Governing the public-private-partnerships of the future: learnings from the experiences in pandemic times. (Special Issue: COVID-19 health system governance.)

When observing countries' responses to COVID-19, conclusions can be drawn on the modalities, successes, failures and governance challenges of partnerships between the public and private sectors during the pandemic. In the United Kingdom, Israel and Austria, these partnerships have contributed substantially to the overall emergency response, albeit with gaps and weaknesses in their structures and processes. These have differed from those of typical public-private partnerships. To be sustainable, partnerships need to be based on key principles of good governance, notably transparency and fairness as well as equity and social justice, all of which may be strengthened both during and post-pandemic.

Use of digital health tools in Europe: Before, during and after COVID-19

Digital health tools hold the potential to improve the efficiency, accessibility and quality of care. Before the pandemic, efforts had been made to support implementation across Europe over many years, but widespread adoption in practice had been difficult and slow. The greatest barriers to adoption of digital health tools were not primarily technical in nature, but instead lay in successfully facilitating the required individual, organizational and system changes. During the COVID-19 pandemic many digital health tools moved from being viewed as a potential opportunity to becoming an immediate necessity, and their use increased substantially. Digital health tools have been used during the pandemic to support four main areas: communication and information, including tackling misinformation;surveillance and monitoring;the continuing provision of health care such as through remote consultations;and the rollout and monitoring of vaccination programmes. Greater use of digital health tools during the pandemic has been facilitated by: policy changes to regulation and reimbursement;investment in technical infrastructure;and training for health professionals. As the pandemic comes under control, if health systems are to retain added value from greater use of digital health tools, active strategies are needed now to build on the current momentum around their use. Areas to consider while developing such strategies include: Ensuring clear system-level frameworks and reimbursement regimes for the use of digital health tools, while allowing scope for co-design of digital health solutions by patients and health professionals for specific uses. Combining local flexibility with monitoring and evaluation to learn lessons and ensure that digital health tools help to meet wider health system goals.

European support for improving health and care systems

Although the primary responsibility for health systems within the European Union (EU) lies with its Member States, the EU also has many tools that can support the strengthening of health systems. Many of the EU's tools can provide support even though strengthening health systems is not their primary objective, such as the European Semester, the Cohesion Policy Funds, Horizon Europe and the Recovery and Resilience Facility. The available tools address different parts of change processes. Making best use of these instruments typically requires combining various EU tools with different objectives across multiple stages of the change process. The need to combine diverse tools creates the challenge for Member States of being aware of many different tools and their potential to support health systems, and in aligning objectives and processes between health objectives and the requirements of those tools. There are some examples of technical assistance from the EU to help with doing this, although none are specifically focused on health systems strengthening. There is potential to combine support from the EU with support from other sources, such as national and regional instruments or other international bodies like the World Health Organization (WHO), although this also presents countries with the challenge of combining instruments with diverse objectives and processes. The EU's support to health systems respects the primary responsibility of EU countries for their own health systems. Nevertheless, being able to draw on EU support has been increasingly important, in particular for Member States that have joined since 2004, and will become even more vital in the coming years. As health systems across Europe deal with the consequences of the COVID-19 pandemic, there is scope for greater collaboration between individual countries and at EU level to make best use of EU tools to strengthen health systems.

Retrospective analysis of phenobarbitone prescribing in palliative patients in the acute hospital setting

Background: Phenobarbital is classed as a sedative anti-epileptic that has an overall effect of depressing the central nervous system. It has a dual action of prolonging the opening of chloride channels on GABA receptor complex as well as inhibiting glutamate transmission at non- NMDA receptor channels. Phenobarbitone is licenced for treatment of epilepsy. In palliative care phenobarbitone is considered in patients with seizures and those with terminal agitation not responding to high dose benzodiazepines and anti-psychotics. Aims and objectives: To identify the frequency, duration of treatment , dosing regime and goal of phenobarbitone prescribed by specialist Palliative Care team in the acute hospital setting and identify demographics of this cohort. Another aim to identify whether it was used as an adjuvant or a single agent and establish any side effects. Method: A Retrospective analysis of patients prescribed phenobarbitone between May 2020 and February 2021 was carried out. We identified initial dose prescribed, titration to effect, duration of treatment, PRN requirements pre and post introduction. We recorded each diagnosis and response in the first 24 hours. Side effects were also analysed. Results: 46 phenobarbitone prescriptions were issued in the 9 month period. 25 were female and 21 were male. Majority of the patients had a malignant diagnosis or covid. The most common indication for phenobarbitone prescription was management of agitation at end of life not responding to high dose benzodiazepine/ anti-psychotics. All patients received stat dose of phenobarbitone 100mg followed by initiation of continuous subcutaneous infusion. Conclusion: Phenobarbitone is a valuable and effective drug in management of terminal refractory agitation in selected cohort of patients.

Keeping what works: remote consultations during the COVID-19 pandemic. (Special Issue: COVID-19 health system response.)

The COVID-19 pandemic saw a rapid rise in the use of remote consultations by telephone and video link. Remote consultations proved important as a way of supporting non- severe COVID-19 patients, reducing pressure on inpatient care, and maintaining access to routine services. Although remote consultations cannot fully replace face-to-face consultations, it is a cost effective and efficient way of enabling access to care that was being promoted long before the current pandemic but with relatively low uptake in most systems. Further development of remote consultation infrastructure would build greater surge capacity into systems to help protect from future shocks while also ensuring platforms are designed to protect patient confidentiality.