Select Committee on European Scrutiny Twenty-Ninth Report


7 Action Plan for a 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
DepartmentHealth
Basis of considerationMinister's letter of 4 July 2004
Previous Committee ReportHC 42-xxiii (2003-04), para 3 (16 June 2004)
Discussed in Council1/2 June 2004
Committee's assessmentLegally and politically important
Committee's decisionCleared

Background

7.1 On 16 June, we considered this Communication which:

  • 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.

7.2 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."[14]

7.3 The Annex to the Communication sets out the Action Plan. It includes, for example:

  • 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.
  • 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.
  • 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.
  • By the end of 2007, Member States should adopt conformity testing and accreditation schemes following successful best practices.
  • 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.
  • 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."

7.4 The staff working paper (ADD 1) attached to the Communication contains no estimate of the cost of any of the proposed actions. It says that all the activities included in the Action Plan are consistent with the principle of subsidiarity and are proportionate. No extended impact assessment of the proposals is recommended.

7.5 The Minister of State for Health at the Department of Health (Mr John Hutton) told us that most of the actions ascribed to Member States in the Action Plan are already being taken forward in the United Kingdom through the National Programme for IT in the NHS. The Minister added that the Communication had no immediate implications for subsidiarity. His Explanatory Memorandum of 7 June said that the Communication "will be discussed at the Health Council 1-2 June".

7.6 In our view, the status of the Action Plan is not clear. Nor is it clear if the Plan is put forward for approval or as a statement of what Member States are, in some way, obliged to do. We asked the Minister to tell us the items in the Action Plan to which the Government is already committed and any to which it has not yet made a commitment.

7.7 Since neither the Communication nor the Minister's Explanatory Memorandum contains an estimate of the cost of implementing the Action Plan, we asked the Minister to estimate the costs and benefits to the UK of implementing the Action Plan; and for his comments on the view that an extended assessment is not required.

7.8 We noted that the Action Plan sets dates by which Member States are to complete specified activities. It seemed to us that the Action Plan might 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 asked the Minister to enlarge on his comment that the Communication has "no immediate implications for subsidiarity".

7.9 We also noted that the Minster's Explanatory Memorandum of 7 June said that the Communication was to be discussed by the Health Council on 1 and 2 June. We were surprised that the Explanatory Memorandum did not tell us about the discussion. We asked the Minister to tell us about it.

7.10 Finally, we noted that the Communication envisages a "European eHealth Area". It was not apparent whether this is a would-be piece of slick presentation or if the words had some real meaning. We asked the Minister to comment on the point.

The Minister's letter

7.11 In reply to our question about the status of the Action Plan, the Minister says that the Plan:

"contains a large number of actions that are either the responsibility of the Commission or Member States. The actions do not have any legal status and no legislation is required or envisaged at this stage. The UK will not face court action over any failure to implement the action plan."

7.12 In answer to our question about the items in the Plan to which the Government is committed, the Minister tells us:

"the National Programme for IT (NFfIT) is as part of its overall work programme developing an infrastructure that is capable of supporting the targets contained within the action plan. These targets specifically include the key areas of:

  • addressing common challenges such as developing targets for interoperability and their standards, patient identifiers, investment in ehealth, health information networks;
  • pilot actions to accelerate implementation including the use of cards, telemedicine, eprescription, ereferral and telemonitoring; and
  • working together and monitoring practices setting benchmarking [sic], evaluation and dissemination of best practices."

7.13 The Minister has not provided the estimates of the costs and benefits to the UK of implementing the Action Plan for which we asked. He says, however, that the Plan will be implemented as part of the National Programme for IT and that "the funding for these initiatives are [sic] in line with the spending plans to implement Delivering 21st century IT support for the NHS: national strategic programme."

7.14 The Minister adds that:

"No formal extended assessment [of the Action Plan] is necessary at EU level nor is one necessary at UK level. The actions proposed do not have any direct economic impact and do not create any additional regulation."

7.15 In reply to our request that he enlarge on his comment that the Communication had no immediate implications for subsidiarity, the Minister says:

"the targets contained within the documentation have no legal basis and are aspirations. The NPfIT has published through its work programme a detailed implementation plan that will allow the action plan to be implemented. A number of these targets have already been met as England remains considerably ahead of its European partners. Therefore the Government believes that this Communication is compatible with the principle of subsidiarity. The Government also believes the actions proposed are proportionate."

7.16 Finally, the Minister tells us that, on 2 June, the Council noted that the Commission aimed to establish a European eHealth Area through a programme of activities to address common challenges; he also says that the Council's conclusions on eHealth were adopted without debate.

Conclusion

7.17 It appears from the Minister's letter that the Commission's Action Plan is a mere list of "aspirations". It is not binding on Member States and, so it seems, it is not worth assessing the Plan's costs and benefits. In our view, this raises the question whether the cost of producing the Plan represents good value for the taxpayers' money and whether the expenditure could have been put to better use on investment in services for patients. We ask the Minister, therefore, to challenge the value of any proposals to produce similar Plans in future.

7.18 We see no benefit in examining the document further and so, with the reservations made in the previous paragraph, we now clear it from scrutiny.


14   Pages 4 and 5 of the Commission's Communication. Back


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2004
Prepared 29 July 2004