Saturday, 15 August 2009

UK HEALTH CARE OR EU HEALTH CARE?????????

eureferendum.blogspot.com

Dominating the BBC news this morning was the imminent arrival of the government's proposals for a new healthcare directive, although the BBC website now tells us that Brussels has actually delayed releasing its "controversial proposals".

In a manner to which we have become accustomed, though, the BBC paints a resolutely rosy picture of the proposal – whether it appears today or not – describing it as a measure "…that would have made it easier for patients to travel abroad within the bloc for health care."

A similar line is taken in The Times - one of many reports – which heralds the imminent arrival of the proposal with the headline, "Patients to beat NHS queues in EU plan for open health market". Thus does the paper tell us that:

Patients will find it easier to escape NHS queues and head across the Channel for treatment under an EU blueprint for European health tourism to be published tomorrow.

It will guarantee that, in most cases, treatment within the European Union will be funded by the taxpayer. The move will open up competition between the NHS and European health services and is being hailed as a big step towards an open market for public healthcare.
The superficial attraction of this measure, however, belies its more sinister intent, and the profoundly dangerous implications, not only for the provision of healthcare services in the UK, but for our national sovereignty. To these we have referred in earlier posts, specifically here here and here.

The headline issue, of course, relates to the celebrated case of Yvonne Watts (discussed in the posts linked above), who went to France for a hip replacement in 2002, followed by the refusal of her local health funder, Bedford Primary Care Trust, to pay the bill. This led to a legal battle in the ECJ, which reaffirmed the right of patients to seek treatment elsewhere in the EU, without prior approval, if they were suffering "undue delay".

Predictably, Edwina Currie, former junior health minister (of salmonella in eggs fame) and notorious Europhiliac - and also spokeswoman for the Patients' Association – dismisses any deeper agenda, telling The Times that: "This is not about individual countries giving up their health services to Brussels. This will affect a number of people like Mrs Watts who have had to wait too long for routine surgery."

In fact, though, the new proposal issue pre-dates Yvonne Watts, and represents of formal intervention by the commission in a policy area which has been opened up by the legal adventurism of the European Court of Justice, not least through its landmark ruling in July 2001 on the B.S.M. Geraets-Smits v Stichting Ziekenfonds.

What this did, reinforced by the Watts case, was define healthcare as a "service" within the meaning of the treaties, and thus bring healthcare provision fully within the competence of the EU, allowing our central government to become a major player in the provision and management of healthcare services throughout the EU member states. It was precisely that opening which the commission acknowledged in is consultation document last year, when it stated:

In its rulings, the Court made clear that when health services are provided for remuneration, they must be regarded as services within the meaning of Treaty and thus relevant provisions on free movement of services apply.
Thus, the proposal for a new directive is a "Trojan horse" and we can expect to see over term greater and more detailed EU intervention in the provision of primary healthcare. This will lead to member states' freedom of action being progressively circumscribed, with a similar distortion of heathcare priorities.

The point, as always, is that there is an intensely political dimension to this, which can be adduced from the commission's own healthcare website. It declares:

A key priority of the European Union is achievable and effective mobility for EU citizens. The Community is working to encourage open and easily accessible opportunities for citizens to move around the Union for educational, professional, healthcare or other purposes. A major aim is to make it easier for citizens to take advantage of the benefits of European integration and the European Single Market.
In other words, the primary policy aim of the EU, in respect of health care, is not – as is the case with member state governments - the provision of health services to the indigenous population, but the pursuit of European integration.

Whatever temporary (and limited) benefits might accrue from commission intervention, therefore, the net effect is to open up healthcare provision to another player which has its own agenda, one completely different from that which drives those who pay the bills and use the services.

In term of the bigger picture, what we are seeing is Whitehall losing its monopoly control over the health service. It is now sharing power with the central government in Brussels, to which it becomes subordinate in this policy area, in common with many other policy areas where it has already abandoned its monopoly.

Given the dire structure and management of the NHS, there will be voices who argue that this is no bad thing, except that one might need to remind oneself that the power is going to the same organisation which is so famed for its superbly efficient management of our fisheries and agricultural policies.

But, if that is a credible argument, there is no difference in principle in using the same argument for, say, defence. Since the management of the MoD is dire, should we not be looking to place power over defence in the hands of the EU commission?

