Featured Reference Site: Skåne - Interview with Ylva Reisnert & Alexander Dozet

Interviewer: Maddalena Illario

Population Ageing is posing several important challenges to our societies, that overcome country boundaries   and hence require concerted global policies aimed at implementing sustainable approaches to transform it into an opportunity for sustainable development. Health inequalities, public health emergencies, environmental factors affect high, medium and low income countries, where they hinder the achievement of human full potential.

Which public health challenges do you foresee as priority for your Country and for your Region?

The objective of Region Skåne in public health is to achieve good health on equal terms for the entire population of the region. The societal challenges in health cannot be solved through measures targeting the healthcare sector alone, but require joint efforts across a range of actors to improve the health system as a whole. This includes health promotion and disease prevention, where we also have to focus on health determinants. Skåne’s most important challenges in public health result from a demographic development with increasing numbers of both older and younger people (in proportion to the working population), increasing inequalities in health, and an increasing number of people reporting mental ill health (especially the young). Physical inactivity and obesity are also important public health challenges.

Public health priorities at the national level in Sweden are similar, with an overarching goal to create societal conditions for equal health of good quality for every citizen and close preventable health gaps within a generation.

Skane is located in the heart of Northern Europe, at the crossroad between Baltic and Nordic Sea: which public health challenges do you see as peculiar of this setting? Which ones do you share with the part of Europe that is locate more South?

Generally the challenges are similar, but it also depends on how you define southern Europe. The rate of smoking is lower in Skåne than in most other countries in Europe. Obesity rates are also lower in Skåne than in some European countries, but higher than in some others. However, suicide rates are higher indicating a higher prevalence of certain types of mental ill health. Another challenge more specifically linked to the elderly is fall prevention, as we provide elderly care in the home setting probably to a greater extent than some other countries.

Despite being surrounded by water, Skåne is a border region thanks to the bridge between Malmö in Skåne and Copenhagen in Denmark. The Öresund Bridge celebrates 20 years this year. In 2019 almost 20 500 cars and 33 500 train passengers crossed the bridge between Skåne and Copenhagen daily, and many people work or own a house on the other side of the border. The two regions collaborate in several areas, including health where we have an agreement between Region Skåne, the Capital Region of Denmark and Region Zealand regarding emergency care and some fields of specialised care including cancer and plastic surgery. There are also discussions regarding investment into a joint emergency helicopter.

The cross border collaboration is based on the presumption that each region is relatively small on its own but can achieve greater critical mass and efficiency through working together in order to offer a broader or more specialised care to its citizens. Our challenges reside mainly in the legal framework, where the regions are responsible for health care coordination and delivery, but the laws regulating these responsibilities are set at the national levels. Our experience is that it is often the legal framework that sets boundaries for interregional collaboration in health, rather than political will or regional ambitions. This experience might be shared by other border regions in Europe.

What role do you think the digital transformation of health and care can play in addressing these challenges?

Digitalisation is one of the components that will contribute to solving challenges in health and care, when it is used to achieve efficiency gains and personalised services. However, we must achieve a better understanding and knowledge of the entire system and how we can reform it to prevent undesirable effects. We need a whole system perspective in order to optimise individual solutions, including digital ones.

Region Skåne is currently investing in a new digital health care system, SDV, which will transform the health care delivery in Skåne. The system is a new comprehensive, fully interoperable and standardised digital platform for all health care providers in Skåne, linking them together with common working methods to offer better health for more people. The introduction of SDV means that the separate medical record systems that are currently used in primary and hospital in- and outpatient care are replaced by a system with one login, one medical record and one prescription list for each patient. In addition, a patient portal, a module to promote public health, and a number of automated solutions to simplify the everyday life of healthcare staff are launched. SDV is the most comprehensive renewal work in the history of Region Skåne and it is expected to be fully implemented by the end of 2023.

Which enabling factors and bottlenecks do you see for implementing new solutions to improve health services in your RS?

It is important to review in detail and improve the overall health care system, i.e. the interaction between the components of the system, in which we find ourselves today. Changes at the system level must keep pace with changes in society. Improving and adapting laws and regulatory frameworks are also important to address in the changing landscape. The pandemic crisis and the debate that followed has highlighted examples of shortcomings.

How do you ensure all the stakeholders in your Reference Site are engaged in addressing the Region's AHA priorities?

For the purpose of the Reference Site we have a regional group in Skåne with representatives of all our partners (13 organisations, from municipal social care providers and hospitals to universities and companies) with whom we communicate information and opportunities arising within the EIP on AHA. All partners are organisations with whom we, as the regional authority responsible for health care, collaborate also in other constellations related to health, innovation or other aspects of regional development. We also have a broader mailing list for general updates about EU health policy, open calls, partner searches, etc where anybody with an interest in EU policy in the health domain can register.

Which digital, or other innovative, solution is having the biggest impact on health or social care outcomes in the Region?

It is difficult to point at any specific solution since we are in a development phase and the outcome is not yet known. We consider that innovation is not based on solutions only, but is the result of the definition of a challenge and a clear assignment to address the challenge with the help of innovation processes. But it is also important to reflect on reforms of the system that we operate within today, to be better aligned to the challenges we are facing.

Video consultations is probably the individual solution whose effect can be most accurately evaluated at this stage. Self-care solutions for chronic patients is also a strong candidate, and we have a good spread and good effect of security alarms for the elderly.

What barriers did you have to overcome in implementing it?

Collaboration between primary care, which is a regional responsibility, and municipal social care is a challenge. There is still a need to strengthen the ability to work with innovation processes and development in this sector.

What kind of support do you expect from the RSCN?

It is always interesting to be able to access good examples and learnings from other regions, which the RSCN can facilitate. It would also be great if the network could help with accessing funding and partners for projects, for example through match-making and information about relevant calls.

Would you be available to be an ambassador for the RSCN in your area?

Yes, Skane agrees to collaborate with the RSCN to start/engage in discussions within stakeholder groups, thematic groups, webinars.

Are you aware of the WHO Decade of Healthy Ageing (2020-2030)?

Yes. It was proposed that members of Skane could frame a collaborative activity with RSCN, highlighting activities aligning with the Decade.