Denmark's Healthcare Reform and the Future of Community Services: Will Regional Responsibility Improve Care Closer to Home?

For an older person in Denmark, the distinction between a regional hospital, a municipal nursing service and a general practitioner may seem unimportant until care needs to move between them. A hospital may decide that treatment can continue at home, but the practical arrangements depend on organisations with different responsibilities, budgets and professional relationships.

Denmark's healthcare reform seeks to change parts of this architecture. The planned move towards four regions, new health councils and revised responsibility for selected community healthcare functions creates an opportunity to organise more care around local population needs rather than established institutional boundaries.

The implications extend beyond hospitals. They affect the community health pathways, nursing services, rehabilitation arrangements and local partnerships examined throughout the Denmark Knowledge Hub on ageing, long-term care and community support.

However, structural change does not automatically produce better coordination. Transferring responsibility can clarify one boundary while creating another. A regional organisation may gain greater influence over community healthcare, but municipalities will continue to play an important role in everyday support, prevention and the conditions that enable people to remain at home.

The central question is therefore not whether regional responsibility is inherently preferable to municipal delivery. It is whether Denmark can use reform to create clearer clinical pathways, more equitable access and stronger accountability while preserving the local knowledge and continuity on which effective community care depends.

Why Denmark Is Reforming the Organisation of Healthcare

Denmark's healthcare system has longstanding strengths: predominantly tax-financed healthcare, broad population coverage, established general practice and a substantial role for municipalities in community services.

Its organisation has nevertheless required continuous coordination between institutions that control different parts of a person's care.

Under the existing framework, five regions are responsible for hospitals and regional healthcare arrangements, including general practice. Denmark's 98 municipalities administer important local functions, including community nursing, prevention, rehabilitation-related services and assistance for older people and people with disabilities, subject to the applicable legislation.

These responsibilities are not interchangeable. Medical diagnosis and treatment, municipal support and social assistance are governed through different professional, administrative and financial arrangements.

The model can work effectively when organisations communicate well and service capacity is available. However, people with several long-term conditions may require repeated transitions between hospital, general practice and municipal services.

Those transitions create opportunities for fragmented information, delayed decisions and uncertainty about which organisation should respond to changing needs.

Demographic change intensifies the importance of these relationships. An ageing population and increasing numbers of people living with complex conditions mean that hospitals cannot be considered separately from the services supporting people before and after admission.

The reform responds partly to the need for a more coherent distribution of healthcare resources, improved geographical access and stronger provision outside major hospitals.

It also reflects a wider policy recognition that prevention and earlier intervention require dependable connections between clinical services and everyday community support.

The challenge is to translate this ambition into practical arrangements that work across urban centres, smaller municipalities and more geographically dispersed communities.

What the Reform Changes and What Remains Distinct

The healthcare reform agreement reached in 2024 provides for significant organisational changes, with major elements scheduled to take effect from 2027.

Among its central features are a reduction from five regions to four and the introduction of 17 health councils, known as sundhedsråd, intended to strengthen the planning and coordination of healthcare closer to local populations.

The reform also provides for transferring responsibility for selected health functions from municipalities to regions, including municipal nursing and specified rehabilitation and other health-related services.

These changes should be understood as a phased transition rather than a single event that instantly replaces all existing service arrangements.

During 2026, preparation, transition planning and the establishment of new governance arrangements are particularly important. The operational effects will depend on implementing legislation, detailed decisions and the arrangements adopted by the responsible organisations.

Importantly, the reform does not mean that municipalities cease to have responsibilities affecting health and wellbeing.

Municipalities continue to have important roles in personal assistance, older people's services, disability support, prevention and wider community conditions. The precise responsibilities for individual healthcare functions must be understood in relation to the applicable legislation and implementation timetable.

Nor does regional responsibility mean that every service will physically move to a regional building.

Some services may continue to be delivered in municipal facilities or people's homes under revised organisational and contractual arrangements.

The distinction between responsibility and delivery is central. One organisation may hold the formal responsibility for a healthcare function while another delivers agreed activities through a lawful arrangement.

For leaders, the relevant questions are who determines service requirements, who funds the activity, who employs or manages the workforce, who holds clinical responsibility and how quality concerns are resolved.

The reform's effectiveness will depend on whether those questions receive consistent answers at the point of care.

Four Regions and the Geography of Healthcare Responsibility

Denmark's planned regional structure involves four regions rather than the existing five.

