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Joe Simpson: We could learn from the Danish approach to integration

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One of the privileges of my job is that, each year, I get to spend a week with senior health colleagues looking at the Danish health and social care system. Like us, Denmark has a health service that is free at the point of use. We can therefore compare, contrast and learn.

Not everything in Denmark works. But there are some striking differences in the two systems which reveal where we might learn from them.

First, local governance is much more significant. The hospital sector is administered through a regional tier of government. Like us, the Danes have had the challenge of reconfiguring a set of predominantly district general hospitals to create some key centres of excellence. Like us, the Danes did not have an innate enthusiasm for that idea. But 15 years on it’s possible to say that, in the main, the job is done. Put on the spot, politicians were able to make the tough calls.

And while here the debate rages about the respective balance between health and social care, in Denmark they ask a different question. Namely: what must we do to enable people so they do not need either? And the Danish obsession with design is in the DNA of health and social care. So, the question becomes: how do we design a house so people can live happily at home without needing our intervention?

Similarly, digital health is not a slogan but a practice. Here we have seen aids and adaptations as a budget subject to rationing (any insider knows it’s better to apply in April, at the beginning of the financial year, than it is in March). But the Danish premise is that only through a proactive stance will we reduce the much more expensive need for care provided by staff.

Thirdly, while the Danes often speak better English than we do, there is always one set of questions which they struggle to answer. It’s when our various regulators ask which body is their Danish equivalent.

Tough decisions are made in Denmark (not least through the ballot box – public dissatisfaction caused the chair of one of the regional councils to lose an election when I was last there) but the Danish model is much more based on trust. That plays through in consistent polling figures which show public levels of trust in government much higher than here.

Fourthly local government has adopted a much more proactive public health policy. Consider Copenhagen, a delightful city determined to be the most cycling-friendly in the world. They are clear active lives are more healthy lives. Making that happen is local government’s job.

Joe Simpson, director, Leadership Centre

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