5 lessons for the NHS from Denmark

“The year of living Danishly: Uncovering the Secrets of the World’s Happiest Country” is such a witty title I was intrigued to read the book some years ago. It tells the true story of the author, Helen Russell, spending a year in Denmark to see if she could understand what it took to be rated the happiest country in the world.?

As well as being a happy nation, it is a healthy one, with a very well regarded health care system, providing rapid access with short waiting times and a reputation for embracing innovation and technology. While I couldn’t spare a year, it was great to spend time there last week at the Copenhagen Health Tech Summit organised by the Danish Government, including visits to healthcare organisations, to see if I could uncover some of their secrets in healthcare.?

It is always fascinating to learn from other countries’ health systems and the event brought together attendees from 15 countries making it a brilliant opportunity to compare notes on how we are addressing challenges. My focus naturally is on digital home care and what we can learn to accelerate the pace.

In another stunning European city - Barcelona - the global Hospital at Home summit was held last month, and while I didn’t attend that one, colleagues who did said a consistent theme was admiration from other countries at the pace of scale of the virtual ward model in the NHS, now in every single ICS. This was echoed in Copenhagen.?Denmark has been an enthusiastic adopter of digital home care long before the UK, so I was keen to understand how they have made it work.

Here follow 5 things we could learn from Denmark on digital home care:?

• Short list of national must-dos that focus on digital home care?
• Incentives related to progress on these?
• Long term conditions: impressive results in using RM for reducing COPD admissions
• Consideration of the bigger picture and supporting carers?
• Healthy appreciation that the private sector is a helpful partner??

I will expand on each below, but first, some context on Denmark’s health system.?

Like the NHS, Danish citizens have access to universal healthcare paid from taxation. There are differences though; it is a progressive income tax, Denmark is recognised as having a strong, high performing health system, with long life expectancy and low waiting times. Denmark has also had less legacy backlog from the pandemic, demonstrating itself agile in scaling of testing and having resilience.?

“Denmark quickly scaled up its testing capacity at the beginning of the pandemic, which enabled effective detection, tracing and isolation of confirmed cases early on. Rapid implementation of teleconsultations and lower than expected pressure on designated COVID-19 capacity ensured relatively low unmet needs during the pandemic.”?

Denmark punches above its weight in terms of health tech start ups and as a country is considered “world champion in digitalisation” according to the 2020 UN E-Government Survey. In 2021, it was ranked #11 on the World Index of Healthcare Innovation, because of its contribution to scientific discoveries and the wide adoption of health information technology across the country. It has also taken some important steps to prioritise and incentivise the use of digital home care -

“Health care is financed mainly through a progressive national income tax. […] A portion of state funding for regional and municipal services is tied to specific priority areas and targets, usually defined in the annual economic agreements between the national government and the municipalities or regions. […] The scheme incentivizes further transition from hospital care to primary and home-based care and further development of digitally supported and integrated care by making part of the national funding contingent upon five general criteria:

• Fewer hospital admissions per citizen
• Less in-hospital treatment for chronic care patients
• Fewer unnecessary readmissions within 30 days
• Increased use of telemedicine
• Better integration of IT across regional and municipal sectors.”

Each one of these five criteria speaks to advancing digital home care.?

For more on this see -?

In recent years this has been taken further with an explicit move to provision of care at home or closer to home (in centres they refer to as proximity hospitals) associated with dedicated investment and importantly

“A significant proportion of the money must be invested in digital health solutions.”?

“The package formalised the “health clusters” for better integrating the 21 acute care hospitals and primary and local care with a new governance structure that included representatives from the regions, municipalities, and general practice. [Funding was] allocated to establishing up to 25 “proximity hospitals” throughout the country, aiming to strengthen local capacity to provide chronic care. A significant proportion of the money must be invested in digital health solutions.”

For more see below -

So these inspire the first two aspects to emulate?

1 Short list of national must-dos that focus on digital home care?

2 Incentives related to progress on these?

To be fair to the NHS in England, the mandate and funding for virtual wards demonstrates these two principles well, and shows how scale can be achieved effectively and rapidly through deploying them. Plus the most recent planning guidance provided a far more focused list of must-dos.?

