Mr.
O'Brien: Moving on to a separate question, will the
directive and the provisions therein apply to military personnel? The
Ministry of Defence commissions health care directly, and Greece, for
example, is clearly nearer to our current theatres of operation. Do
they apply to diplomatic personnel—the Foreign and Commonwealth
Office also commissions its own health care directly? When dealing with
military facilities, will our military hospitals and units be obliged
to take members of the military—or indeed
civilian—populations of other member
states?
Dawn
Primarolo: As I explained earlier, the draft directive is
not designed to confer any new rights or actions. Nothing would change
from current behaviour in the circumstances that the hon. Gentleman
describes. It is imperative to ensure that there are no new rights or
obligations on member states. Our first objective is to ensure that
there is no legal uncertainty to allow further European Court
intervention by case law. We would fail at that
point.
The
Chairman: Order. The hour allocated for question time in
the Committee is almost over, but there are several hon. Members who
wish to ask questions. Under the provision of Standing Orders, I extend
question time to allow for the remaining questions. We will move on to
the debate after no more than half an hour. Any extra time given for
questions will be deducted from the total time for debate and we shall
finish no later than 7
o’clock.
Mr.
O'Brien: I am grateful to you, Mr. Martlew. I
move on to the Minister’s responses to the European Scrutiny
Committee, contained in addendum 1 to the motion documents. Have the
Minister’s officials contacted the Commission, and is article 95
an appropriate legal base? Will she clarify the word
“ensure” in article 6.1 of the directive, and when does
she intend to do so?
Dawn
Primarolo: The answer is yes and yes. I confirm that
article 95 is the correct legal base and we continue to hold view.
Regarding the point raised by the Scrutiny Committee—presumably
this deals with the question of obligation to ensure treatment in
another member state—we have had those discussions with the
Commission, and informally it has accepted the
point.
Mr.
O'Brien: On the same theme, will the committee of
representatives mentioned in article 19 have representatives from all
member states? Who will draw the line between implementing and
substantive measures?
Dawn
Primarolo: That needs to be part of the discussions that
we are having now. Clearly some matters will need to be discussed
following the directive’s implementation. I intend to ensure
that the directive covers as much as possible and that what is not
covered and needs final tidying up is tidied up succinctly and in a
timely fashion, with no further
implications.
Mr.
O'Brien: So when can we expect the first progress report
mentioned in the European Scrutiny Committee’s 34th report? Will
that be made publicly
available?
Dawn
Primarolo: The first update for the House will be made
after the discussions at the Health Council in December, when I will
make my formal response in writing about those discussions. It will
then be for hon. Members to decide what they want to do
next.
Mr.
Cash: There appears to be some difference in opinion
between the advice that the European Scrutiny Committee has received
from its legal adviser, who is now also Speaker’s counsel, and
the advice being given to the Minister in the Department of Health.
Would it be possible for the European Scrutiny Committee to be
supplied with the legal advice that has been received by the right hon.
Lady on the principle of the European Court of Justice’s latest
announcement with regard to the disclosure of legal
opinions?
Dawn
Primarolo: The hon. Gentleman is an experienced Member of
Parliament so he knows, first, that it is not unusual to be able to get
several different opinions on the same point from several different
legal representatives; and, secondly, that the Government do not
disclose their legal advice, particularly when they are acting
on
it.
Mr.
Cash: In that context, it may be of
interest—certainly it was to me—if I mention the recent
Turco case. Does the Minister agree that under that case,, which dealt
with confidentiality of legal advice, Governments are required, as the
Commission is required, to provide legal
opinions?
Dawn
Primarolo: With respect to the hon. Gentleman, I will
confine my comments to the draft directive and my area of competence as
a Health Minister, not speak as a legal
adviser.
Mr.
O'Brien: Bringing us back to the draft directive, I have a
technical point relating to the recommendation of 12 July 1999, cited
as 1999/519/EC, on the limitation of the exposure of the general public
to electromagnetic fields of 0 Hz to 300 GHz, which is on page 173 of
the document bundle. Will the Minister confirm that this legislation
has no read-across to the Physical Agents (Electromagnetic Fields)
directive, which has been said to pose a “serious threat”
to MRI scanning in the
UK?