The reform combines the Capital Region and Region Zealand into a new eastern regional structure, while the remaining regional areas continue within the revised national framework.

The intention is not simply to redraw administrative boundaries. Regional organisation influences hospital planning, workforce distribution, specialist capacity and the relationship between larger clinical centres and local healthcare provision.

In eastern Denmark, bringing together areas with different population densities and healthcare infrastructure creates opportunities for coordinated planning across a larger territory.

However, a larger region must still respond to substantial differences between metropolitan Copenhagen and communities elsewhere in Zealand.

Residents in central Copenhagen may have relatively short journeys to major hospitals, while people in rural districts may face greater travel requirements and different access to local services.

Similar issues arise elsewhere in Denmark, particularly where specialist facilities serve dispersed populations.

Regional consolidation should therefore not be assessed solely through administrative efficiency.

The more meaningful question is whether regional planning improves access to appropriate care without unnecessarily centralising services that could be delivered safely closer to home.

This requires a distinction between services that benefit from specialist concentration and those whose effectiveness depends on local availability.

Highly specialised hospital treatment may require centralised expertise. Routine follow-up, selected rehabilitation activities and appropriate community clinical services may be more accessible when organised near people's homes.

Regional planning must balance these requirements rather than treating all services as candidates for either centralisation or localisation.

The broader challenge of geographical health inequality and equitable access is therefore directly relevant to how the new regional structure operates.

The New Health Councils as a Test of Local Accountability

The planned health councils are among the reform's most significant governance developments.

They are intended to provide a stronger connection between regional healthcare planning and local population needs, bringing regional and municipal perspectives into the organisation of services.

Their effectiveness will depend on the powers, resources and operational relationships established under the new framework.

A health council cannot improve continuity simply by bringing representatives together. It needs reliable information about where care pathways are underperforming and sufficient influence to support corrective action.

For example, a locality may experience repeated hospital admissions among older people with complex conditions. The underlying causes might include limited access to timely clinical review, difficulties arranging community nursing or inadequate coordination after discharge.

Different causes require different responses.

A council examining this pattern needs to understand which organisations control the relevant services and whether proposed changes can be funded and implemented.

There is also a risk that new governance arrangements become disconnected from frontline delivery.

Local representation is valuable, but it must be accompanied by clear responsibility for decisions, follow-through and review.

Useful governance evidence may include:

• Population needs and differences in service access across the council's geographical area.
• Hospital admissions, readmissions and discharge patterns interpreted alongside clinical circumstances.
• Community workforce capacity, competence and geographical coverage.
• Delays or recurring difficulties at organisational interfaces.
• Patient experience, continuity and outcomes following treatment.
• Implementation progress and whether agreed changes produce measurable improvement.

These indicators should support professional judgement rather than replace it.

Organisations exploring similar governance challenges can use the Governance Maturity Assessment to structure questions about leadership, accountability and assurance. It is a general organisational resource, not a Danish health council assessment or regulatory instrument.

The strongest opportunity for health councils lies in making local healthcare problems visible within regional decision-making, while retaining a practical connection to municipalities and the people using services.

Operational Scenario: Planning Community Access Across Eastern Denmark

Consider a hypothetical planning exercise involving communities in Region Zealand and the Capital Region as they prepare for the new eastern regional structure.

Regional planners identify differences in access to follow-up appointments after hospital treatment for chronic conditions.

Residents living close to major hospitals generally have more straightforward access to specialist appointments. Some people in smaller towns face longer journeys, particularly when several visits are required over a short period.

Municipal representatives explain that travel can be especially difficult for older residents who also receive assistance with everyday activities.

The planning group considers whether selected follow-up activities could be delivered through local healthcare facilities, supported by appropriate specialist consultation.

However, the proposal is not approved solely because it appears convenient.

Clinical leaders examine which assessments require hospital equipment or specialist examination and which could safely take place in a community setting.

Workforce representatives identify the competence required and whether suitable professionals are available locally.

Financial planning then considers the cost of premises, staffing, information systems and any continuing hospital involvement.

A limited service change is introduced where the necessary arrangements can be established, with outcomes reviewed before wider expansion.

The review considers attendance, clinical safety, patient experience and whether the new arrangements genuinely reduce unnecessary travel.

This scenario illustrates the practical purpose of stronger regional-local governance. The objective is not to move services into the community as an end in itself, but to determine which services can become more accessible without compromising clinical quality.

