Examination of Witness (Questions 111-119)
Mr John Bowis
2 NOVEMBER 2006
Q111Chairman: First of all we would like to
thank you very much for coming to see us. I am sure you are going
to make an extremely valuable input into our considerations of
this matter. When we first looked at the paper we were conscious
that the potential scope of what was being considered was extremely
wide and we want to focus our inquiry so that we can produce a
timely report and make a constructive contribution to the next
part of the discussion by concentrating on desirable, practical
and proportionate public policy objectives where the European
Union has an appropriate and valuable role to play. That is the
way we are trying to focus the report. We have been assisted in
our report by Professor Martin Knapp —sitting on my right
here—who is Co-Director of Health and Social Care at the
LSE. We have had oral evidence from the European Commission and
from the UK Health Department as well as having received quite
a lot of written evidence. We have certainly studied the very
comprehensive text of the European Parliament Resolution on Mental
Health in its form as adopted on 6 September. We want to explore
that with you today. Just on a matter of some housekeeping, this
session is open to the public; there are in fact no members of
the public sitting here but it is an open meeting. It will be
recorded for broadcasting or web casting. A verbatim transcript
of your evidence will also be taken and that will be published
on the parliamentary website and in an annexe to the report that
we will eventually write. You have a right to look at that transcript
and to correct it if you have been misrepresented or for any other
reason. Also, as sometimes we do not manage to get all the points
out in these conversations, it is also an opportunity for you
to add anything else you feel has somehow been overlooked during
our conversation. You should have a note of members' interests
before you. The last point I need to make is that the acoustics
in this room are very bad so if you can speak in the traditional
manner, ie with your head up, it helps enormously for us to be
able to hear what you are saying. Perhaps for the recording and
for the script you could state your name and your official title
and then you might wish to make an opening statement and if so
you are most welcome to do so.
Mr Bowis: Thank you very much, and thank you
for inviting me. My name is John Bowis; I am a Member of the European
Parliament representing London and I am Rapporteur in the Parliament
for the Green Paper on Mental Health amongst others including
patient mobility and perhaps other related issues. I am also spokesman
and coordinator for the EPP group in the Parliament. Formerly
for three years I was responsible for mental health in the Department
of Health and went on, when the electors gave us leave of absence,
to work with the World Health Organisation on its Nations for
Mental Health campaign which then led into my work initially with
the Finnish Presidency in 1998 to 1999 and by then I was in the
Parliament and could take a part from the other side of that particular
counter. By way of introduction I can be very brief because my
introduction really is my report. I think mental health is a fascinating
area and I do not think that anyone has got it right yet. I always
said when I went into the Department of Health that I thought
I knew it all; after a year I knew I did not; after two years
I knew nobody else did either and that is when I really started
to enjoy exploring the options and the solutions and the problems
of mental health, but also the opportunities which have been largely
underplayed to promote mental wellbeing and thereby have a fit
community and hence a fit economy under the Lisbon Agenda for
Europe and so forth. I list here the background; I do not need
remind you of the cost of ill health and mental disorder to our
society and our economies and I would just highlight perhaps the
five areas of deficit that I identify: the inadequacy of community
services; the failure to listen to the service users and their
carer; the inability or unwillingness of agencies to work together;
serious under-funding; and little, if any, interest in policy
making in the health promotion area.
Q112 Chairman: Thank you. That leads
straight into the first question on our list. You have produced
an extremely interesting document which has an enormous number
of different points in it, all of which are important and interesting
points. Is there a sense of prioritising not so much in terms
of the pre-considerations but in the actual recommendations that
the document makes between these various points? Where would you
like the focus of the Commission's efforts to lie?
Mr Bowis: I apologise for the length of the
document; if you saw my initial draft it would have been rather
a slimmer version but as you probably know European legislation
is like a Christmas tree and everyone pins their bits on. We see
how much of that we can accept and it goes through and we hope
it will eventually be of use in different ways. I think to me
the fundamental issue is how we put the individual centre stage—the
individual patient, the individual service user and the individual
carer—both in terms of managing his/her own health but also
in the planning of services. If we get that right then I think
an understanding in government of the cost of mental disorder
and the potential benefits to everyone of investing in good health,
would be of benefit. I think if you asked me which of the specific
areas of action are the most important I would say defeating stigma
is fundamental (we are a long way from understanding either what
causes it or how we cure it). The second is suicide, the most
unnecessary waste of lives—very often young lives—and
if governments and societies understood that that cost in death
was higher than for road accidents and higher than for HIV Aids
then I think they would see the need to tackle what is in effect
an epidemic. Then there are the three areas which were highlighted
in the original Finnish Presidency in the WHO EU document in January
and in this Green Paper which are: how we look after children
and avoid some of the behavioural problems, the eating disorders
and those sorts of things; how we look after people at work (that
is a very direct responsibility of the European Union, ever since
the Treaty of Rome we have had responsibility for health and safety
in that area but we have tended to neglect the health side as
opposed to the accident prevention side and we have certainly
neglected the mental health side as opposed to the physical health
side); then of course the challenge of the ageing population with
more people happily living longer lives—I have a mother
of 101—but by then you become frail either physically or
mentally and the cost of neuro-degenerative disease is enormous.