However, wrapping a focus on digital home care across the must-dos would more closely emulate Denmark and advance this significantly. It will also be crucial that long term funding models are implemented for digital home care, as the virtual ward investment ends in March 2024. It is interesting that countries such as France and Germany have made huge strides recently on the ongoing funding of digital health and digital home care specifically. This will be important to crack across the NHS if we want the momentum to continue and for the model to scale sufficiently to improve flow.?

3 Impressive results in using RM for reducing COPD admissions

The session I enjoyed most during the trip to Denmark was hearing from Helen Houmoller Rasmussen and Henrik Ibsen on the progress of digital home care across the country.

Helen shared results from the TeleCare North project which has been supporting people living with COPD and Heart Failure for eight years having begun in 2015.?

Not only have they achieved reductions in emergency admissions and lengths of stay, the patient feedback is universally positive and they believe that they have radically upgraded the quality of care by helping people stay in control of their disease.?A readable summary of the work is below, and adds further weight to the case I am increasingly convinced by - that a proactive care model supported by digital tools can make a huge difference to both the experience and hospitalisation rates of those living with these long term conditions, and ought to be something we advance across the NHS at pace.

The Tele Care work builds on strong digital infrastructure in Denmark with everyone having access to their health records and results via a portal/app for many years. Something that is in sight in the NHS but not achieved yet; this plays such a key role in unlocking patient powered health care.

4 Consideration of the bigger picture and supporting carers?

Recently Richard Taunt wrote a splendid long-read on the NHS and his first point was about “Youth” and how the demographic shift will mean we are unable to recruit the health and social care needed. A logical sequel is to imagine both more roles undertaken by staff groups we can recruit but also a future where more input from family based carers is required.?

Currently, in our country, those who opt to take time out of work to care for relatives do so entirely unpaid, and there would be likely many more who would choose to do this for a period of time, if they could afford to. The line that Denmark takes is to ensure carers leaving work are paid, for upto nine months. It is a really interesting approach, and as a policy compliments the increase in home based care.?

“Relatives of seriously ill individuals are allowed to take paid leaves of absence from their jobs for up to nine months. These can be incremental and may be divided among several relatives.”

Source:

Richard's excellent article is here

5 Healthy appreciation that the private sector is a helpful partner??

Finally, it was refreshing to see the straightforwardness of the public sector’s approach to the role those in health tech and the private sector more broadly can play. David Schjerlund, global director for innovation at the Danish Ministry summed it up by saying that often the public sector has the problems and the private sector has the solutions. For more on this, see Pilar Fernandez Hermida’s excellent blog on the summit and the strength of public and private partnerships.?

We sometimes get a bit tied up with this in the NHS and have polarising thoughts about this, that doesn’t help us do the best for patients at scale.?

So that’s my summary of a great visit and five important takeaways from me. Huge thanks to the team who organised this European exchange that led to terrific conversations and real learning.?The Trade Council of Denmark, Health Tech Hub Copenhagen, the Danish Government Ministries of Health and Foreign Affairs and the relevant Embassies.

David Schjerlund Helen Houm?ller Rasmussen Henrik Ibsen Martin Vesterby Anna-Karin Edstedt Bonamy Joakim Steen Barron-Mikkelsen Sephora Akako Ida Kok Rasmussen Jesper Gr?nb?k Martin Broch Pedersen Daniel Bamford Lauren Harkins Dimitri Varsamis PhD Pilar Fernandez Hermida Tony Young Konrad Dobschuetz Bj?rn Zoega Jesper Juel-Helwig Anders Tunold-Hanssen Rich Taunt

Further links and reading

• https://read.oecd-ilibrary.org/social-issues-migration-health/denmark-country-health-profile-2021_2dce8636-en#page1
• https://www.healthcaredenmark.dk/media/jcnjuopx/nordic-smart-digital.pdf
• https://www.healthcaredenmark.dk
• https://sum.dk/english
• Why Denmark Is The Best Place For Healthcare Start-ups (intellisoft.io)
• Denmark is a world leading hub in digital Health solutions (investindk.com)