It also shows why a larger regional structure needs mechanisms capable of responding to smaller communities rather than relying exclusively on region-wide averages.

Community Nursing and the Transfer of Service Responsibility

The planned transfer of municipal nursing responsibilities to regions is particularly important because hjemmesygepleje, or home nursing, connects hospital treatment with healthcare delivered in people's homes.

Municipal nurses currently undertake a wide range of activities, including clinical assessment, wound care, medication-related interventions and support for people with complex health conditions. Their work frequently involves cooperation with general practitioners, hospital departments and municipal personal assistance services.

Changing the organisation responsible for nursing services creates several implementation questions.

First, regional planners need to understand the existing distribution of nursing capacity and competence. Municipal services are not organised identically, and local arrangements may reflect geography, population needs and established relationships with other professionals.

Second, employment and management arrangements require careful handling. A transfer of formal responsibility does not necessarily mean that every employee changes employer or workplace in precisely the same way. The applicable transition arrangements determine how responsibilities and staffing are reorganised.

Third, clinical oversight must remain clear throughout the transition. Nurses need to know who provides professional supervision, how medical advice is accessed and which organisation responds to service risks.

Fourth, the interface with municipal personal assistance remains essential. A resident may require nursing treatment alongside help with washing, dressing, meals or mobility. Those activities may remain subject to different statutory responsibilities.

The reform should therefore preserve effective local working relationships even where formal accountability changes.

The principle of workforce resilience and continuity is especially important during a transition that may alter management structures, professional reporting arrangements and future career opportunities.

A well-managed transfer would give frontline professionals clarity before organisational changes affect their work. It would also protect patients from unnecessary changes in visiting arrangements or uncertainty about whom to contact.

The strongest measure of success is not whether a new organisational chart has been implemented on schedule. It is whether the transition strengthens clinical support while maintaining dependable care at home.

Hospital Discharge and Rehabilitation Under Revised Responsibilities

Hospital discharge is another area where regional and municipal responsibilities meet directly.

Under existing arrangements, hospitals determine when inpatient treatment is no longer required, while municipalities may provide relevant nursing, rehabilitation and support services following discharge.

Rehabilitation responsibilities vary according to the legal basis and type of intervention. Under the current framework, hospitals may prepare a genoptræningsplan, or rehabilitation plan, where appropriate, with subsequent rehabilitation organised according to the applicable division of responsibilities.

The healthcare reform provides for regional responsibility for specified rehabilitation functions, including specialised elements, alongside other changes to community healthcare responsibilities.

This does not mean that all rehabilitation or everyday functional support becomes a single regional service.

Municipal responsibilities for assistance, reablement-related support and broader social participation remain relevant, and the precise division of functions must follow the legislation and implementation arrangements.

For a person recovering from surgery or serious illness, the distinction may be difficult to understand.

They may need physiotherapy, nursing interventions, personal assistance and adaptations to their home. Each element contributes to recovery, but the responsible organisation and professional arrangements may differ.

Reform planning should therefore begin with the complete pathway rather than individual service categories.

The key questions concern when rehabilitation starts, how goals are agreed, how information moves between professionals and what happens if the person's needs change.

For example, a patient whose mobility improves may need less formal support. Another may develop complications requiring renewed medical assessment.

Both situations require the pathway to respond to changing needs without leaving the individual to coordinate separate organisations.

These issues connect with the wider principles of hospital discharge, recovery and community support, although Denmark's legal and professional arrangements remain distinct from those of other countries.

Regional responsibility may strengthen continuity between hospital treatment and subsequent clinical rehabilitation. However, the benefit will depend on whether municipal services remain effectively involved where recovery also requires practical assistance and support for everyday independence.

Operational Scenario: Rehabilitation After a Stroke in Aalborg

A hypothetical 68-year-old resident of Aalborg experiences a stroke and receives acute treatment at a regional hospital.

Following stabilisation, the hospital team assesses his rehabilitation needs. He has reduced mobility, difficulties with some everyday activities and concerns about returning to the home he shares with his wife.

His recovery requires several forms of support. Clinical rehabilitation is needed to address physical functioning, while practical assistance and possible home adaptations may be necessary to make everyday life manageable.

During the transition towards revised regional responsibilities, the organisations involved examine which rehabilitation activities fall within the regional framework and which support functions remain municipal.

The hospital's clinical assessment informs the rehabilitation arrangements. Municipal staff consider the person's home environment and the assistance required for daily living.

