EPSO meeting Cork, IrelandMay 14th and 15th, 2009

WELCOME

Jan VesseurChief Inspector

Dutch Health Care Inspectorate

• BELGIUM Krist Debruyn, Greet Helsen,     • DENMARK Anne Mette Dons, Torben Haerlev, Lena Graversen, Eva

Bidstrup,     • ENGLAND Alex Mears, Alan Rosenback,     • ESTONIA Ullar Kaljumae,  Lydia Alliksoo     • FINLAND Katia Käyhkö,     • FRANCE Jean Bacou, Charles Bruneau,     • HUNGARY Zsolt Kovacs,     • IRELAND Tracey Cooper, Deirdra Mulholland, Jon Billings, Marion

Witton,  Niall Byrne,     • NETHERL. Paul Robben, Wouter Sparreboom, Frank Neefjes,

Jooske Vos, Jan Vesseur, • N-IRELAND Glenn Houston, Quinn Phelim,     • NORWAY Geir Sverre Braut, Einar Hannisdal,     • SCOTLAND Sean Doherty, • SWEDEN Goran Mellbring, Asa Ekman,

Thursday 14th May 2009

3 pm – 5 pmInformal discussion about the Proposal for aDirective of the European Parlaiment and of the Council on the application ofpatients’ right in cross-border healthcare

6.30 pm – 8 pm welcome session/networking

8 pm – 10 pm diner organised by the Health Information and Quality Authority

Friday May 15th

9.00 am – 9.10 am opening by Tracy Cooper, HIQA9.10 am – 11.00 am Prof. Kieran Walshe, Professor of Health Policy and Management at the Manchester Business School: effect of supervision /inspection on Health Care11.00 am – 11.15 am Break11.15 am – 0.15 pm Wouter Sparreboom: research project on effects of supervision in Health Care in EU member states0.15 pm – 1.15 pm Paul Robben: Evaluation Program of Supervision in the Netherlands2.15 pm – 2.45 pm Planning for future EPSO co-operation and research2.45 pm – 3.00 pm Break3.00 pm – 4.00 pm Tracy Cooper: The financial crisis and its impact on supervision in health care 4.00 pm – 16.30 pm Evaluation.

Next meeting in Stockholm, September 2009

Presentationpatients’ right in cross-border

healthcare • Introduction of the directive

– History and time table– Content– Present status

• Possible effects for supervising organisations• Discussion in groups• Coming to conclusions?

History and time tableJuly 2nd 2008: COM (2008) 414 Def: Proposal for aDirective of the European Parlaiment and of the Council on the application of patients’ right in cross-border healthcare

Main aim of the Directive should be to codify the European Court of Justice decisions

Progress report on Employment, Social Policy, Health and Consumer Affairs Council (EPSCO) meeting in December 2008

Fr and CZ presidency prepared discussions with the result of a compromise proposal concerning all articles (March 18, 2009)

History and time tableApril 23, 2009, European Parlaiment legislative resolution (Codecision procedure): approves the Commission proposal as amended (finally 115 amendments)

CZ Presidency decided to bring the compromise to COREPER I

May 14th and 15th: discussion in Permanent Representatives Committee I: to prepare EU Council of Ministers on June 9th 2009

EU elections : June 4 – 7, 2009

Context and background•Conficting agenda of desire to retain national health policies and systems and desire to encourage mobility, competition in services and greater harmonisation

•The differences between numbers and scale and the potentially increasing importance

• Strong commitment to national health models

•Lack of clarity in entitlements in many systems

•Some services are evidence based, some are partially, some are not

Context and background

Health care professions are responses to needs and historical accidents

There remains some diversity between countries

There is a need to consider new configurations especially around mental health, changing technologies, laboratory medicine, care of older people

The Directive that no-one wanted?

Content of the Directive

The stated aim of the proposal are three-fold:

•To help patients exercise their rights to access cross-border helath care;

•To give people assurances about safety and quality of cross-border care;

•To help national health systems coorperate to achieve economies of scale

Content of the Directive

Aspiration to provide a framework for safe, high quality and efficient care

Member states retain control within common principles

Patients have the right to receive in another state services covered by their own state on the same terms and subject to the same conditions

Intended not to lead to financial difficulties in health care funding or planning

Content of the Directive

States to provide information about receiving health care in a neighbouring state

Prescriptions should generally be recognised across borders

Encourages the development of reference networks for highly specialised care

Encourages co-operation in training of professionals

Support for development of E-Health

Content of the Directive

Encourages co-operation on health care technologies

Reiterates and reinforces safeguards for confidential information on patients

Content of the Directive

Chapter II:Responsibilities of the authorities of the member states to follow the common principles for health care

Chapter IIIThe use of health care in another member state

Chapter IVCooperation in health care

Implications of the Directive

There are risks of large unexpected costs, despite desire not to have that effect

There are new problems of planning capacity if an inknown number will travel in or out

It is likely that covert rationing system will become more explicit

Mechanisms for rationing are likely to become more open to challenge

Implications of the DirectiveThere will be a need for more harmonisation of professional and provision specification

If succesfull the need to travel may reduce since contestability may improve domestic provision

It is more likely that it will concentrate in few areas where common, useful procedures are in high demand and in areas of super specialised work

If patients travel more, professionals may travel less

Greater standardisation of professionals and provisions is likely

Implications of the Directive

Risk of shortages occuring in countries with more constrained recources

Better information and monitoring are likely to improve safety

Not clear how existing failures at national level will be helped by the new arrangements

Greater transparancy and comparability could be useful

Implications of the Directive

Some potential to encourage greater co-operation in biomedical research

Significant potential to encourage research on provision of services

Patient confidentiallity issues may become worse

Professions and approaches to care may become more rigid

Thanks to prof Charles Normand, Health Policy and Management, University of Dublin, Trinity College

Present status

Proposal of a lot of member states to move the part from Chapter II, article 5 about safety, quality and supervision to Chapter IV about co-operation on the field of health care

The amendment of the European Parlaiment:Chapter II, art. 5: New:•Quality and safety standards of the Member States of treatment are made public in a language and format that is clear and accessible to all citizens•They immediately and proactively inform eachother about health providers when regulatory action is taken against their registration or their right to provide services

The amendment of the European Parlaiment

Article 13, paragraphs 2a, 2b, and 2 c (new)

2a. Member States, particularly neighbouring countries, may conclude agreements with one another concerning the continuation or potential further development of co-operation arrangements.

2b. Member States shall guarantee that registers in which health professionals are listed can be consulted by relevant authorities of other Member States

2c. Member Sates shall immediately and proactively exchange information about disciplinary and criminal findings against health professionals where they impact upon their registration or their right to provide services.

Possible effects for supervising organisations

A need for more co-operation

•in the education of inspectors/auditors

•in setting standards of techniques of supervision

•In the publication of results of supervision

•exchange information about health care professionals and providers

AND MORE

Discussion in groups

1. Suggests the themes of co-operation of supervising organisations

2. What should be the way to co-operate related to the themes (suggestions, possibilities)

3. What should be the position of EPSO in the co-operation between supervising organisations

4. What action can EPSO undertake in the direction of the European Commission

Coming to conclusions

Thank you!

Jan VesseurChief Inspector for Patient Safety, HealthIT and International

AffairsHealth Care Inspectorate

P.O. Box 3928000 AJ Zwolle, the Netherlands

Tel +31384671881j.vesseur@igz.nl