The real issue, therefore, is that where the management of public sector systems in this country is poor, we should be looking for a change of government in this country, not rejoicing in (or even allowing) the handing over of management responsibility to a completely different, unelected government in Brussels.

Unfortunately, within the current treaty structure, this government undoubtedly feels it has no option but to go along with this directive. But, if it follows the same line, that means a new Conservative government will also face the prospect of its freedom to develop new initiatives in the provision of healthcare being circumscribed, as it is forced into a mould increasingly dictated by Brussels.

And this is but one measure in a week that has seen major other increments in the progress of European integration, with the White Paper on the "Integration of EU Mortgage Credit Market" and the Laval un Partneri Ltd judgement. Yet, with the focus on the new treaty, all these derive from earlier treaties and are actually based on the fundamental principles of the European Union, embodied in the original Treaty of Rome.

Going back to the period in the 1970s when there were earnest discussions on our joining the then Common Market, no one could have dreamed that, in one week over thirty years later, we would have seen measures which extended the Brussels remit into our health service, into our mortgage market and our fundamental labour laws - most of which has happened completely under the domestic political radar.

For this and many other reasons, it becomes more and more imperative that the Conservative party takes a long hard look at where the whole integration process is going. It is no longer enough just to erect a dam against the Lisbon treaty – or the next one, which surely will come. It urgently needs to work towards forging an entirely new relationship with the EU, one in which the inexorable march of integration is not only arrested but reversed.

In the absence of that, the next general election will be that in name only. In fact, it will be an electorally mandated reshuffle. We will change the faces in domestic politics but the real government (in Brussels) - and its policies - will remain the same. That is the measure of the beast.

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The Times leader today comments on yesterday’s ECJ ruling in favour of Yvonne Watts

Interestingly, in its piece, headed, "The European Court's unerring knack of erring", it mirrors the line taken by this blog. Thus it suggests that, while "at face value" the ruling would appear to hold potential benefits for NHS patients, in fact it is going to create a legal minefield.

More to the point, The Times notes the way the Court has defined healthcare as a "service", thus allowing the court to invent a huge amount of new law. It "has now become a player in the NHS, on the ground that it is legislating on free movement of services," the paper concludes.

That is very much the way we saw it, with the added proviso – we think - that this paves the way for the commission to propose "harmonising" legislation affecting the provision of healthcare throughout the EU.

Thus, while The Times considers that yesterday's ruling "is further proof that when given the choice, the European Court will always place its limitless desire for harmonisation and integration before all else, including the interests of the sick," it is also a step change in the process of integration.

Despite the significance of the judgement, though, the politicos have been remarkably silent about its implications.

If The Times is getting the point, the Conservative website simply has Andrew Lansley using the ruling to make a facile party political point about the government's "target culture". Possibly, Lansley does not understand what has happened, but then he could hardly complain about more integration. After all, the Conservatives don't do "Europe" any more.

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Keeping us fully up-to-date with events, the MoD website is offering a piece on a "healing garden" winning a medal a Chelsea Flower Show.

If that is not to your taste, you can read how 2 Rifles' Sangin base gets a new healthcare centre. Then, hot news on the MoD Afghanistan blog is a heart warming story about how ISAF has provided "humanitarian aid to flood victims".

Meanwhile, from US sources, we find that that "intense fighting between troops and militants has unfolded over the past few days" – in an area which was formerly a British area of operation. But we're not retreating and ISAF does not mean "I Slunk Away Frightened".

Read more on Defence of the Realm.

Britain should continue to give development assistance to China despite the phenomenal growth in prosperity which has seen the Far Eastern giant overtake the UK and Germany to become the world's third largest economy.

So says the Commons International Development Committee, which states that, despite increasing wealth in some parts of China, around 16 percent of the country's 1.3 billion people - equivalent to one-third of the population of sub-Saharan Africa - still live in poverty.

We should thus continue to offer, through the Department for International Development, between £5 million and £10 million a year until 2015 in a "development partnership" to support projects to provide healthcare, education, sanitation and clean water.

To give them their due, the Toriesoppose the idea. One never ceases to marvel though at the stupidity of some of our MPs. Do they not have the first idea what is happening in the real world?

And have they no memory? We have seen recently a "mere" £50 million in extra aid given to Afghanistan, for much needed projects which are directly in our strategic interests yet, over the same period, our MPs want to give £60 million to China?

