Select Committee on European Union Minutes of Evidence

Examination of Witnesses (Quesitons 73-79)

Mrs Kathryn Tyson, Ms Susannah Rix and Mr Jim Fowles

19 OCTOBER 2006

  Q73Chairman: First of all I would like to thank you on behalf of the Sub-Committee for coming today. It is obviously quite a difficult inquiry for us coming to the subject rather new. We have got our heads around it more or less but I am sure you will be able to help us to do that. I think, Mrs Tyson, you want to make a statement later on but if you do not mind I am going to go through a few things first which we need to remind ourselves and you of. You have seen the transcripts, I think. We have had a lot of other responses from people who have written to us and we want to make a timely report and a constructive contribution to the Commission strategy by concentrating on desirable, practical and proportionate public policy objectives where the EU can have a worthwhile role. We are hoping that this morning you are going to help us get a clearer idea of what the Government thinks the EU strategy can and should try to achieve and how the Member States and the Commission can work together with the WHO in achieving those objectives. We also would be glad of your views on some of the evidence which we have already received and to know what issues have been raised in the Government's own consultations on the Green Paper. We hope that towards the end of the inquiry your Minister will be able to come before us and sum up the Government's position and comment on some of the subsequent evidence that we have to have. That is where we are, as it were, in the story of the inquiry. This meeting is open to the public and, as you can see, is being recorded for broadcasting or webcasting and a verbatim transcript will also be made. That will be published on the parliamentary website and in an annex to the inquiry report. Shortly after this meeting you will receive a copy of that so that if you wish to correct it because you have been misrepresented in some way or something does not sound quite like what you really wanted to say or there are accuracy problems please advise us of that as soon as possible and those corrections will be taken on board before publication. If we get to the end of our time and, as quite often happens, there is extra information that you would have wished to pass on to us, we would be very happy for you to submit supplementary evidence in writing. I think you have in front of you a note of members' interests. With no further ado please would you make your first statement?

  Mrs Tyson: Shall I start, my Lord Chairman, by introducing my colleagues and myself?

  Q74  Chairman: Please do.

  Mrs Tyson: I am Kathryn Tyson, as you can see, and I am Programme Director for Mental Health in the Department of Health, which means that all matters to do with the mental health of working age adults, and by extension and co-operation with other parts of the department, all other adults beyond working age, are part of my concerns. Jim Fowles is a member of my team. He is Senior Policy Manager and he has a particular interest in matters about equalities, human rights and European and international aspects. Susannah Rix is our UK counterpart to the World Health Organisation on mental health issues. As you see, we come from the mental health policy area and, with the possible exception of Susannah, our understanding of the intricacies of European instruments and so forth is perhaps not all that we would need to be able to help you through everything you want to say, but we can, of course, find things out and come back to you and we will do our best to answer your questions. On the EU strategy, I have some very brief opening remarks. Of course, the strategy itself has not been drafted, much less published, so we are still working on the basis of the Green Paper and what we know of the consultation responses, including our own Government response, but we have welcomed the Green Paper and what it suggests it will set out to do in terms of being a helpful addition to the ways in which Member States can help take forward implementation of their particular aspects of the Helsinki Declaration. That is the way we have approached the Green Paper. That is all I wanted to say by way of opening.

  Q75  Chairman: Thank you for that. I am going to explore that a little further. Obviously, in letters and in the response to the Green Paper there were several principles and approaches which have been laid down about the EU mental health strategy, it should be a contribution to the Helsinki Declaration's implementation and not an alternative, it should accommodate and support Member States' own priorities, it should not duplicate or confuse existing European activity and particularly it should act in accordance with and not in order to confuse the Helsinki approach. It should be flexible enough to recognise and accommodate Member States and their different starting positions in relation to this kind of topic. Following the consultations of the Department does the Government believe that these principles and tests can be met? Are they satisfied, broadly speaking, that the new approach, the mental health strategy, is going to go along the lines that they would like to see in this context and can you see anything which might go wrong? Are there any pitfalls which might lie ahead?

  Mrs Tyson: Yes, we think that the principles and tests can be met. From what we have observed of the processes and the degree of co-operative consultation that has gone on in the period towards the drawing up of the Green Paper itself and following that throughout the whole consultation we do see that as giving some indication that that is the way things will work out. As you probably know, the Helsinki Declaration and the Green Paper, by the quirks of these things, did end up being published at round about the same time, and in fact they cross-refer to one another in the ways in which we set out that we would wish to see that they did. Our observations of the way that officials involved in both work streams have worked together show that there has been lots of cross-membership, cross-attendance of each other's meetings, significant involvement in each other's discussions and a significant effort to ensure that the one feeds into and supports the other. We do feel that the tests and principles could well be met by the strategy that arises, and I suppose in a small way this is mirrored by the approach that we take here. It is the same team that deals with mental health matters for the Helsinki Declaration and for the strategies in the Green Paper, so we are not saying one thing to one set of people and another thing to another set; we are approaching it as if that is the case. Of course, largely our approach to the improvement of mental health services is what is set out in our National Health Service Framework published in 1999 and we continually look to that to see in what ways it expresses our intentions to fulfil the Helsinki Declaration and we will use it again as our central platform for the ways in which we would pursue things set out in the EU strategy. With regard to possible pitfalls, I suppose that, like any consultation of this kind, it gives a lot of people the opportunity to dust off hobby-horses and raise issues again that we perhaps rather thought had been put to bed. We clearly will deal with these in the usual way. We will give them due consideration and take from them the things that we need to apply to the way in which we seek to implement Helsinki and any relevant parts of an EU strategy, and, of course, the EU officials will want to strike their own balance as they continue to conduct the analysis of the consultation responses that they are now undertaking. They will need to take that into consideration.