Dawn
Primarolo: I read hundreds of pages to prepare for this
Committee, and I always try to be helpful, but notice of detailed
points like that is sometimes useful. To my knowledge there is no
read-across, but of course I will look at that matter, now that the
hon. Gentleman has put it on the record, and ensure that I my answer
correct.
Mr.
O'Brien: I am grateful for that. I appreciate that that is
a technical matter and it is only because I was reading the document
bundle all the way through that I spotted it. However, it is important
in terms of a potential serious threat, so quoted, to MRI scanning in
the
UK. While
I am dealing with technical matters relating to computers and so
forth—e-health—the last time we debated this matter, I
questioned the former Minister, who asked for the Committee’s
indulgence, not knowing the up-to-date position with regard to
Connecting for Health. I appreciate that the Minister here today has
had a chance to brief herself. We have touched on interoperability. I
place on the record, because I am not pushing for an answer today
unless the Minister wishes to provide one, a question about where the
emphasis on the directive on terminology might leave the SNOMED
CT—systematised nomenclature of medicine clinical
terms—project. Could she re-iterate, because she has touched on
this already, whether the directive will force the UK to make any part
of its electronic health records, through access to the spine,
available Europe-wide?
Dawn
Primarolo: I am tempted to say that it is always easy for
hon. Members to ask questions because they do not have to know the
answers: it is much harder to answer questions. As he will know, the
plan in place to be implemented by 2010 respects the differences
between national health care systems and member states’
responsibilities for the organisation and delivery of their health care
systems. He would not expect me to do anything that breached that
principle and I confirm to him that I will
not.
Mr.
O'Brien: I am happy to swap jobs if that is what the right
hon. Lady would like.
Moving on to
the European reference networks, what crossover might there be with the
European networks of excellence programme running out of the science
and research directive in the Commission? Can the Minister confirm that
the directive will concentrate research rather than dilute it? In the
industrial field, for example, it is madness that the regional
development agencies in the south-west and the north-west are both
trying to become nanotechnology centres, with all the added marketing
expenditure of having two offices in Brussels, when we might be lucky
if we can manage one.
The
Chairman: Order. The hon. Gentleman must not
stray.
Mr.
O'Brien: I hope that the Minister will confirm that the
Government would not allow that sort of stupidity to repeat itself in
the area of health
research.
Dawn
Primarolo: I understand that the hon. Gentleman is keen to
ask lots of questions but my advice to him would be to confine himself
to what is in the draft
directive.
The
Chairman: That is a matter for the
Chair.
Dawn
Primarolo: I apologise, Mr. Martlew. I am
grateful for that correction. The matters the hon. Gentleman raised are
not relevant to the draft
directive.
Mr.
O'Brien: I very much look forward to the Minister, when
she gets into the detail of it, making sure that the references to the
European networks of excellence programme are dealt with.
I look
forward to the questions on devolution. We have touched on the
devolution questions within the United Kingdom. Given that the proposal
also applies to Gibraltar, can the Minister tell us what input the
Government of Gibraltar have had and how important that is? At the same
time and by the same token could she also tell us how this will apply
to residents of overseas
territories?
Dawn
Primarolo: They have to be members of the European Union
and overseas territories are not.
Dawn
Primarolo: I am answering the hon. Gentleman’s
question. He asked it in two parts. With regard to the impact on
devolved Administrations, the fact that the Department of Health leads
on the UK response to the consultation document, which is binding on
the UK, means that all those matters are
covered.
Mr.
O'Brien: For clarification, Gibraltar, for some purposes,
is classed as an overseas territory. Therefore it was relevant to ask
the other question by
analogy. Moving
now to waiting times, in the Commission’s study of the main
reasons for the unmet need for medical examination and treatment, in
2.14 per cent. of occasions the reason is a waiting list, making us
fourth in Europe with this problem. In dental examination and treatment
the figure is 4.09 per cent., which is by far the highest in Europe.
The next is Finland at 1.39 per cent. Could the Minister explain how
that comes about and whether the directive includes measures to
mitigate that
problem?
