example, a member of the House of Lords (our second chamber of Parliament) Lord Darzi, himself a surgeon, was commissioned to reform stroke services. He advocated centres of excellence rather than inadequate services in every area, and his reforms are saving about 300 lives a year.

But despite the perils, we must reform our system if we want it to survive as a tax-funded, free-at-the-point-of-need health service.

I am especially interested in your experience of moving away from central targets and towards local flexibilities, within an overall framework of quality. In the UK, some targets have been dropped, for example length of wait in Accident & Emergency, but it has not led to an increase in quality.

The chief executive of the National Health Service (NHS) in England, Simon Stevens is a moderniser and a reformer, and in a recent speech he established the three priorities for reform over the next five years.

I will offer these to the answer the 'what can we learn from each other' part of the title of this presentation, and I will be interested to hear your reactions:

Prevention. It is obvious that we need to tackle the causes of ill-health and injury if we are to be able to afford free healthcare. That means smoking cessation. Tackling junk food and high-fat, high-sugar foods, especially ones targeted at children. Getting people away from the television and onto the sports field or swimming pool.

We know that we must tackle the obesity crisis today, if we are avoid millions of cases of cancer, cardio-vascular disease and diabetes tomorrow.

It also means a new focus on mental well-being, and a new effort to tackle depression, anxiety, eating disorders, loneliness and other mental illnesses.

Care. We need to re-imagine our approach to care, and blur the lines between primary and secondary care, so that we aim for a whole-person approach.

A patient with cancer, or dementia, or post-natal depression needs a healthcare system working together, in close coordination, to tackle the different dimensions of their condition. We can't treat one bit of the body in one building, and another bit in another building down the road.

I know here in Denmark this is well-understood and forms the basis of much of your impressive reforms in recent years.

Sustainability. Our NHS needs an extra £8 billion pounds by 2020 just to meet demand. That means it will face huge pressures to find efficiencies and savings within its huge budgets.

Those were Simon Stevens's priorities, and I think he has it about right.

That last point about efficiency opens our discussions to the role of the private sector in delivering public healthcare.

There is a major public debate in the UK about the role of the private sector in delivering public health services.

Much of the debate is ideological in nature, often clouding the realities. Our general practitioners are usually private businesses, for example, as are our pharmacies, as are the people who manufacture pharmaceuticals. A typical patient might go from a doctor to a high- street pharmacy to pick up a drug - all provided under the umbrella of the NHS, but delivered by the private sector.

The Tony Blair government used private suppliers to challenge public institutions and to cut waiting lists for treatments such as cataracts or knee operations.

But it also introduced public-private partnerships to build hospitals which have been controversial for their expense over the long-term. The mantra was 'what matters is what works' but that admirable plea for practicality has been lost recently in the fog of political debate.

I think the same questions apply across any public service which uses private sector suppliers;

Is the service better for citizens as a result of private sector involvement?

Are there demonstrable efficiencies and savings to the public purse?

Does the relationship withstand public scrutiny and transparency?

Does it pass the 'smell test'? In other words is it fair, efficient and free from the whiff of profiteering, preferment or patronage?

This debate is bigger than the UK or Denmark, and bigger than just healthcare.

It is the fundamental question of where do the boundaries lie between state and citizen, and between public and private sectors, and it is the very stuff of democratic politics.

So what have I learned from my engagement with the Danish healthcare system?

I started by saying what a privilege it has been to meet such enthusiasts for improving the patient experience.

I'm going to take three lessons home with me.

First, the need to empower the patient. I mentioned earlier how populations have more information, less trust, ask more questions, and demand more answers, and this is a good development.

In healthcare it means that patients, especially ones with long-term conditions, can become 'expert patients', capable of challenging healthcare professionals as equals.

In the UK, half of all patients in hospital say they aren’t as involved in their care as much as they would like. This figure hasn’t improved in a decade.

I have been involved in a major study of over 100 countries through the All-Party Group on Global Health (a body made up of British parliamentarians). We observed success stories from across the globe, including the developing world, where patients are directly involved in the design and commissioning of services, and in their own treatments.

