How Safe are We? Conferenceof the Directorate of Health on Patient Safety

Conference speakers, ladies and gentlemen:

We have important topics up for discussion at this conference, the safety of patients and quality of health services. What is the state of these issues, where are we going and what can we do to best ensure the safety of patients at the same time as we must as never before exercise restraint in health expenditures, as in all other areas.

I thank the Directorate of Health for convening this conference and, last but not least, I welcome the main speaker, Sir Liam Donaldson, the Chair of the World Alliance for Patient Safety which was established by the World Health Organization. There are probably few, if any, with as extensive knowledge of the issue of the day as he possesses.

For years, we Icelanders have prided ourselves of a healthcare system amongst the best in the world regarding access, quality, safety and efficacy, as shown by international standards. According to a recent European survey, Iceland is in third place in comparison of 43 European countries, after Sweden and Norway in first and second place, respectively. In the survey, the policy of countries in ten areas was compared: Campaigns against tobacco and alcohol, nutrition information, fertility, pregnancy and birth, child healthcare, contagious diseases, analysis and treatment of high blood pressure, screening for cancers, traffic safety and air pollution. The political, economic and social aspects of healthcare policy were also surveyed. The survey revealed a considerable difference between European countries, and the authors of the study conclude that the health of European populations could be significantly improved if methods were employed that yielded the best results.

We can be proud of this conclusion and it presents a timely reminder to us how important it is that the health authorities have a clear policy and implement it. Healthcare policy is in need of continual revision; it must take account of circumstances at each and every time, be realistic and implementable.

Although we have for years been in a good position by international standards, it must be said that there are issues at hand that must be dealt with. Expenditure cuts in recent years have weakened the basic pillars of the healthcare system and signs thereof have become visible. Equipment is becoming obsolete, so are premises, and the pressure on hospitals, especially the University Hospital, has increased at the same time as the recruitment of professional manpower in the system is becoming increasingly difficult as a result of the spending cuts I mentioned, a source of serious concern.

The Icelandic healthcare system is supported by a strong legal and regulatory framework that also includes the overview and surveillance system which provides guidelines and discipline for healthcare services. Nonetheless, it is very clear that this framework does not by itself ensure the safety and quality of the healthcare service. If the pressure on the institutions providing the service is excessive and the underlying pillars are beginning to crack, the danger is clear that the quality of the service as well as patient safety is at risk. In these circumstances it is eminently clear that we must revise our emphasis as well as improve and develop a more efficient organisation.

One of the elements in reducing the ever-increasing pressure on the healthcare system is to improve preventive care and strengthen public health measures. This is an ongoing task, since it is important to strengthen public consciousness of the responsibility of each individual for his or her own health through a deliberate program of education and support. The same applies to patients as users of healthcare services. It is very important that patients become active participants in their own treatment, as much as possible. A nationwide electronic patient healthcare database and easy access by patients to information regarding their communication with the nationwide healthcare system constitutes an important aspect hereof. Let me also mention a project underway in the Ministry of Welfare for a round-the-clock, nationwide telephone healthcare service. This service will be supported with an interactive website with education for the public, information on the healthcare system and where to turn for services. The aim is to improve access to healthcare services and guide users through the healthcare system. This project is modelled after comparable services in other Nordic countries.

It is generally agreed that the local healthcare centre should be the first stop for people in the healthcare system. This has not always turned out to be the case, and ways must therefore be found to ensure that the local healthcare centres will function in their key role. If not, patients must resort to specialists, even if it is not in their interest, because the healthcare centres are overloaded. It will therefore become necessary to introduce service guidance into the healthcare system, with an emphasis on improved services that ensure timely and appropriate solutions for patients, while at the same time improving efficacy and better use of funds. The healthcare centres will at the same time be strengthened in order to make them the first stop of patients in the healthcare system and invest them with a key role in the provision of health services.

Ladies and gentlemen.

I have covered a great deal of ground in this brief address. Each of these topics is worth of discussion at length, since there are many sides to these complicated issues. Let me in closing mention two further issues of importance regarding our possibilities for organising the healthcare system, assess its effectiveness and ensure its quality. The first is a nationwide patient database and the second is a consistent registration and publication of health information from service providers. Here we have some way to go; we do not have an important overview for decision-making. This is a large project that we must determinedly work on over the next several years.

In conclusion, let me thank the Directorate of Health for convening this important conference. I am certain that the results will be of use to all of us as we deal with the important tasks ahead.