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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