In that report, we highlighted Denmark's pioneering work on allowing patients to own their own medical records, to give patients real access, and the ability to edit them.

For decades, a citizen's medical records were held by the state, and the citizen did not have access to them, without going through a tortuous process of disclosure. Yet what is more personal, and of more value to us, than knowing what our medical records say?

In the UK we've had success in providing patients with information on surgeons' published records, helping people make meaningful choices about their surgery. But this is just the start. And it took a long time to get here

The digital revolution is transforming every area of our lives, including our healthcare. We are entering a world of data-sharing, open data, and empowered digital citizens.

We can own a watch which tells us how many calories we've consumed or expended, our heart-rates and how many steps we've taken. Soon it will know our blood pressure, levels of cholesterol and probably what we're thinking!

So of course the world should copy Denmark in access to digital health records.

Second, allied to this idea of digital empowerment is Tele Health. I've been impressed by Danish Tele Health, especially here in this City.

Tomorrow I will be seeing for myself the changes implemented by the local municipality here. I was impressed when I met the Deputy Mayor of Odense in London and learnt from her about the technology being embraced to improve the patient experience and save money, but also by the political courage in delivering this fast.

I am impressed by your ambitious National Action Plan for Dissemination of Telemedicine. The action plan consists of five initiatives, for citizens with chronic obstructive pulmonary disease (COPD), diabetes, and depression, as well as for pregnant women with and without complications.

I understand that the action plan takes the first steps towards maturing telemedicine and eHealth solutions on a large scale in Denmark.

And the next steps are the Strategy for Digital Welfare, which is no less ambitious.

In future, all relevant patients in Denmark will be treated and monitored in their own homes using telemedical solutions. Also, leading up to 2020, telemedicine solutions will be tested on new, relevant groups of patients on a large scale. This is seriously impressive work, and I will be encouraging my colleagues in the UK Parliament to keep a close eye on how it works. I am confident it will be met with great success.

Let me share our own experience: The UK’s Department of Health’s Whole System Demonstrator launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices.

Three thousand and thirty people with one of three conditions (Diabetes, Chronic Heart Failure and COPD) were included in the telehealth trial.

The evaluation proved that tele health methods led to a;

45% reduction in mortality rates

20% reduction in emergency admissions

15% reduction in A&E visits

14% reduction in elective admissions

14% reduction in bed days

8% reduction in tariff costs

Of course this is fantastic news for patients, but is also good news for taxpayers as it saves money as well as lives.

And that leads me to the third of my lessons: effective procurement.

As chair of the Public Accounts Committee, I am constantly aware of the need to use taxpayers' money wisely. We never refer to the 'government's money'. It is taxpayers' money, hard-earned and reluctantly surrendered, and public bodies should never forget it.

I think we have much to learn from Denmark's experience of dealing with private suppliers, for example Falck which has a long-standing relationship to supply ambulance services.

Also it seems that your relationship with IT suppliers has been better handled than anything we have managed in the UK.

My committee highlighted the failure of the UK Department of Health dealings with IT suppliers as part of the National Programme for IT in the UK, which has cost billions and is seen as a failure. My colleague and committee vice chair called it the 'worst and most expensive contracting fiascos in the history of the public sector.' On Monday we are reviewing yet another IT failure.

As we're in the birthplace of Hans Christian Andersen, I have to say it reminds me of the fairy-tale of the Emperor's New Clothes, where the unscrupulous tailors sell the Emperor nothing but air, pretending it is cloth of great value. It is a useful tale when it comes to public procurement.

Here, you have a much more healthy relationship, with built-in flexibility, just-in-time deliveries, and a greater transparency of contracts.

This is an area where the British system can learn so much.

So, if asked to distil so many experiences and lessons, I would highlight these three:

Empowering patients

Harnessing technology for tele health

Smart procurement to get the very best from suppliers

Finally, I'd like to thank you for your hospitality, your warmth and your insights. You are all welcome in London anytime!

ENDS