3 European eHealth Area
| (25646)
9185/04
COM(04) 356
+ ADD 1
| Commission Communication : eHealth — making healthcare better for European citizens: An Action Plan for a European eHealth Area
Commission staff working paper — preliminary impact assessment
|
| Legal base | — |
| Document originated | 30 April 2004
|
| Deposited in Parliament | 12 May 2004
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| Department | Health |
| Basis of consideration | EM of 7 June 2004
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| Previous Committee Report | None
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| Discussed in Council | 1/2 June 2004
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| Committee's assessment | Legally and politically important
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| Committee's decision | Not cleared; further information requested
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Background
3.1 Article 152(1) of the EC Treaty provides that:
"Community action, which shall complement national policies,
shall be directed towards improving public health, preventing
human illness and diseases, and obviating sources of danger to
human health. Such action shall cover the fight against the major
health scourges, by … health information and education …"
Article 152(2) provides that:
"Member States shall, in liaison with the Commission, coordinate
among themselves their policies and programmes in the areas referred
to in [Article 152(1)]. The Commission may, in close contact
with the Member States, take any useful initiative to promote
such coordination."
Article 152(5) provides that:
"Community action in the field of public health shall fully
respect the responsibilities of the Member States for the organisation
and delivery of health services and medical care."
3.2 In March 2000, the Lisbon European Council set the EU the
goal of becoming the most competitive and dynamic knowledge-based
economy in the world by 2010. It concluded that:
"The shift to a digital, knowledge-based economy … will
be a powerful engine for growth, competitiveness and jobs …
To make the most of this opportunity, the Council and the Commission
are invited to draw up a comprehensive eEurope Action Plan
to be presented to the European Council in June this year …"[8]
3.3 The first such Action Plan covered the period to 2002. The
objective of its successor, the eEurope 2005 Action Plan,
is to provide a favourable environment for private investment
and for the creation of new jobs, to boost productivity, to modernise
public services, and to give everyone the opportunity to participate
in the global information society.
3.4 The eEurope Action Plan 2005 contains
a section on eHealth.[9]
It says that Member States should develop health information
networks between points of care, with broadband connectivity where
relevant, and ensure that online health services are provided.
3.5 In February 2004, the Commission presented a
mid-term review of the eEurope Action Plan.[10]
The Commission noted that most Member States had developed eHealth
plans and some had set specific targets for how much of the budget
should be invested in eHealth. Although there had been
good progress, the review identified the lack of sufficient inter-operability
and common standards for health products, systems and services;
safety and security issues; and legal and privacy issues. It
recommended dissemination of the benefits of eHealth solutions
through agreed EU-wide benchmarks and cost-benefit analyses.
The document
3.6 The Commission's Communication :
- describes the benefits of eHealth
systems and services for consumers, the health professions and
health service managers;
- summarises what the Commission sees as the challenges
facing Health Ministers, health service providers and managers,
and the eIndustry; and
- sets out an eHealth Action Plan for Member
States and the Commission.
3.7 In the Introduction to the Communication, the
Commission says:
"Member States have shown that they are keen
to take an eHealth agenda forward, drawing on best practices
and experience from across the Union. This should enable a move
towards a 'European eHealth Area'; a framework built on
a wide range of European policies and initiatives…
"eHealth plays a clear role in the European
Union's eEurope strategy, and is key to achieving stronger
growth and creating highly qualified jobs in a dynamic, knowledge-based
economy … To move ahead, action will be required within several
important policy areas that range from research and the roll-out
of broadband networks in telecommunications, to action in public
health, and work in Member States that promotes mobility and assesses
the implications of European ageing on healthcare systems."[11]
3.8 The Annex to the Communication sets out the Action
Plan. It includes, for example:
- " (i) By the end of
2005, each Member State is to develop a national or regional roadmap
for eHealth. This should focus on deploying eHealth
systems, setting targets for interoperability and the use of electronic
health records, and address issues such as the reimbursement of
eHealth services.
- (ii) By the end of 2006, Member States, in collaboration
with the European Commission, should identify a common approach
to patient identifiers. This should take account of best practices
and developments in areas such as the European Health Insurance
Card and identity management for European citizens.
- (iii) By the end of 2006, Member States, in collaboration
with the European Commission, should identify and outline interoperability
standards for health data messages and electronic health records,
taking into account best practices and relevant standardisation
efforts."
- (iv) By the end of 2007, Member States should
adopt conformity testing and accreditation schemes following successful
best practices.
- (v) Adoption of implementation of an electronic
health insurance card by 2008.
- (vi) By the end of 2008, the majority of European
health organisations and health regions (communities, counties,
districts) should be able to provide online services, such as
teleconsultation (second medical opinion), eprescription,
ereferral, telemonitoring and telecare.
- (vii) By the start of 2005, Member States, in
collaboration with the European Commission, should agree on an
overall approach to benchmarking in order to assess the quantitative,
including economic, and qualitative impacts of eHealth."
3.9 Attached to the Communication is a staff working
paper (ADD 1) headed "Preliminary Impact Assessment".
It contains no estimate of the cost of any of the proposed actions.
