Select Committee on European Scrutiny Thirty-Second Report


9 Health care and long-term care

(25576)

8131/04

COM(04) 304

Commission Communication: Modernising social protection for the development of high quality, accessible and sustainable health care and long-term care: support for the national strategies using the "open method of coordination"

Legal base
DepartmentHealth
Basis of considerationMinister's letter of 20 September 2004
Previous Committee ReportHC 42-xx (2003-04), para 6 (18 May 2004)
Discussed in Council1 and 2 June 2004
Committee's assessmentPolitically important
Committee's decisionNot cleared; evidence from Minister requested

Background

9.1 Health care and long-term care are the fourth "limb" of the European Community's approach to social protection (the other three limbs are employment, pensions and social inclusion). In May, we considered a Communication from the Commission proposing "high-level objectives" for the Community.[20] The objectives were as follows:

  • to ensure fair and universal access to health and long-term care;
  • to promote the provision of care of high quality; and
  • to ensure that high-quality, universally accessible care is financially sustainable in the long term.

9.2 The Commission proposed specific measures to give effect to each of these objectives. For example, the Commission called on Member States to ensure close coordination between social services, hospitals and health services based in the local community to provide high-quality, easily accessible and sustainable care for elderly people; to adopt measures to recruit and train care staff and remove disparities between regions in the provision of services; and to evaluate drugs, equipment and treatments in order to identify best value.

9.3 The Commission proposed the application of the "open method of coordination" to define a common framework to support Member States in the reform and development of health care and long-term care. The Commission saw the next steps as including:

  • agreement of the objectives before the end of this year;
  • meanwhile, the Commission would start work on identifying possible indicators for the objectives;
  • by March 2005, Member States would send the Commission reports covering the challenges facing their systems at national level, current reforms and medium-term policy objectives;
  • the Commission would then analyse the reports; and
  • this would lead, in 2006, to an initial series of "development and reform strategies" in health care and long-term care for the period 2006-2009.

9.4 The Lisbon European Council defined the Open Method of Coordination as follows:

"This method, which is designed to help Member States to progressively develop their own policies, involves:

—  fixing guidelines for the Union combined with specific timetables for achieving the goals which they set in the short, medium and long terms;

—  establishing, where appropriate, quantitative and qualitative indicators and benchmarks against the best in the world and tailored to the needs of different Member States and sectors as a means of comparing best practice;

—  translating these European guidelines into national and regional policies by setting specific targets and adopting measures, taking into account national and regional differences; and

—  periodic monitoring, evaluation and peer review organised as mutual learning processes."[21]

9.5 The Minister of State for Health at the Department of Health (Mr John Hutton) told us that:

"We are considering further how the open method of coordination in this area should best relate to the other strands of activity for the EU affecting health care … Our initial view is that whilst the opportunity to exchange and share information with member states, facilitated by the Commission, on health systems could be helpful, it should not be heavy handed and dominated with indicators."

9.6 We noted that the primary responsibility for health care and long-term care rests with each Member State. We agreed with the Minister that sharing information with other Member States about the issues discussed in the Communication could be helpful. There might be useful lessons and ideas to be learned from other countries. But the open method of coordination goes well beyond the exchange of information; it involves detailed reports, the setting of benchmarks and targets and so on. It did not appear to us that the Communication provided a sufficient justification for the application of the open method of coordination to heath care and long-term care.

9.7 We said, therefore, that we should be interested to know if other Member States shared our doubts about the Commission's proposal. Accordingly, we asked the Minister to keep us informed of the progress of the discussions in the Council.

The Minister's letter

9.8 In his response of 20 September, the Minister tells us that:

"the Social Protection Committee (SPC) has produced its opinion on the extension of OMC [the open method of coordination] to healthcare. In essence, the [main] findings, which closely mirror our views, are that OMC should be introduced in a progressive and flexible manner and should place a strong emphasis on added value. It also adds that implementation must reflect the objectives of streamlining, in particular, to bring about a simplification of procedures with a view to avoiding unduly bureaucratic practices. The Opinion also states that Health Ministries should be directly involved to ensure that there is good interaction on the OMC with the new Commission High Level Group on Health Services and Medical Care and the proposed Council Group in the same field. Overlaps between the various groups at EU level must also be avoided, which is a key UK concern, given the various strands of health related work being carried out at EU level, although joint work with the Economic Policy Committee should be encouraged, to ensure due consideration is given to financial sustainability.

"Under the OMC, Member States will be required to submit a short concise policy note in the Spring of 2005, based on the three principles of accessibility, quality and financial sustainability. The notes are expected to contribute to the framing of across-the-board objectives for the streamlined process in early 2006. The SPC recognises the importance for the OMC of developing common indicators but that development of such indicators should aim primarily to establish a common understanding of issues and thereby to facilitate exchanges.

"Overall, the SPC Opinion is a good result for the UK, particularly as it shares our view that the OMC should not be overly burdened by indicators, or duplicate existing work. We will continue to push within the SPC that the process is as light a touch as possible and concentrates on adding value. We have a number of allies in the Committee who have a similar view."

Conclusion

9.9 We are grateful to the Minister for his response. It is still not clear to us why the open method of coordination needs be applied in this case and why such exchanges of views as are required could not be achieved by other, less intrusive, means (the Minister refers, for example, to the existing or proposed Commission and Council groups on health services and medical care). Accordingly, we invite the Minister to appear before us to give oral evidence on these questions.


20   See headnote. Back

21   Conclusion 37, Lisbon European Council, 23 and 24 March 2000. Back


 
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