These people are barking mad.

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Laws on disclosure of trial data by drug companies are to be toughened up, the BBC helpfully tells us, after GlaxoSmithKline (GSK) were accused of being too slow to raise the alarm over Seroxat and the risk of suicidal behaviour.

This stems from May 2003 when the Medicines and Healthcare Products Regulatory Agency (MHRA) received data from GSK confirming that patients under 18 had a higher risk of suicidal behaviour if they were treated with Seroxat compared with placebo. The data also showed that Seroxat was ineffective in treating depressive illness in under 18s.

The MHRA subsequently launched an investigation to look into claims that GSK had known about the risks for some time before it had disclosed it. Investigations by BBC's Panorama showed the company may have first known about problems with the drug in the late 1990s.

But, after reviewing more than one million pages of evidence the MHRA said no criminal proceedings could be brought against GSK because legislation on disclosure at the time was "not strong enough".

The Guardian offers a little more detail, including the text of a written ministerial statement published today from Dawn Primarolo, the health minister. This said:

The process of investigation has revealed weaknesses in EU legislation as it stood at the time, in terms of what safety information drugs companies were legally obliged to provide to the regulators.
Therein lies the clue. The marketing of the drug is not regulated by British law but by EU regulations, and reference to the official MHRA report reveals a stunning picture of legislative confusion and uncertainty, both within the framework of EU law and the parallel British legislation.

The EU law at the time was – as is typically the case – undergoing constant revision, increasing in scope and complexity all the time, to the extent that the regulators seemed to be unaware of what it actually meant. Then, when they attempted to prosecute GSK, their own lawyers found glaring loopholes which enable the company to escape any liability.

Crucially, because of the constant changes and amendments, during the period when the clinical trials of Seroxat were conducted (April 1994 – January 2002) there was no specific EU legislation governing the conduct of clinical trials, or of the reporting of adverse reactions occurring during such trials. The conduct of clinical trials undertaken in the UK was governed by British law.

Here was the yawning gap, which it had been assumed that the EU legislation filled. The British law did require a person conducting a trial to report adverse reactions occurring during a trial, but failure to do so was not a criminal offence. And the legislation only applied to trials conducted wholly or partly in the UK – not Europe and not other parts of the world where trials were carried out.

In every sense, therefore, this is a massive regulatory failure and, since the EU takes the lead on drugs safety law, its own legislators bear much of the blame for the inadequacy and confusion.

However, it is British ministers which are being "called to the bar", but it is to Brussels that they are having to turn to for amendments to the law, to close the loopholes discovered. Meanwhile, an evidently unsafe drug has been on the market for over a decade, permitted by EU law which should have safeguarded the users.

And, will anyone in the EU be brought to book? Don't ask.

COMMENT THREAD

In response to a report on the safety of MRI scanners, in today’s Daily Telegraph we get a letter from Andrew Jones, Chairman, MR Safety Working Party of the British Institute of Radiology.

Under the heading, "MRI scanners are safe", he writes:

Sir - The proposed research into the use of MRI scanners (report, May 22) is intended to collect hard evidence that they present no health risks. There is certainly no evidence that they have any harmful effects.

Indeed MRI is a very powerful diagnostic tool, which has been instrumental in pinpointing the need for treatment for very many patients.

It would be sad if unfounded concerns among patients or even healthcare staff undermined clinical services of patient care.
What he does not say (or is not allowed to) is that the research has been commissioned for the sole purpose of seeing off an insane and potentially lethal EU law, the Physical Agents (Electromagnetic Fields) Directive, which would – had it not been stopped at the eleventh hour - have made illegal some 30 percent of scans, needlessly endangering the health of thousands of British patients, many of them children.

Thus, we wrote on 22 May, does the elephant live, this time costing an unknown sum and hundreds of hours of fruitless work, simply because the EU commission failed to do its homework before introducing totally unnecessary legislation and now needs to save face.

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When you think about it, if our government in London had flagged up a major policy initiative, and then pulled it at the last minute – amid rumours of rows and recriminations – the story would be on the front pages of every national newspaper.

But, when it comes to our government in Brussels doing exactly the same thing – in this case on the open market in healthcare - it gets only a couple of articles, such as this one in The Times.

