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"
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| Legal base | — |
| Department | Health |
| Basis of consideration | Minister's letter of 20 September 2004
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| Previous Committee Report | HC 42-xx (2003-04), para 6 (18 May 2004)
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| Discussed in Council | 1 and 2 June 2004
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| Committee's assessment | Politically important
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| Committee's decision | Not cleared; evidence from Minister requested
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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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