Healthcare across EU borders: a safe framework - European Union Committee Contents

Examination of Witnesses (Questions 80-98)

Rt Hon Dawn Primarolo, Mr Paul Whitbourn and Mr Jonathan Mogford

30 OCTOBER 2008

  Q80  Chairman: Minister, you have already given us over an hour. We are obviously finding this extremely useful. Are you happy to continue for another ten minutes or so?

  Ms Primarolo: Yes, of course.

  Q81  Chairman: We need to ask you that out of courtesy.

  Ms Primarolo: I am happy to stay.

  Q82  Baroness Gale: May I ask one question on the Minister's reply in terms of language. It could prevent someone seeking treatment, if the patient had to pay for translation facilities, because it could be quite expensive. If somebody from the UK was going to France, for example, and would have to provide their own translation facilities, or if people were coming into this country, surely that is going to limit the people who are coming because of that extra cost. If you cannot afford that, you cannot go for that treatment.

  Ms Primarolo: Under the case law, the individual will be checking with a provider and maybe that is something they might like to ask. I feel just a little uneasy about using National Health Service money to provide additional services that we would not provide, on the basis that an individual has made that choice, when we know that across the budgets of the NHS we are always having to look at priorities and there is never enough money. I think it comes back to this—and in your deliberations you might consider this: What is the role of the individual? What is their responsibility in taking up this legal right that is provided? At the moment, I absolutely agree with you that it would be a cost but they would have to take that into consideration.

  Q83  Chairman: We must move on. It is a tension between equity and rationing, is it not?

  Ms Primarolo: It is indeed.

  Q84  Chairman: Which is what we have perpetually.

  Ms Primarolo: Well, equity and planning.

  Q85  Lord Lea of Crondall: Minister: mutual recognition of qualifications. Obviously this has been going on for donkey's years. I remember, it must be 30 years ago, that the TUC helped the BMA find their way around Brussels. One of the big developments has been the professional qualifications system. Does this Directive bear on this or not? We have received written evidence from the Nursing & Midwifery Council who say that the rules on recognition need clarifying. I am not very clear what they are saying there, but would you like to comment about whether this is totally, as it were, down to the professions or is there something that has a bearing on it in the discussion of the Directive?

  Ms Primarolo: Article 11 says, "This article does not apply as far as recognition of professional qualifications is concerned." I think that is quite clear. It comes back to the point I was making earlier on, that at the moment I am keen to keep outside of this draft Directive anything that is not directly relevant to codifying the case law. I have seen the evidence from the Nursing & Midwifery Council. The Directive on professional qualifications did bring together a number of Directives into a single Directive and, if you like, the transposition of that into UK law included a consultation process as well. The draft regulations amending Nursing & Midwifery Orders were drawn up in very close co-operation with them. I think that the general principle of healthcare in the draft Directive is that standards of Member States of treatment apply in their healthcare systems. That is quite clear and, therefore, I do not take a view. I think it is my job to be focused on making sure that inside the National Health Service we have high quality, safe health services. That is paramount in terms of our standards. We set the standards and the qualifications for us. This is one of the difficulties. Given that we are not creating a European-wide health service, because of subsidiarity, and quite clearly we are not, that happens when people step outside and the standards of that country apply. I hear the point and they have made it before. There are remedies and that is being taken forward, but I do not think, in my view, it is relevant to this Directive. I stand to be corrected, but that is my view.

  Q86  Chairman: It is for this Committee to be asking the question about standards within the Directive, I would have thought.

  Ms Primarolo: Absolutely.

  Q87  Chairman: Which is a different issue.

  Ms Primarolo: Absolutely.

  Chairman: Thank you very much indeed. That is helpful. Lady Perry is going to ask about co-operation between Member States.

  Q88  Baroness Perry of Southwark: Minister, you said in your evidence that you have some concerns about co-operation between Member States. Could you expand on those, particularly in regard to the recognition of prescriptions issued in other Member States. To what extent might this impact upon the possibility of making a top-up payment for drugs that are not publicly funded?

  Ms Primarolo: My view on co-operation is that, as long as we are clear what it is, it is a good idea. For instance, I co-operate and we have discussions on pandemics influenza, not only across the European Union but more widely. It is true that there is now the matter of prescriptions and being able to have a prescription from one Member State into another. We are consulting on templates, and, again, that is part of this, but they can be fraught, in that they then imply vast systems that make it very difficult to maintain the planning of the Member States' health systems. My view is that the European reference network, exploring and looking at e-health within certain arrangements, the technology assessment programme where we are sharing experience and information, are things that we can do, because we co-operate and we speak, but I do not want to see it moving into the main text of the draft Directive. I think it will open up areas that are not dealt with in the legal judgments, so there is a place, but we need to be clear on what that is.