Nevertheless, The Times did manage to tell us that the plan was shelved over disagreements on when precisely the right of a patient to demand overseas treatment should kick in.

If they can simply demand overseas treatment straight away, in direct competition with the NHS, UK ministers are concerned that this will lead to an uncontrollable loss of NHS funds abroad, but supporters say it is just the kind of competition the NHS needs to bring about improvements.

There are other issues which the paper highlights, all of which suggest that there is a strong lobby in Brussels which is arguing that the proposals go too far.

However, the plot thickens. According to the European Federation of Public Service Unions, the proposals have not gone far enough. The Federation thus claims that the postponement represents a "major victory for advocates of universal health coverage".

When it comes to domestic politicians, Frank Dobson and a number of left-wing Labour MPs are also expressing alarm, with Dobson claiming that, "It will be catastrophic for the NHS if this directive goes through," adding, "The Commission either has no idea what damage this will cause to our NHS, or they simply don’t care."

The issue has even spilled over into an exchange between Labour and the Tories, reported byConservative Home yesterday.

But, as far as what seems to be complete disarray in the EU commission goes, this has totally failed to capture the imagination of the media. Perhaps it is because the two main players, health commissioner Markos Kyprianou and internal market commissioner Charlie McCreevey, are total unknowns to the British audience, or perhaps it is because the "row" is being played out behind closed doors in a foreign land.

Certainly, it is very much the case that politics never really come alive in this country until they are seen in terms of opposing personalities, and perhaps it is the lack of household names in the EU matrix that dooms political discourse on EU issues to obscurity. There is simply no interest in shadowy figures operating in the margins.

If that is so, then this is another good reason why we cannot allow our politics to be run from Brussels. Without the high drama, there is no real discussion or scrutiny of the issues. That means that ordinary people will never be fully engaged in the political process and there will never be that sense of "ownership" of whatever emerges.

That is the puzzle for the "colleagues" in Brussels. If they cannot "light the fires" of political discourse at a European level – and so far their efforts have met with singular failure – then they are never going to be able to sell their "project" to the masses.

Perhaps my co-editor has a point.

COMMENT THREAD

You can tell it's September. The EU commissioners are back from the long hols and the EU news agenda is stirring back into life. And, like attention-seeking children, the commissioners feel they must have something on the slate to prove they still exist.

One seeking to grab the limelight is Markos Kyprianou, the EU health commissioner who has told theFinancial Times that "Europe's" public healthcare systems must brace for radical change as barriers to patients crossing borders to seek treatment drop. Kyprianou is saying that he intends to act to implement the right of patients to travel for treatment across the EU, in the wake of recent court judgements. 

This relates to a European Union Court of Justice (ECJ) ruling in May last which supported 74-year-old grandmother, Yvonne Watts, in her claim for free treatment in France after her own health care trust had placed her on a one-year waiting list for surgery.

But this is not the only case. Others include the B.S.M. Geraets-Smits v Stichting Ziekenfondsjudgement in July 2001, which accepted that a system of prior authorisation, before patients could seek treatment abroad, was justified, if there were overriding reasons connected with "the financial balance of social security systems" and "the maintenance of hospital services available to all", provided such restrictions were not applied arbitrarily.

As we pointed out at the time, the EU is stretching the boundaries of the Treaties, all in a back-door attempt to create a European health service. The overall objective, though, is the same old thing – pursuing European integration by creating systems and service structures on an EU-wide level.

As we also noted, this initiative presents a serious challenge to eurosceptics. Most would welcome a weakening of state control over health services and wider patient choice, but it is uncomfortable to find that the impetus for "liberalisation" comes from the European Union.

But, as we all know, the EU has no real interest in the functioning of health care services – all it is interested in is having them at a European level. And, given its disastrous management of the Common Agricultural Policy, the Common Fisheries Policy and, latterly, its flawed rules on waste recycling, the only thing you can guarantee is that, however bad the current National Health Service is, under EU direction it would be even worse.

The temptation, therefore, is simply to say "no way Hosé" – or José, since the commission president bears that moniker – and to ignore the issue in the hope that it will go away, just as the Conservative Party and the media do.

But that is not a safe option. The commission niggles away at its pet projects, coming back again and again, never - as we saw with the constitution - able to take "no" for an answer. Even if they are defeated again and again, they still come back, wearing you down with their persistence until, eventually, they get their way.