We spend more now on drugs for Parkinson's Disease than for cancer.
It is the big challenge for the future, how we prevent some of
the dementia and cope with it when it is there.
Q113 Baroness Howarth of Breckland:
We have been told—and some of us know from experience—that
standards across the European Union vary enormously. We wondered
what perspective you had on those differences and how realistic
is it for us to try to reach some common standards across Europe
both in dealing with mental illness and looking at wellbeing,
but also if we accept that that may not be realistic in the short
term do you think that we could find some minimum standards for
countries to aim for?
Mr Bowis: I think we can find minimum standards
in some areas; we certainly could in terms of employment law and
we certainly could in terms of human rights and the UN Convention
in that area is going to be very helpful. Yes, you are right,
we are looking for good practice and that is what Europe is rather
good at actually. It is finding and sharing good practice and
then describing that rather than prescribing it so that there
is pressure on Member States because their citizens, their media
and their professionals know what is possible in other Member
States and can put pressure to raise standards there.
Q114 Baroness Howarth of Breckland:
Do you have a time perspective in terms of what might be achieved?
Mr Bowis: I think the time perspective is the
Commission's proposals, which is unusual, that we do move towards
recommendations (which is a type of legislation). There has been
considerable discussion as to whether that should also take the
form of a framework directive rather as we have done for clinical
trials which is, again, finding that compendium of good practice
and setting it out, a bit like the Highway Code, again not prescribing
that every Member State has to do everything in it but just to
say that here is good practice. If I think of the good practice
and the bad practice that I have seen within Europe I think of
some of the work in Italy where there has been a tremendous amount
of work to close institutions, to move people into the community—as
we have done here since the 60s—perhaps sometimes doing
it too fast before there are adequate community services ready.
Nevertheless they have put the boat out to move in that direction.
I have seen some of the worst, of course, in Leros, the Greek
Island, which had to be tackled and closed with Greece moving
towards a more humane society. I have seen in incoming Member
States, in Bulgaria for example, some of the most appalling conditions
in hospitals and particularly in hospitals where they link to
the justice system. However, I have seen good practice in many
parts of Europe and I think the concept which the WHO has of the
demonstration sites—I have seen that at work, I have pinched
the idea for my Report to say that we should do something like
that in Europe—is a good way of telling each other how to
tackle a particular problem (Lithuania's suicide; how to do better
than the Czech Republic's use of the caged bed and so forth).
I think there is a lot there. I do not think any Member State
has got it all right but some are doing better than others.
Q115 Baroness Greengross: The Commission
we know would like to see a Platform to take this discussion forward
and I wondered what you thought about that and what you think
about the open method of coordination, and whether you think that
is—as the Commission have suggested—terribly resource
intensive? I feel so strongly about this and I just want to know
what you think would be the best way forward and then we might
argue about resources later. How do you think we could best make
sure this is a really effective strategy?
Mr Bowis: Platforms are flavour of the month
in the Commission; they set them up for everything. The most alarming
one they set up was the Obesity Platform (we just hoped it was
strong enough!). We also have things called High Level Reflection
Groups; I have been on one of those and it was amazing. The concept
of the Platform I have no problem with if it is bringing people
together. What they do do is bring together not just the policy
makers but the NGOs and the experts (no doubt people like Martin
Knapp would be sitting on a Platform advising the Commission as
well as yourselves). If that is gathering together good practice
and if that is monitoring how different problems are tackled in
different Member States, that is fine as long as that is not the
end of the story. It has to be a tool for further action. My preferred
further action is the Framework Directive with or without the
specific recommendation areas. The open method of coordination
is, I think, a cop out (if I may use un-Parliamentary language).