His wife is invited to contribute information about their circumstances, but her willingness to provide support is not treated as an unlimited substitute for formal services.

Before discharge, the responsible professionals clarify the initial rehabilitation arrangements, the contact routes for changing needs and the process for reviewing progress.

Several weeks later, the resident improves sufficiently to manage some activities independently, although he still requires assistance with others.

The rehabilitation team reviews his clinical goals, while the municipality reassesses the practical support needed at home.

The case illustrates how healthcare reform may change organisational responsibility without removing the need for coordinated decisions.

It also shows why successful rehabilitation cannot be measured only through the completion of treatment sessions. Meaningful outcomes include functional improvement, confidence, participation and the ability to live safely in familiar surroundings.

Funding Reform and the Problem of Costs Crossing Organisational Boundaries

Denmark's healthcare system is predominantly financed through taxation, but regional and municipal expenditure has historically been organised through different budgetary responsibilities.

Regions receive public funding for healthcare responsibilities, while municipalities finance their own statutory functions through municipal revenue and wider public financing arrangements.

Existing financial relationships between the two levels have also included mechanisms intended to connect municipal interests with healthcare expenditure.

When responsibilities change, financial arrangements must change accordingly.

Transferring a healthcare function from municipal to regional responsibility raises questions about the resources required, the treatment of existing expenditure and the distribution of future financial risk.

A service may appear less expensive within one organisation because another organisation provides essential complementary support.

For example, an expanded regional community nursing pathway may reduce the need for some hospital appointments. However, the person receiving treatment may still depend on municipal assistance, transport arrangements or support with everyday activities.

Those costs should not disappear from the analysis simply because they sit outside the regional healthcare budget.

Similarly, a municipality may benefit from stronger clinical services if residents experience fewer avoidable complications, but those benefits may be difficult to isolate financially.

Regional and municipal leaders therefore need a shared understanding of the consequences of service redesign.

The relevant assessment should include the direct cost of treatment, workforce requirements, infrastructure, travel, administration and the impact on people using services.

It should also distinguish between genuine system efficiencies and costs transferred from one organisation to another.

There is a further question of investment timing. Developing local clinical capacity may require expenditure before benefits become visible through reduced hospital use or improved outcomes.

Where organisations operate within separate financial planning cycles, this can discourage investments whose benefits emerge elsewhere.

The reform's financial architecture will therefore be central to its success. A change in formal responsibility must be accompanied by arrangements that support sustainable delivery rather than creating unfunded expectations.

For organisations examining comparable decisions, the Digital Twin Scenario Modeller provides a general framework for exploring how changes in capacity, workforce and service demand might interact. It does not provide an official model of Danish regional funding or determine the financial consequences of the reform.

General Practice and the Clinical Relationships That Reform Must Preserve

General practice, or almen praksis, occupies an important position in Denmark's healthcare system.

General practitioners provide ongoing medical care, manage many long-term conditions and act as an important point of access to specialist services.

They also maintain relationships with patients whose healthcare needs extend across hospital and community settings.

The reform's ambition to strengthen care outside hospitals will depend partly on how general practice develops alongside regional community services.

Transferring nursing responsibility to regions does not automatically establish effective communication between nurses and general practitioners.

Both professions need clarity about clinical decisions, prescribing responsibilities, follow-up arrangements and the circumstances requiring medical assessment.

A patient with several long-term conditions may receive nursing visits while continuing to rely on a general practitioner for treatment review and medical advice.

If regional community nursing services become more closely connected with hospitals but less responsive to general practice, the reform could replace one coordination problem with another.

Conversely, stronger regional planning could create opportunities to improve communication, support shared clinical pathways and develop local services that respond more effectively to general practice needs.

These benefits will depend on professional relationships as well as organisational structures.

General practitioners work within established contractual and professional arrangements. Their clinical responsibilities should not be treated as interchangeable with those of municipal managers or regional service administrators.

Effective reform must respect these distinctions while ensuring that patients are not disadvantaged by them.

The stronger opportunity lies in designing practical pathways around clinical responsibility, timely communication and continuity, rather than assuming that a common regional structure will automatically create integrated practice.

Digital Infrastructure and the Governance of Shared Information

Denmark has established digital healthcare infrastructure, including electronic communication arrangements and the national health portal sundhed.dk.

These systems provide important foundations for sharing and accessing healthcare information, but digital integration remains dependent on the systems involved, the information available and the applicable rules governing access.

