Task-shifting in healthcare systems:
EuroHealthNet welcomes the draft opinion prepared by the Expert Panel on this important issue. The actions recommended are reasonable, given the very limited evidence available which is “much less than desirable” so far. Therefore, EuroHealthNet calls for further evidence, including health equity impact assessments and learning from other sectors, to be gathered with urgency in relevant and comparable settings and models, including via EU research, health, ESIF and other programmes.
It is essential for us to see a strong focus on ensuring task shifting in healthcare strengthens, not undermines, principles of equity and quality. We agree that task shifting should not be viewed in isolation but in the wider context. This means not only within health systems as narrowly defined, but in terms of whole systems towards wellbeing, particularly as established in the integrated goals of UN Agenda 2030 and the SDGs, which we are surprised is beyond the scope of this draft opinion but should be included.
Health and well-being is a product of co-creation by various sectors and ownership levels. Therefore, shifts to new ways of working have multiple societal and governance impacts. Community workers are mentioned, but in terms of “requiring better integration into health and care systems”. In the real world, the opposite might offer better returns: health professions need to be better integrated within wider public health workforces and systems, including public, private and voluntary sectors.
While traditionally the emphasis has been on tasks related to delivery of medical care, it is also other tasks that can be shifted: responsibility for organisation or financing of specific types of care (including health promotion or social care “prescribing”), central government to regional authorities or municipalities, public and private insurance tasks. Beyond changing roles of health professionals, changing roles of patients and healthy populations should be considered.
The draft acknowledges that evidence is weak again on patient/carer/public “self-management of chronic conditions” We call on the Panel to consider learning from the CHRODIS Plus, Joint Action Health Equity Europe and other relevant EU Joint Actions in these respects, where role shifts need to be integrated.
It is notable that health literacy and – increasingly more importantly – digital health literacy is barely mentioned, but that needs to be pivotal, both for the public, and for training of all relevant professionals.
The Opinion clearly states that the final goal of European healthcare systems should be achieving universal access, with particular attention to vulnerable (patient) groups. As such, EuroHealthNet certainly shares much of the vision and messages described in the document.
On the other hand, it is important to underline that the document focuses on access to treatments and medicines, and with little or no attention to public health or broader social policies.
This implies that the proposed definition of value-based healthcare is (mainly) meant to support the reform of the way healthcare systems provide care and treatment, and very little for improving prevention policies or policies aimed at improving the social determinants of health. The document could give more attention to social determinants of health, health promotion and prevention. Also, the scope should not be limited to just patients, but addressing more the whole population.