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


CHAPTER 6: Patient Safety and the Pathway of Care

The issue

121.  In this chapter we discuss the issue of patient safety and, allied to this, the pathway of care, which represents a co-ordinated multidisciplinary approach to the delivery of healthcare for a patient. We consider how continuity of care can be ensured and how the effective exchange of patients' records and medical practitioners' fitness-to-practise information can be achieved across borders.

Contents of the proposal

122.  The aim of the Directive is to provide a framework for the provision of safe, high quality and efficient healthcare.[39] The Commission recognises that it is vital to make certain that there are mechanisms for ensuring this quality and safety and that continuity of care between different treating professionals and organisations is an important aspect of this process.[40]

123.  The Commission acknowledges that ensuring continuity of care requires the transfer of relevant health data and, in particular, a patient's medical records.[41] However, as highlighted in recital 17, the right to protection of personal data is a fundamental right recognised by Article 8 of the Charter of Fundamental Rights of the European Union.[42] The Commission's consultation identified a concern that ensuring protection of personal data can hinder the appropriate transfer of medical records. The Directive therefore provides that this personal data should be able to flow freely from one Member State to another, while safeguarding individuals' fundamental rights. [43]

The pathway of care

124.  The importance of the pathway of care for patient safety was highlighted by the Patient Liaison Group of the Royal College of Surgeons (PLG), which suggested that because treatment often involves a series of procedures delivered by a multidisciplinary team, it is crucial to have someone with overall responsibility for managing the delivery of that care. Patients are not always aware of the pathway of care and tend instead to see their treatment as discrete packages of care. PLG considered that if patients sought a discrete piece of care abroad, they might then lose the continuity of care that the pathway provides. They also questioned how patients would get back onto the pathway of care on their return to the home Member State. (Q 143) The British Dental Association made a similar point in relation to dentistry, highlighting that this too is not often a "snapshot" event and that consequently seeking one-off episodes of care elsewhere can be very dangerous. (Q 298) Unite agreed that the pathway of care should address the needs of the individual from diagnosis right through to the post-treatment stage. This included the emotional and psychological well-being of the patient, which Unite suggested the Directive did not sufficiently take into account. (Q 371)

125.  Conversely, the British Medical Association took the view that it would be possible for a pathway of care to be properly delivered under the Directive but suggested that certain differences across the Member States, such as the medical culture and language, would need to be addressed in order to ensure patient safety. (Q 298)

126.  It is equally important that clear responsibilities within the pathway of care are assigned. PA Consulting believed that it was unclear in the Directive how the dialogue and responsibilities for managing the patient pathway between the home Member State and the providing hospital would work. Providers needed to be clear about what was included, and excluded, from their responsibilities. (Q 3)

127.  Another important area of responsibility is follow-up care, both planned and, when treatment goes wrong, unplanned. The Association of British Insurers and PA Consulting suggested that greater clarification of responsibility for follow-up care was needed, though neither group specified where they thought this responsibility should rest. (QQ 31-32, p 158) The Minister also called for greater clarity, though she nevertheless confirmed that the UK NHS would, without question, treat any complications that might arise upon a patient's return. (Q 78)

128.  For Unite, UNISON and the Royal College of General Practitioners Northern Ireland Council this led to the logical conclusion that the package of care should be determined in advance of a patient receiving any medical treatment. The Royal College of General Practitioners stressed that this would be particularly important with complicated procedures. (Q 372, p 170)

Exchange of patient information: continuity of care

129.  Handling of patients' records in cross-border healthcare is particularly sensitive. Patient information would need to be transferred between providers and commissioners and across borders and this would need to be done safely, completely and securely. As the RCN noted, this would be essential for the continuity of care. (Q 259)

130.  The efficient flow of crucial information and the continuity of care could be particularly challenging on an EU-wide scale. In a cross-border setting there are obvious concerns that the threat of data misuse would also be increased. (Q 143, p 168) The Government indicated that they would be studying the implications of aftercare arrangements in the UK for clinicians, including difficulties that might be experienced in understanding case notes. (p 18)

Exchange of fitness-to-practise information

131.  The exchange of fitness-to-practise information is essential in cross-border healthcare, an issue which a number of witnesses argued needed to be addressed in the Directive. For example, the RPS highlighted that Directive 2005/36/EC on the recognition of professional qualifications requires collaboration on information exchange across the Member States. However, they, along with the GMC, have found that some regulators are prevented from exchanging information because of rigid national interpretations of data protection legislation. Consequently, the RPS would "like it to be an absolute requirement to share information and that regulators should disclose and exchange all relevant regulatory information." (QQ 167, 211) The GMC also hoped that the new Directive would enable "blockages" to be overcome, suggesting that privacy legislation can be over-interpreted and is not always the impediment to sharing information that it is made out to be. (QQ 211-212) The Nursing and Midwifery Council argued that the diversity of standards within the EU meant that action was required at EU level. (Q 212)

132.  The Royal Pharmaceutical Society and the General Medical Council highlighted a specific need for this exchange of information, whereby currently a doctor could be registered simultaneously in more than one country and could be subject to disciplinary proceedings in one of those countries. However, if that doctor was already registered in the UK, information on their fitness to practise would not routinely be sought and that practitioner might continue to practise in the UK despite having proceedings against them. (QQ 167, 211) Currently, the General Medical Council rely upon the country where the disciplinary action is being taken to notify them of these proceedings. Nevertheless, they stated that "we do not routinely receive information about the action taken against doctors in other countries". (Q 211)

133.  The General Osteopathic Council called for "a more robust European-wide approach to communication and information sharing (such as registration and fitness to practise data on healthcare professionals) between competent authorities." (QQ 167, 193, 308, p 87, 165)

Conclusions and recommendations

134.  We conclude that clarity is required about the responsibilities of all those involved in the pathway of care. This is particularly important in order to ensure patient safety and to enable patients to make an informed decision to seek cross-border healthcare, aware of who is responsible for every stage of their treatment and who will be accountable should anything go wrong along the pathway of care.

135.  The secure and timely transfer of patients' records across borders is essential for patients' continuity of care. This may be problematic if case notes are recorded in different languages in the host and home Member State. We recommend that a clearer system is established for the transfer of patients' medical records.

136.  We note that Directive 2005/36/EC (see paragraph 131) on the recognition of professional qualifications requires collaboration on information exchange across the Member States. Nevertheless, we consider that without an obligation to exchange fitness-to-practise information this would not take place at a satisfactory or uniform level across all Member States and could result in problems such as medical practitioners with proceedings against them still being able to practise in other Member States where they were already registered. We therefore recommend that Member States should be obliged to exchange information on medical practitioners' fitness to practise.

137.  We note that over-rigid application of data protection rules has acted as an obstacle to such systematic sharing of information in the past. We therefore recommend that the European Commission examine the extent to which data protection legislation may need to be amended in order to facilitate the exchange of information on fitness to practise, whilst minimising the threat of data misuse.


39   (COM(2008)414) Article 1 Back

40   (COM(2008)414) (pp9-10) Back

41   (COM(2008)414) (p12) Back

42   (COM (2008) 414) recital 17 Back

43   ibid. Back


 
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