Cross-Border Health Care

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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.
Mr. O'Brien: Gibraltar?
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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