Healthier ageing across Europe: speech by Health Secretary Shona Robison

Health Secretary Shona Robison addresses a conference in Brussels on a global approach to medicine.

Thank you Claire [Dhéret, from the European Policy Centre], and thank you for moderating today's event on behalf of the Scottish Government and the Simpathy Consortium. It is a great pleasure to welcome you all to Scotland House in the heart of Brussels.

Scotland has had a presence here in Brussels for many years, and despite last year's referendum result, I want to assure you that the Scottish Government fully intends to continue engaging, participating and collaborating with our partners across Europe over the next decade and beyond. We will also continue to engage in a constructive and positive manner with the UK Government throughout the forthcoming Brexit negotiations in order to protect the interests of our citizens, our businesses and our wider economy and society.

Turning now to the business of the day. You will hear from some excellent speakers today, who will no doubt highlight a number of well-known common challenges facing our health and care systems.

We know that simply doing more of the same clearly wouldn't be the best use of resources, or the best way in dealing with our ageing population.

Many of the challenges we all seek to address are complex and may require radical shifts to deliver those real differences we need to see – not just in Europe but globally.

Succeeding will necessitate looking across boundaries, across disciplines, across borders – pulling together the excellent talent that we have within our systems and organisations of Europe and, indeed, globally.

If anything this is one of the core messages I want to get across today, for as the Cabinet Secretary for Health and Sport in Scotland, I see on a daily basis the importance of the need to tackle our health and care challenges head on through greater collaboration.

We all share a common priority for improving people's care, and events like this are crucial for making sure that we share good practice and lessons learned.

While this afternoon is about sharing our experiences from across Europe related to polypharmacy management, I would ask if you can indulge me for a few minutes as I would like to share with you some of the approaches we are taking in Scotland.

For I believe we are pursuing a culture of collaboration – regardless of disciplines and sectors – with a focus on delivering results that are of benefit to our citizens and, ultimately, citizens throughout Europe.

For people who have multiple complex needs – young or old – health and social care support that is well joined-up can be the key to living full lives: going to work, living in their own homes, and participating in the activities of their communities.

Across the developed world, people are living longer lives, which is testament in large part to great improvements in health and care provision over many years.

For us in Scotland, as people live longer, our focus has been on formally integrating health and social care with the intention of adding quality of life to people's years of life, particularly people with long-term conditions. This is a goal shared by the European Commission through the European Innovation Partnership on Active and Healthy Ageing, which aims to increase the number of healthy living years we all have by two years.

Integration is also about ensuring that we bring compassion – solace, familiarity and dignity – to people and their families at the end of life. It is about ensuring that services are co-produced with our citizens, maximising their involvement in the planning of their own care.

So we recognise the importance of planning ahead, ensuring our systems are in good shape to help make Scotland an excellent place to live, whatever your age, whatever your circumstances and whatever your support needs.

These are objectives that I know we all share, for ourselves and our loved ones. We also all know that reform is challenging – changing the way we have done things for years is not without its difficulties.

And this applies equally to medication management, the topic of today's conference.

As you are all aware, as our populations live longer, they are more likely to develop a range of long-term conditions – all of which can require multiple different medications. Up to 11% of all unplanned hospital admissions are attributable to medicines-related harm. Data from the World Health Organisation (WHO) and the World Bank estimates that a mismanaged polypharmacy contributes to 4% of the world total avoidable costs due to suboptimal medicine use. A total of 0.3% of global total health expenditure, or 18 billion US dollars worldwide, could be saved by managing polypharmacy correctly.

These are prescribed in a traditional condition-specific manner, rather than as part of a holistic person-centred approach. And we know that at least 50% of those on four or more medications do not take them as prescribed, and up to 6% of all admissions to hospital are caused by incorrect use of medicine.

This is a significant challenge for our healthcare systems – not just for the added cost that we collectively bear, in a time when resources are tighter than ever, but also for how we enable our citizens to enjoy as high a quality of life as possible.