Regional healthcare organisations, general practitioners and municipalities have different operational systems and responsibilities.

Changing responsibility for community healthcare functions may therefore require changes to documentation arrangements, system access and information-sharing processes.

A successful transition must preserve access to information that frontline professionals need while protecting patient confidentiality.

For example, a community nurse may require current treatment instructions, relevant medication information and details of recent hospital assessments.

The same professional may also need to understand practical circumstances recorded within municipal services.

Those records may not be held within one system or governed by identical access arrangements.

Reform implementation must therefore distinguish between information that should be shared for legitimate care purposes and information that should remain subject to appropriate restrictions.

The broader challenge of interoperability and system integration is not solved simply by transferring an organisational function.

Data quality also matters. A shared record is of limited value if it contains outdated treatment instructions or fails to identify the professional responsible for the next decision.

Digital implementation should address staff training, access permissions, system resilience and procedures for correcting information.

Organisations considering similar transitions can use the Digital Transformation Readiness Assessment to examine organisational preparedness, workforce capability and information governance. It is not a Danish legal compliance assessment.

For patients, digital reform should reduce the need to repeat their circumstances to different services while preserving control over personal information within the applicable legal framework.

The test is whether better information supports better care, not merely whether more organisations can access the same technology.

Workforce Transition and the Importance of Professional Stability

Major organisational reform can create uncertainty for the people responsible for delivering services.

Denmark's community healthcare workforce includes registered nurses, physiotherapists, occupational therapists, social and healthcare assistants and other professionals whose work may intersect with the functions affected by reform.

Not every professional group or service will experience the same organisational change.

For those directly affected, implementation planning needs to address employment arrangements, leadership, professional supervision, workplaces and continuing development.

Some employees may welcome closer connections with regional clinical services. Others may be concerned about losing established municipal relationships or becoming part of a larger organisation with less local flexibility.

Both perspectives deserve consideration.

Local knowledge is a practical asset. Community professionals often understand the circumstances of patients, the availability of nearby services and the informal relationships that help resolve everyday difficulties.

Regional organisations may bring broader clinical expertise, professional networks and opportunities for workforce development.

The strongest model would preserve the advantages of both.

Workforce planning should therefore consider more than the number of employees formally transferred between organisations.

It should examine whether staff retain appropriate supervision, how specialist advice will be accessed and whether new management arrangements support responsive local decisions.

There is also a risk that uncertainty encourages experienced employees to seek alternative employment.

Maintaining open communication with staff, professional representatives and managers can help identify concerns before they affect service capacity.

Where responsibilities are transferred, continuity plans should identify roles that depend heavily on individual expertise and ensure that important clinical knowledge is retained.

For people receiving care, the most visible consequence of workforce transition may be whether familiar professionals remain available and whether the quality of support changes.

Workforce stability is therefore not a secondary administrative consideration. It is a central condition for maintaining safe and dependable community services.

Operational Scenario: A Nursing Service Transition in Southern Denmark

Consider a hypothetical municipality near Esbjerg preparing for the transfer of responsibility for a community nursing function.

The existing service includes registered nurses who work closely with municipal personal assistance teams and maintain established relationships with local general practices.

Regional transition planners begin by mapping the clinical services delivered, staffing arrangements, equipment, digital systems and professional responsibilities.

The review identifies that nurses frequently coordinate with municipal colleagues when patients need both clinical treatment and practical assistance.

Although formal responsibility for nursing is expected to change, those everyday relationships will remain necessary.

The municipality and regional representatives therefore develop an agreed operational interface that identifies how staff communicate, how urgent concerns are escalated and which organisation responds to different types of need.

They also examine the implications for patients who receive regular visits from the same nursing team.

One resident, an 84-year-old woman with several long-term conditions, is particularly concerned that organisational changes will mean unfamiliar staff attending her home.

Her views are considered during continuity planning, alongside clinical requirements and workforce availability.

During the transition, managers monitor missed or delayed visits, changes in staffing, communication problems and concerns raised by patients or professionals.

Where recurring difficulties emerge, the organisations examine whether the new arrangements require adjustment.

The scenario demonstrates that transferring responsibility is not equivalent to transferring a complete, self-contained service.

Community nursing operates within a network of clinical and practical relationships. Reform implementation needs to preserve those relationships deliberately rather than assuming they will continue unchanged.