It is very much linked to the employment policies of the European
Union it is not something we have used in the health or environment
areas, and it is a way of sidelining the Parliament; Parliament
has no role at all in the open method of coordination. The Commission
has very little role apart from surveillance, and it is just an
agreement by Member States on the Council to say, "Let's
get round this; we'll have this open method of coordination and
we will talk to each other about how we are doing things."
I have no problem with that in itself, but it is seen as being
the end of the story; that is why Parliament does not like the
method. I think if you have an elected Parliament its role is
to have efficient scrutiny; its role is to revise and advise and
to push increasingly for areas where we can move forward in legislation.
I am not happy and I think Parliament feels very strongly on issues
of comitology and throughout health and environment on my Committee
in the Parliament where I am spokesman we go for co-decision and
I think that works effectively. It puts pressure on governments
and sometimes governments do not like that but that is what they
are there for, to be challenged.
Q116 Earl of Dundee: What do you
think about the proposal for a directive on mental health and
how is that likely to be received among Parliamentary members?
Mr Bowis: As I say, I think it should be a framework
directive; I am not looking for a directive which sets targets
and dates and so forth. I think it should lay down reasonable
standards of practice and I do cite the Clinical Trials Directive
because I think that has been a good way forward. We have been
looking to do something like that in the areas of diabetes and
cancer screening and so on. I think that would be my preferred
way and it would link to the idea of the demonstration site where
you provide opportunities for Member States to go and look at
another Member State's experiment maybe or what they see as good
practice (it could be in looking after children and behavioural
problems; it could be caring for the elderly; it could be the
Czechs looking for a better way of managing disturbed people than
locking them into a bed with bars on it).
Q117 Earl of Dundee: The focus is
on standards and good practice of course, but can you say how,
in your view, if the directive proposal comes to fruition, it
would add value to results otherwise engendered by the Platform
approach?
Mr Bowis: It gives it a little more strength
than just sharing good practice. It is like the Highway Code in
that it could be brought in evidence if a Member State is being
questioned as to its effectiveness in an area. It is possible
that it could be developed so that the individual citizen would
be able to cite it as good practice when, for example, looking
for access to his or her rights under the patient mobility laws
as they now stand. At the moment the assumption is that we are
talking about physical health when we are talking about patients'
rights to go to another Member State if they are facing undue
delay; there is nothing in the legislation or the judgments which
suggests it should not also apply to mental health delays. That
is an area where we could raise the standards, but I think I would
also be looking—and it may be separate from the framework
directive—for some amending legislation to require employers
to report each year on their mental health at work policy and
that would put pressure on them to look around and to see what
is good practice and to then put it into effect. Then the requirements
of international conventions on human rights and so on could be
added on.
Q118 Earl of Dundee: Could the latter
come to be incorporated within the terms of the directive?
Mr Bowis: They could do but there is a complication
in that within the European Union you are dealing with different
directorates and different committees and therefore you tend to
have employment legislation dealt with by the Employment Committee
and my committee might have an opinion on it rather than a comprehensive
directive which would probably come to the Environment and Health
Committee. I am open minded as to whether one should have a single
framework directive or a broadish framework directive plus some
specific pieces of legislation, particularly on employment and
human rights.
Q119 Earl of Dundee: Whichever it
may be, what caveats would you give about its composition?
Mr Bowis: The caveat always is that we can go
as far as we can or dare within the treaties. I have to say that
I am one who believes that we should always test that limit and
I do not accept that just because somebody tells me a treaty says
we cannot do something we should not be able to do it. We have
to find ways through the treaty. To give an example, it is impossible
to do anything about tobacco under the health aspect of the treaty
so it is done under the single market legislation. It is impossible
to do anything about giving people patient mobility rights under
the health criteria, but it is under the rights of mobility. I
am not saying that you should ignore the treaties; I am saying
that sometimes you have to look at the treaties as a whole. My
answer to Lord Dundee is that we have to be careful all the time
that we are not trespassing on the rights of the Member States.
Article 152 of the Treaty gives us a broad requirement that we
should do our best for the health of the citizens of the European
Union but says that we should not impinge on the individual State's
rights to run its own health services and so forth. That has to
be right and has to be how we manage it, but things do move on.
I am not one who supported the European Constitution but had that
gone through and our Government was willing to advocate it, that
would have given a stronger health competence than is the case
now. That may well come back in any future treaty because I suspect
there is going to be a treaty rather than a constitution in the
future, but I am getting into dangerous constitutional grounds
here.
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