Scotland already has a good track record around developing approaches to the management of polypharmacy for patients with multimorbidities. We have had national guidance since 2012 – it was introduced into the GP contract and is part of our action plan, Prescription for Excellence, to make sure all patients with multiple morbidities get support with managing their medicines.

The approach to deliver this in Scotland was a multiprofessional input with the doctor and pharmacist working in collaboration to deliver medication reviews in partnership with patients. And the Scottish Government has invested nearly €18 million for pharmacist input to general practice to ensure that polypharmacy reviews can be delivered nationally. This aims to optimise patient outcomes from medicines and minimise harm from medicines, thereby improving patient safety.

And ultimately, it is about patient safety. I am delighted that the World Health Organisation has recognised this as a major global patient safety issue.

Last month Alpana Mair, our head of effective prescribing and the overall Coordinator for the Simpathy Project, was involved in the WHO Global Ministerial summit in Bonn, where the third Patient Safety challenge was launched with a focus on medication safety. Europe has a clear leadership role in driving this work forward. I am pleased that we have Dr Neelam Dhingra from WHO to speak to us later about why we need to work together to address this issue.

Today, on behalf of the Simpathy Consortium, we are launching a handbook that is the product of a multinational collaboration and is intended to influence change in polypharmacy, leading to new strategies for the safer, more effective use of medicines for multimorbidity in ageing. Alpana will cover the key findings from Simpathy in a moment. From a Scottish perspective, I am particularly delighted to also announce that an economic tool has been developed by our economist Nils Michael, who has led the work on behalf of Simpathy using the Scottish modelling that began in 2011. This tool will be available for all countries to access and use from the Simpathy website.

Delivering a large-scale change requires strong political and clinical leadership that has many challenges, and I am thrilled to welcome professor Marty Linsky from Harvard who is going to speak to us this morning about leadership challenges to deliver polypharmacy, but also run a workshop this afternoon to help us navigate through these issues.

This is the beginning of this journey which will require ongoing leadership and I am pleased to note that the Simpathy consortium has established strong links with the International Foundation for Integrated Care. At their international conference in Dublin in May, they will be launching a Polypharmacy Special Interest Group which will be led by Alpana Mair and will continue much of the good collaborative work progressed through Simpathy. Later today, we will hear from Dr Albert Alonso about the International Foundation for Integrated Care's (IFIC) commitment to this work.

Before I finish, as the Cabinet Secretary for Health and Sport in Scotland, I have been clear that changes are needed across health and care services to ensure that comprehensive, integrated and patient-centred solutions are provided to address the current and future challenges of polypharmacy. I would like you to join me in pledging your support for change and improvement in the use of multiple medicines, and I believe there is a plaque for us to sign later.

In closing, I urge you to remember that our obligation, both as nations and as individuals, is to ensure that we plan, design and provide high-quality services in ways which best meet people's needs in a safe environment – both now and in the future.

This is not only a more sustainable approach to the planning and delivery of public services, but it is an approach which is better for people, carers, families and communities, and appropriate management of medication is absolutely at the vanguard of effective delivery of better outcomes.

We are a global healthcare community working together – you learn from each other, then implement those lessons and best practice to ensure we produce and deliver the best quality healthcare we possibly can for our people.

Scotland is keen to continue with these and new partnerships and build networks so we can share and learn from others.

I hope this is something we can do today. For if we can encourage more collaborative working and all of our players, and everyone here today, to come together, to focus on our purpose, to tackle our health challenges, the results will be tremendous.

I am proud of the fact that Scotland has embarked on this journey, and I am proud that Scotland was recognised as one of the leading reference sites as part of the European Innovation Partnership on Active and Healthy Ageing.

I believe that we have a lot to offer Europe, and likewise that Europe – and, indeed, further afield – has a huge amount to offer us.

I, and this Government, am committed to our continued involvement in tackling polypharmacy, and see conferences such as this as being critical to sharing our learning and building a shared understanding.

Thank you, and enjoy your day here at Scotland House.


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