Examination of Witnesses (Questions 80-98)|
Rt Hon Dawn Primarolo, Mr Paul Whitbourn and Mr Jonathan
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 thisand 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
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
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
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
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 documentthis is the consultation document
going out across the United Kingdomnaturally, 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
Q95 Baroness Gale: In EU consultations
with the devolved nationsand I am thinking in particular
about Walesyou 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 haveI do not recollect any right
nowbecause 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
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 readyor they do now!to
answer any further questions that might arise in your considerations.
Chairman: Thank you very much indeed.