  Q89  Baroness Perry of Southwark: If a patient were to come back from France, let us say, clutching a discharge prescription for a drug which currently the NHS is not prepared to pay for in their PCT, what would the position be?

  Q90  Chairman: You may be in some political difficulty in answering this question.

  Ms Primarolo: I may be. In fact, I am. Could I come back and answer that question another time when I am able to be more frank with you. How could I put it? I think there is a way around this. I am sorry. Forgive me, but I think this should be one of the notes—

  Q91  Chairman: We do understand. This is an ongoing matter.

  Ms Primarolo: -- when I am able perhaps to be a little clearer on whether we think that is a possibility.

  Q92  Chairman: In the terminology: you will write to us.

  Ms Primarolo: Yes. Thank you very much.

  Q93  Chairman: We have a few minutes before half-past. You might wonder why I am asking the question about consultation and administration. That is because we are so well represented on this Committee: we have a Welsh, a Scottish and an Irish background member, and so the English member is asking the question. You say in your EM that you have consulted with the other administrations during the preparation and the discussion and we just wondered if you would tell us how that consultation has taken place and whether there has been a good response.

  Ms Primarolo: There are the discussions that I have and the exchanges that I have had directly with the ministers in the devolved administrations. I am the English Health Minister but I sit on the Health Council. This draft Directive is for the whole of the UK, and so, particularly at official level, there has been a great deal of discussion and we have drawn on their views. We agree. I have correspondence, as you would expect, before embarking on this, from the ministers, saying that they agree with our negotiating position and the sort of points we have discussed this morning, and these are their fears as well. On the consultation document—this is the consultation document going out across the United Kingdom—naturally, we have their agreement. There is not a separate consultation. The closing date for the consultation is 8 December, but that is running now. I will hear from them again, and we will then be discussing, before it is published, what the consultation says and what we might do next, so that we are all agreed.

  Chairman: The Committee are keen to know what happens if there is a view in Scotland that is directly different from one of the other administrations?

  Q94  Chairman: And I only take Scotland as an example.

  Ms Primarolo: I am sure there will not be.

  Q95  Baroness Gale: In EU consultations with the devolved nations—and I am thinking in particular about Wales—you have this consultation, you talk about it, and you come to a decision. Are these discussions within the devolved administrations made public? Could we have a look at them to see really what had happened in those discussions? If there were to be a disagreement, do you eventually resolve it, so that you have one view going?

  Ms Primarolo: Actually, it has gone swimmingly. There having been discussions at official level, I then wrote to the ministers saying, "This is how I think we should try to manage these negotiations. Here are the headlines. What do you think?" They then took their officials' advice. They replied back to me, saying that, yes, they agreed. They flag up any concerns they might have—I do not recollect any right now—because every minister is motivated by the operation of their health systems to the maximum benefit of the systems. On the consultation document there was an issue as to whether each administration would do their own consultation, and then it was agreed that might not get us some very good responses and we should all be asking the same thing. That was agreed. Whether I could release those private letters, I do not know. I would need to ask them. But I think I am right in saying that we never resolved the conflict because there was not a conflict in how we should approach this development. If there was, we would have to sit down as ministers and find a consensus position.

  Q96  Baroness Gale: It would not be the norm to release these letters. That is all I am asking.

  Ms Primarolo: No. These are private exchanges between ministers. I have to say, they are not earth shattering, because we were in complete agreement. If the Committee really, really wanted to see them, I do not think it would shed very much light. It is, "Dear Edwina" and then a letter comes back, "Dear Dawn, Yes, I agree. We are concerned about this like you are."

  Q97  Chairman: It would not be admissible under the Data Protection Act, because it is ongoing work in a piece of work.

  Ms Primarolo: It probably comes under policy, yes.

  Q98  Chairman: Minister, I would normally ask the Committee if there are any more questions, but I am not going to do that for obvious reasons. You have supplied us with an absolutely excellent framework for us to move forward and you have given us room for many more questions that we will be able to ask. We note that there are one or two things on which you are going to come back to us and there are things on which we may well come back to you through your officials if we have further questions. Meanwhile, I am sure the whole Committee joins me in thanking you for an excellent session.

  Ms Primarolo: Thank you very much. We will get the information to you as quickly as we can and of course my officials stand ready—or they do now!—to answer any further questions that might arise in your considerations.

  Chairman: Thank you very much indeed.

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