Policy responses for Denmark - HSRM


Policy responses for Denmark

5. Governance

5.1 Governance

The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.

Statens Serum Institut has developed a mathematical (SEIRS) model to support decision making in the re-opening phase. The model is based on assumptions about behavior and infection rates derived from Danish data where possible, supplemented with international data, e.g. from England about contact patterns for different age groups. The report presents different scenarios based on different re-opening policies, and has been directly supporting political decision-making. SSI highlights that there are significant uncertainties related to some of the assumptions in the model. In particular, the total infection rate is unknown, using behavior data from other countries can be problematic due to cultural and structural differences in interaction patterns, the role of children in contracting and spreading the infection is unclear and seasonal variations are uncertain. Additional uncertainties relate to modelling of the implications for hospital capacity as there is still limited data available about the length of stay and the need for follow-up treatment of persons after intensive care

On June 30, the Danish Health Authority published a compilation of revised guidelines on how to increase clinical activity while preventing the spread of COVID-19 (https://www.sst.dk/-/media/Udgivelser/2020/Corona/Retningslinjer/Generelle-retningslinjer-for-planlaegning-af-aktivitet-i-sundhedsvaesent.ashx?la=da&hash=9F3B08A0B72C4167F97D07DE114115A7AC61E665).

On December 4, Region Sjaelland decided to move from level 0 to level 1 of their COVID-19 hospital contingency plan until December 31 due to the increasing number of infected patients. This implies a postponement of some of the planned orthopedic operations in order to secure sufficient beds for COVID-19 patients (https://www.regionsjaelland.dk/nyheder/Sider/Region-Sjaelland-gaar-til-trin-1-i-COVID-beredskab.aspx).

On December 18 the government announced, that a large majority in the parliament has agreed on a new Epidemics Act which will replace the current act, including the emergency legislation from the spring 2020 (https://sum.dk/Aktuelt/Nyheder/Coronavirus/2020/December/Bred-aftale-om-ny-epidemilov.aspx).
On January 21 the Ministry for Health and Senior Citizens was slimmed down, as responsibilities concerned with social care for the older population were shifted to the Ministry of Social Affairs. No new ministers were appointed (https://sum.dk/ministeren/sociale-medier-arkiv/2021/januar/2101-aendringer-i-ministeriet).

On March 1, the new Epidemic Act came into force, and all current executive orders continue to apply (https://sum.dk/nyheder/2021/marts/information-om-viderefoerelse-af-bekendtgoerelser-i-medfoer-af-epidemiloven).

A law on epidemics has been in place for a number of years, with the most recent revision in 2019: LBK nr 1026 of 01/10/2019  (https://www.retsinformation.dk/Forms/R0710.aspx?id=210518). However, capacity planning e.g. for testing, was not fully in place. The General Health Law (article 210, 3) already states that national authorities can require that private hospitals and clinics provide equipment and capacity in an emergency situation.

A set of emergency legislation has been adopted to deal with the pandemic. They include new powers to the health minister, but with a sunset clause of 1 March, 2021. The new legislation entails:
• Power to force people who are infected to be isolated and treated (The Danish Patient Safety Authority has utilized this power twice (two patients in total); https://stps.dk/da/nyheder/2020/styrelsen-for-patientsikkerhed-har-givet-to-paabud-om,-at-borgere-skal-lade-sig-isolere-covid-19/)
• Power to forbid meetings and assemblies
• Power to restrict access to transportation
• Power to suspend the rules about rights to choice of hospital and rights to fast access (the general one month waiting time guarantee for diagnosis and treatment).
Power to suspend other legislative requirements under specific circumstances.
The government intervention has been decided by the national security council headed by the Prime Minister and ministers of justice, foreign affairs, defence, and minister of finance, the permanent secretaries as well as the minister of health and the director of the national health authority and the director of Statens Serum Institut. The first known meeting of the expanded security council took place on February 27. The Prime Minister has taken strong leadership throughout.

The national health authorities (Ministry of Health, Danish Health Authority, Danish Medicines Agency, Statens Serum Institut, etc.) have established a “COVID-19 Intensiv Task Force” together with the Danish Regions (that are responsible for specialized health care and general practice). The task force is in charge of assessing and governing resources needed during the pandemic. There is close coordination between the different levels of government, and no major differences in approaches across the five regions. There has been fast track approval of six clinical trials of repurposing existing drugs and the Danish Medicines Agency is coordinating surveillance and reporting (https://laegemiddelstyrelsen.dk/da/nyheder/temaer/ny-coronavirus-covid-19/~/media/F17E7272B4734EADA1FD0DA3EA082411.ashx).