Two sections are particularly worthy of note. One says:
"All actions have been assessed for their compatibility
with the principle of subsidiarity. They are also proportional,
taking into account the current state of play in eHealth
and the kind of action required relative to the challenges outlined."
The other says:
"For this Communication, no extended assessment
is recommended. It focuses mainly on bringing together coherently
already existing and already planned or foreseen actions, with
a limited number of new actions. While these new actions are
consistent with and reinforce the actions already ongoing, they
do not have [a] direct economic, social, or environmental impact.
Nor do they imply additional regulation, since they are largely
exploratory and aim to open up perspectives for future work in
eHealth."
The Government's view
3.10 The Minister of State for Health at the Department
of Health (Mr John Hutton) tells us that:
"The European Community's research programmes
have been supporting eHealth for the last fifteen years.
eHealth is also an important and integral part of the eEurope
2005 Action Plan. Following the eHealth conference in
Brussels in May 2003, a Ministerial Declaration was issued. [The]
Minister of State for Health was also a signatory to this Ministerial
Declaration. This contained a commitment to the development and
use of modern information and communication technologies as tools
for enhancing health promotion and health protection, as well
as quality, accessibility and efficiency in all aspects of health
care delivery to citizens.
"The second eHealth Conference was held
in Cork on 5th and 6th May 2004 under the
Irish Presidency. Amongst other things, this emphasised the potential
of eHealth developments to contribute to the empowerment
of European citizens in relation to their healthcare and wellbeing.
Following the Conference, additional Council Conclusions were
added to the Draft Council Conclusions document which is for discussion
... on 1 and 2 June.
"…Most of the actions ascribed to Member
States in this Action Plan are already being taken forward through
the National Programme for IT in the NHS. The UK also has definite
plans for the implementation of the first stage of the European
Health Insurance card. … The Commission has set a date of
2008 for the electronification of the European Health Insurance
Card (EHIC) and has included this date in their action plan.
The UK line has been that there must be a UK domestic imperative
for doing this and that each member state must proceed to smart
stage [sic] at its own pace and not at an external commission
driven deadline. The capability to read smart cards is being
introduced in the UK. Plans are in place to provide smart card
readers at healthcare providers to authenticate healthcare professionals'
access rights to patient information.
"By 2006, the NHS will already have laid the
groundwork for the delivery of a modernised NHS using 21st
century information and communications technologies. An aim for
the UK is to drive down the cost of IT for the NHS by driving
down the cost of IT for healthcare on an international basis.
Globalisation of the approach taken by the NHS, in particular
the concept of the NHS Care Record, could subsequently be made
available internationally. Therefore, we support the recognition
in the Action Plan that eHealth is an international as
well as a national issue."
3.11 The Minister says that the Communication has
"no immediate implications for subsidiarity".
3.12 Finally, he says that the Communication "will
be discussed at the Health Council 1-2 June".
Conclusion
3.13 The status of this Action Plan is not clear.
The Commission's Preliminary Assessment says that the Communication
brings together "existing and already planned or foreseen
actions, with a limited number of new actions". It is not
clear, however, to what extent the Action Plan is merely a record
of activities to which Member States have already committed themselves
and to what extent the Plan is making proposals; nor is it clear
whether the Plan is put forward for approval or as a statement
of what Member States are, in some way, obliged to do. Accordingly,
we should be grateful if the Minister would tell us the items
to which the Government is already committed and any to which
it has not yet made a commitment.
3.14 Neither the Communication nor the Minister's
Explanatory Memorandum (EM) contains an estimate of the cost of
implementing the Action Plan. Indeed, the Preliminary Impact
Assessment says that "no extended assessment is recommended".
We should be grateful for the Minister's estimate of the cost
and benefit to the UK of implementing the Action Plan; and for
his comments on the view that an extended assessment is not required.
3.15 The Action Plan sets dates by which Member
States are to complete specified activities. The Minister says
that, in the Government's view, each Member State should proceed
at its own pace in the implementation of the European Health Insurance
Card and not be driven by a deadline set by the Commission. It
seems to us that the Minister's comment on this point illustrates
that the Action Plan may not be compatible with the principle
of subsidiarity because the Plan — for which no legal base
is cited — appears to dictate the priorities Member States
should adopt for the organisation and delivery of health services,
which Article 152 of the EC Treaty recognises as the responsibility
of Member States. We ask the Minister to enlarge on his comment
that the Communication has "no immediate implications for
subsidiarity".
3.16 The Minster's EM of 7 June says that the
Communication was to be discussed by the Health Council on 1 and
2 June. We are surprised that the EM did not tell us about the
discussion. We should be grateful if he would now tell us the
outcome.
3.17 Finally, the Communication envisages a "European
eHealth Area". It is not apparent whether this is
a would-be piece of slick presentation or if the words have some
real meaning. Again, we ask the Minister to comment on the point.
3.18 We shall keep the document under scrutiny
pending the Minister's reply to our questions.
8 Conclusions 5 and 8, Lisbon European Council, 23/24
March 2000. Back
9
(23523) -; see HC 152-xxxii (2001-02), para 18 (12 June 2002). Back
10
(25399) 6418/04; see HC 42-xvi (2003-04), para 6 (31 March 2004). Back
11
Pages 4 and 5 of the Commission's Communication. Back
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