Measuring Reform Through Access, Continuity and Patient Outcomes

Denmark's healthcare reform will generate considerable organisational activity, including governance changes, revised responsibilities and new planning arrangements.

However, implementation milestones should not be confused with evidence of improved healthcare.

The creation of a regional structure or health council demonstrates that a formal change has occurred. It does not establish whether people experience better access or more coordinated treatment.

Meaningful evaluation requires evidence from the services and populations the reform is intended to benefit.

Hospital activity is one important consideration, but a reduction in admissions should not automatically be attributed to community healthcare reform.

Admission patterns are influenced by population health, clinical practice, demographic change and other factors.

Likewise, shorter hospital stays may indicate effective treatment and discharge arrangements, but they may also place greater demands on services outside hospital.

Evaluation should therefore examine the relationship between outcomes and the resources required to achieve them.

Relevant measures may include access to appropriate local services, continuity following discharge, delays in rehabilitation, workforce stability and patient-reported experience.

It is also important to examine whether improvements are distributed fairly.

A region-wide improvement may conceal persistent difficulties in rural communities or among people with complex support needs.

Quality information should therefore be examined across relevant geographical and population groups, while recognising the limitations of small datasets and differences in clinical need.

The principles of quality measurement and meaningful performance evidence can help organisations distinguish service activity from demonstrable improvement.

The Quality Dashboard Builder offers a general way to organise indicators and review evidence. It is not an official Danish reform monitoring system and does not replace national reporting requirements.

Patient experience should be an integral part of evaluation.

People receiving services can identify difficulties that administrative data may overlook, including uncertainty about whom to contact, repeated assessments or changes in familiar support arrangements.

Where those experiences reveal recurring problems, regional and municipal leaders should examine whether the issue arises from professional practice, organisational boundaries or the design of the pathway itself.

The strongest governance approach connects evidence with decisions and then examines whether those decisions have improved everyday care.

International Lessons from Denmark's Structural Reform

Denmark's healthcare reform offers an important international case study in the relationship between organisational responsibility and service integration.

Its approach is shaped by a predominantly tax-financed system, strong public institutions and established regional and municipal responsibilities.

These conditions differ from those in countries where healthcare is organised through multiple insurers, fragmented provider markets or substantially different levels of local government.

The institutional model therefore cannot be transferred directly.

However, several underlying principles have wider relevance.

First, structural reform should begin with a clear understanding of the service pathways it is intended to improve. Changing administrative boundaries without addressing clinical and practical interfaces may have limited benefit.

Second, responsibility for healthcare and responsibility for everyday support must remain connected even where they sit within different organisations.

Third, local population needs should influence decisions about the distribution of services. Larger organisations may improve planning capacity, but they also need effective mechanisms for understanding local variation.

Fourth, workforce continuity and professional competence require explicit protection during organisational change.

Finally, reform should be evaluated through access, quality, patient experience and sustainable resource use rather than administrative completion alone.

Denmark's experience is particularly relevant because it illustrates that integration is not necessarily achieved by placing every service within one organisation.

Some boundaries may be reduced through regional responsibility, while others remain because healthcare, personal assistance and wider community support serve different purposes.

The transferable lesson lies in making those boundaries manageable for professionals and largely invisible to the people receiving care.

Conclusion

Denmark's healthcare reform represents a substantial attempt to reshape the relationship between hospitals, regional healthcare and services delivered closer to home.

The move towards four regions, new health councils and revised responsibilities for selected community functions creates opportunities for stronger clinical coordination, more coherent planning and improved access across different geographical areas.

However, the reform's success will depend on implementation rather than institutional design alone.

Regional responsibility may strengthen connections between hospital treatment and community healthcare, but municipalities will continue to influence the everyday circumstances that determine whether people can live independently and receive appropriate support.

For older people and those with complex conditions, these responsibilities must operate as a connected pathway rather than a sequence of organisational transactions.

That requires clear clinical accountability, sustainable funding, workforce stability, effective information sharing and governance capable of responding to local experience.

It also requires careful attention to geographical differences. A more coherent national structure will have limited value if improvements are concentrated around major clinical centres while smaller communities continue to experience avoidable access difficulties.

Denmark's strongest opportunity is to combine regional planning and professional expertise with the accessibility, relationships and practical knowledge developed through local services.

The ultimate measure of reform will not be how successfully responsibilities are transferred between organisations, but whether people receive safer, more timely and more continuous care in the places where they live.