Dawn
Primarolo: The directive requires a clinical decision on
whether it would be clinically detrimental to the individual concerned
or, put the other way around, whether it would be of clinical benefit
for the individual to be offered and given provision in another member
state. That is the relevant part of the
directive.
Mr.
O'Brien: On the increase in cross-border health care,
paragraph 2.2.2
states: “The
extent of cross-border healthcare has grown in recent years, and is
likely to continue to grow in the future... In an EU-wide survey the
majority of consumers stated that they expect that travelling long
distances for healthcare services will be normal in
2020.” Various
statistics are then quoted to prove that. Have the Government in their
partial impact assessment contemplated undertaking work in a more
disaggregated way, so that they can look at the internal variations
within the United Kingdom, such as Kent being close to the channel
tunnel and the citizens of Northern Ireland being able to cross our
only land border into southern Ireland?
Dawn
Primarolo: Pages 6 and 7 of the partial impact assessment
detail the various projects that were conducted in the UK. The research
shows that when overseas treatment schemes are offered, they are not
taken up. The evidence from the UK, including from the past
12 months—the rights already
exist—demonstrates that when overseas treatment schemes were
offered in a pilot involving three primary care trusts, even patients
with close proximity to the channel tunnel chose to stay in the NHS,
because it offers quality and satisfaction, and it is close to
home.
Mr.
O'Brien: On professional activity. Paragraph 28
states:
“Member
States must also set out time limits within which requests for the use
of healthcare in another Member State must be dealt with, taking into
account the specific medical condition, the patient’s degree of
pain, the nature of patient’s disability and the
patient’s ability to carry out a professional
activity.” Does
that mean that the directive as drafted intends to favour those in
professional work over those who do not have professional
qualifications when it comes to access to health care? Does she not
agree that that would undermine the principles of our
NHS?
Dawn
Primarolo: No, the situation will be the same as now.
Priority is clinically determined by a health professional, including
the treatment. They would take into consideration, for instance, in
relation to the speed of treatment, whether the person’s
clinical need meant
that they were unable to be in their paid employment and whether delay
was detrimental in that regard. That consideration already applies in
the health
system.
Mr.
O'Brien: I am grateful for that, but I suspect that it
points up a wider
issue. This
is a somewhat unusual question. If I have understood the documents, the
directive applies to the European Economic Area—I hope that I am
right in saying that, and my understanding might be assisted by my hon.
Friends. If that is the case, it raises the question whether, in
relation to euthanasia, the Dignitas clinic in Switzerland, which is a
member of the EEA, would be brought into the orbit of UK commissioners.
Furthermore, will UK commissioners be able to prescribe equally
unethical, unsound treatments that are available in other European
countries? Obviously, that question is put in extreme terms in the hope
that I will get the assurance I am looking
for.
Dawn
Primarolo: No, it would not, because we are not
responsible for other member states’ health care systems, only
for our own. In providing for our citizens to go elsewhere, they can go
only for services that would have been offered in the
UK.
Mr.
O'Brien: On waiting times, will all EU residents have the
same priority as UK residents?
Dawn
Primarolo: They will be determined by what is happening in
their country of residence. It will be up to the NHS to decide whether
to reject or accept the referral in the light of capacity
constraints.
The
Chairman: Thank you very much. If no other Members wish to
ask questions, we will proceed to the debate on the motion. Members
will be aware that I have selected an amendment on the motion in the
name of Mr. Stephen O’Brien. I will call him to move
it formally at the end of the debate.
Motion
made, and Question
proposed, That
the Committee takes note of European Union Documents No. 11327/08 and
Addendum 1, Commission Communication, a Community framework on the
application of patients’ rights in cross-border healthcare and
No. 11307/08 and Addenda 1 to 3, draft Directive on the application of
patients’ rights in cross-border healthcare; agrees with the
Government on the desirability of EU legislation to clarify the
operation of cross-border healthcare to provide certainty for patients;
and supports the Government’s belief that the UK should continue
to pro-actively engage in this area in order to achieve the maximum
influence over the shape of the debate and final
Directive.—[Dawn
Primarolo.]
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