Dr. Vytenis Andriukaitis:

May I draw the committee's attention to the experience of Finland? Finland decided to very actively combine its efforts in social care and health care, uniting its budgets, uniting its instruments and discussing how to guarantee community-based approaches at local level and how to create teams. The patient is in the middle. Secondary health care providers and management teams are at another level. They use IT tools. The Finns invested a lot in eHealth instruments. They have joined social care budgets, local community instruments and budgets and health care budgets and have created community-based models and networks. They are innovative and have pilot projects. This required changes in the constitution, of course. They decided to centralise slightly their health care facilities, especially at regional level because they have a lot of hospitals at community level. They tried to go from community hospital care to primary care centres, which are community-based instruments, and of course to combine with regional hospitals. This took three years and was very difficult. They are now on their way to adopting final legislation. I would happily recommend looking at the Finnish experience at the moment.

Spain and Germany, of course, are federal states, but in Spain there are also some states which have introduced community-based principles and methodologies. Some countries, in central and eastern Europe, have so-called systematic connections between primary, secondary and tertiary care. They innovate to improve IT instruments and platforms and eHealth instruments and this helps them to reduce the number of hospital beds. Of course, it is very difficult and painful. I mention centralising regional capacities, especially in tertiary, high-level specialised medicine and monitoring. Only Finland decided to join social budgets and social instruments with health care budgets and it would be a good example to look at in more detail.

We are ready to assist you and to analyse and provide information. We would be more than happy to co-operate with you and to draw attention to some pilot projects that might help you achieve results.