  Q76  Chairman: Thank you. Mr Scheftlein of the European Commission came before us and I must say gave us very careful evidence in which he emphasised on more than one occasion the way in which what the European Union was doing was intended to fit in with the WHO strategies. I do not think he was in any doubt as to where the positioning of his paper was. I think he was to a large extent the author of the paper. On the other hand there are some other difficulties. Health is obviously what the WHO does. The Commission has a much wider remit and can bring together several directorates at the same time. WHO covers 52 countries with a small secretariat and relatively small resources, mainly focused, of course, on deprived countries outside the European Union, or the rest of Europe as well for that matter. Are you confident that despite everyone wanting this to happen these three different levels—the WHO, the European Union and the Member States—can find a modus operandi which will really bring added value to all the things that you want it to? It is a more mechanical question, if you like, rather than a philosophical question.

  Ms Rix: Our understanding of the corresponding roles of the WHO and the European Commission is that WHO, which is the UN agency with the responsibility for health, tends to have more of a role in advising Member States on matters of health services and treatment and providing technical guidance, gathering information and services resources. They published a global atlas of mental health resources around the world, for example. For mental health the European Commission tends to be more focused around population and public health matters and, as you pointed out, has the advantage of having a wider number of directorates with responsibilities for other areas which are also relevant to this broader remit. Our experience so far is that the European office of WHO and the European Commission and Member States have worked together very positively, harmoniously and effectively. There has been positive two-way communication both within the consultation meetings but also outside those meetings. It has also been our experience that where representatives from WHO's European office and from the European Commission have been at the same event or meeting they have both been able to make positive and complementary contributions to the discussions. Regarding the relationship with Member States, WHO Europe has developed this system of having national counterparts who are able to represent and liaise both between individual Member States and also with WHO on specific things, and mental health is one. It seems that on the whole it has been the national counterpart who has also represented individual Member States at the consultation meetings with the European commission, so this is a group of people who have got to know each other quite well and there are good active working relationships. As Kathryn Tyson says, within the Department of Health there is also taken a very consistent and common approach to working in both organisations, the European Commission and WHO Europe, with common representation at both sets of meetings. The other thing to say is that across the 52 Member States in what WHO defines as Europe there is, of course, a wide variety of experiences and starting places or stages of development for mental health policy and systems. WHO, in taking forward the very early stages of the implementation work around the Helsinki Declaration, has been very sensitive in addressing this issue in how they have worked with Member States and a good example of this would be the last meeting of European counterparts which took place in April this year, where the discussions with Member States were structured so that participants were divided into groups and the United Kingdom was part of the first group of 12 Member States who were identified as having the most advanced mental health policy and systems.

  Q77  Chairman: That rather suggests that there is a recognition that some European states, if you take the broad Europe, will have different needs than other European states. Is that what you were saying, that the groups reflected that, so that you were trying to get from the WHO perspective the maximum benefit to all Member States in accordance with what their current effectiveness and competence is in this field? Is that the sort of approach that you are taking?

  Ms Rix: Yes, certainly in terms of the focus that WHO has had in its relationship to different Member States and obviously discussions about the implications of the Helsinki Declaration in the United Kingdom, Holland or France will be rather different from perhaps Latvia and Lithuania. The sorts of issues would be that perhaps for ourselves we are now focusing more on public health issues, more advanced issues, whereas maybe in countries in groups C and D they may be working on more basic issues of de-institutionalisation and human rights.

  Q78  Chairman: Does the Council of Europe play any role in this as well?

  Ms Rix: Less so at the moment. I have to say that it is much harder for us to comment on relations with the Council of Europe because we have not had any recent direct contact with the Council of Europe.

  Q79  Lord Trefgarne: May I ask a supplementary to all of that? In the Department's response two more principles were established. We have talked about the Helsinki accord, where all this stuff is. We have been talking about the open method of co-ordination and we look forward to that. Nowhere in this is there reference to the patients. Are they going to derive any benefit from all of this or is it just going to lead to some huge new European infrastructure?

  Mr Fowles: There is a thing at the moment called the EU Platform on Mental Health and that is the channel or the avenue for people who use mental health services and people who care for those people as well as possibly for providers of services themselves. It is their chance to have a say in the strategies that take shape and in the way they are managed and taken forward once it is published.

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