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The Stockholm Manifesto

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					 European health policy :
Contemporary dilemmas &
       challenges

The Stockholm Manifesto

          Steve Iliffe
    14th IAHPE conference
Thessalonika May 25-28th 2005
                What is the problem?
• Counter-reformation across European health
  care systems
• Regressive modernisation, through markets
• But what is progressive modernisation?




May 25th 2005         14th IAHPE Conference,   2
                            Thessaloniki
                Counter-reformation
• Systems of social solidarity emerged and
  developed in Europe
• Challenged powerfully by market mechanisms
• Pro-market views now have political advantage in
  the European Union

Philip Berman & Petra Wilson (European Health Management Association)
    Facing (uncomfortable) facts: the European dimensions of health services
    European Health Policy 2004;10(3&4):3-5

May 25th 2005                  14th IAHPE Conference,                          3
                                     Thessaloniki
          Regressive modernisation
• Socialised care is unresponsive to citizens
  (tailoring versus one size fits all)
• Socialised care is resistant to change (vested
  interests of professionals)
• Market mechanisms increase
  responsiveness and overcome resistance to
  change

May 25th 2005     14th IAHPE Conference,       4
                        Thessaloniki
                What is progressive
                 modernisation?
Solving problems and retaining social
  solidarity?
We need mechanisms for:
• Increasing responsiveness to individuals &
  communities
• Promoting innovation, smarter working,
  efficiency, re-engineering

May 25th 2005        14th IAHPE Conference,    5
                           Thessaloniki
                Stockholm Manifesto 1
• IAHPE conference in Stockholm, 2003
• Collective knowledge (The many are
  smarter than the few)
• Expert group, diverse experience
• Nominal group methodology



May 25th 2005         14th IAHPE Conference,   6
                            Thessaloniki
                Stockholm Manifesto 2
Steve Iliffe, Medicine, UK
Alexis Benos, Public Health, Greece
Rolf Gustaffson, Social policy, Sweden
Jane Lethbridge, Health Policy, UK
Jens Niehoff , Health Insurance, Germany
Jill Manthorpe, Social policy, UK
Dieter Borges, Medicine, Germany
Jochen Zenker, Public Health, Germany
May 25th 2005         14th IAHPE Conference,   7
                            Thessaloniki
                Stockholm Manifesto 3
• Validation process (Labour reform group
  conference, London, September 2003,
  IAHP conference South Africa 2004,
  Perugia February 2005)
• Open Delphi method – failed
• Version 5
• IAHPE conference in Thessalonika 2005

May 25th 2005         14th IAHPE Conference,   8
                            Thessaloniki
                Stockholm Manifesto 4
• Larger and more diverse expert group
• Analyses of local experiences
• Testing the Manifesto themes
• Produce a philosophy for everyday action in
  European health services
• Version 6
• Consultation after the conference
May 25th 2005         14th IAHPE Conference,   9
                            Thessaloniki
                Stockholm Manifesto 5
The three themes:
• Complexity & system approaches
• Work processes & managerialism
• Public involvement




May 25th 2005         14th IAHPE Conference,   10
                            Thessaloniki
                     1.Complexity
All analyses at all levels depend upon knowing:
• ‘Instruments’: scientific knowledge &
  technologies
• ‘Rules’: financial basis, management, codes of
  conduct
• ‘Community’: the influence of outside interests
• ‘Division of labour’: who does what
• ‘Professionals’: those providing services
• ‘Users’: those using services
Engström’s Activity theory
May 25th 2005                14th IAHPE Conference,   11
                                   Thessaloniki
                            Complexity
                        INSTRUMENTS: SCIENCE,
                       TECHNOLOGY & SERVICES

                                                         After Engström


        HEALTH CARE                     USERS &             OUTCOME
        PROFESSIONAL                    CARERS




  RULES:                    COMMUNITY              DIVISION OF LABOUR:
 ETHICAL,
FINANCIAL

May 25th 2005                   14th IAHPE Conference,                    12
                                      Thessaloniki
2.Work processes, managerialism
Fordist industrialisation of health care
• Cost effectiveness
• Standardisation of knowledge & practice
• Flexibility & teamworking
• Soft bureaucracy: centralisation through
  decentralisation, corporatism.
• Governance
May 25th 2005    14th IAHPE Conference,      13
                       Thessaloniki
                         Governance
All health service management depends on a
  combination of:
• Command: hierarchical control & rules
• Communion: shared values, professional
  leadership
• Contract: exchange of contributions
The balance depends on political forces & cultures.
Stephen Harrison Governing Medicine: theory and practice, Oxford University
   Press, 2004

May 25th 2005                14th IAHPE Conference,                           14
                                   Thessaloniki
                3.Public Involvement
• Democratic and multi-disciplinary norm-setting
• Needs defined & prioritised in transparent process
• Norm-setting identifies priorities that will
  determine investment needs
• People who can think for themselves, functioning
  independently in a decentralised way, will make
  better decisions and judgements than experts, if
  they have a mechanism for aggregating different
  opinions (i.e. voting)

May 25th 2005         14th IAHPE Conference,       15
                            Thessaloniki
         Progressive modernisation
• Whole systems (no simple solutions)
• Stable systems, evolving slowly
• Not-for-profit economics
• Post-Fordist work processes:
  decentralisation, low hierarchies, limited
  standardisation
• Democratic norm-setting
May 25th 2005     14th IAHPE Conference,       16
                        Thessaloniki

				
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