But there are more important things than the EU's integrationalist ambitions – from the disaster in Darfur to the collapse of democratic government in our own country. Having to deal with the EU is a distraction, an irritation and a colossal drain on energy and resources that could and should be better expended elsewhere.

However, if you don't pay attention to the children, they will eventually wreck the joint – so we have to wade in and deal with them, even if it is just to slap them down. All the same though, we can do without this and not for the first time we find ourselves saying, "Why don't they just go away?"

COMMENT THREAD

Last week's announcement by the government that it is to introduce "tougher rules for unskilled migrants" is simply a bid to show that it is tough on immigration, without having any material effect on the flow of migrants into this country.

The clue is, of course, that it is progressively changing the rules in the one area in which it still has any power – third county (i.e., non-EU) immigration – a strategy akin to closing the portholes on the Titanic in a bid to stop it sinking.

But, in exercising that power, a nasty little situation is developing which will have a significant impact on thousands of Filipinos, already in the country. These are the so-called "senior carers" who are giving good service in hundreds of care homes, doing jobs that few Brits want to do, for wages often close to the minimum.

Without consultation, it seems, the Borders and Immigration Agency introduced on 13 August of this year a new requirement for "senior carer" visas, applying to all those who had not yet qualified for permanent residence under the five-year rule.

Unilaterally, it has imposed a minimum hourly wage of £7.02 per hour (as against the £5.52 minimum wage) for these workers and, unless they are able to find employers who are willing to pay them this rate, their visas will not be renewed and they will be deported.

Such is the concern that, according to the Manila Standard, this brought a direct intervention from Philippine president Gloria Macapagal Arroyo last week, in a bid to prevent an estimated 2,000 of her fellow citizens being summarily ejected from the UK. 

The cause has attracted senior backbencher Gwyneth Dunwoody (she of Galileo fame), who has tabled an early day motion, calling for a temporary amnesty for non-qualifying foreign care workers

The ridiculous thing about this new edict is that there are approximately 200,000 Filipinos in this country – the population having grown from roughly 18,000 in 1986 - with 5,000 employed as chefs, 18,000 as health workers and 25,000 senior care workers. 

Targeting the latter group is likely to cause a crisis in the healthcare industry, with private groups like Southern Cross, Barchester and Four Seasons being reported as refusing to implement the pay hike. Not only would it have to be paid to the Filipinos, it would also have to be awarded to the rest of the care staff in the sector, wiping £10 million off the bottom line - all in the context where the bulk of fees are paid by Local Authorities, which are not prepared to pay any increases.

What is especially bizarre is that the National Care Association recommends a salary for a senior carer of £6.00 per hour and there is nothing to stop employers paying the minimum wage of £5.52 to indigenous staff or immigrants from EU countries.

Basically, therefore, this is a discriminatory measure, applied retrospectively to non-EU workers who have been encouraged to come to this country and already have stable employment, all to make room for other immigrants who are queuing up to take their jobs. But, instead of doing it honestly, the government is using a mean-spirited, back-door device of pricing these workers out of the market, something it would not be permitted to do with EU "citizens".

That is the level to which our government has sunk - we can't deport criminals who happen to be EU citizens, so we are reduced to kicking out innocent people who make a genuine contribution to our society.

More from Tapestry, who thinks Cameron should take a hand. He is not wrong.

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Our latest post, in which we demonstrate our conservative values, by discussing the latest in feminine healthcare products.

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So, they ask, where is she? Well, no, I don't suppose they do ask but, anyway, I am around, just busy with other matters, such as attending a conference on "soft Jihad" and how to fight it. There will be a long report or two on that and news of a new publication by Daniel Hannan and Douglas Carswell, launched tomorrow, entitled "The Plan". Here are some of their proposals:


Scrapping all MPs' expenses except those relating to running an office and travel from the constituency

Selecting candidates through open primaries

Local and national referendums

"People's Bills", to be placed before Parliament if they attract a certain number of signatures

Placing the police under locally elected Sheriffs, who would also set local sentencing guidelines

Appointing heads of quangos, senior judges and ambassadors through open parliamentary hearings rather than prime ministerial patronage

Devolving to English counties and cities all the powers which were devolved to Edinburgh under the 1998 Scotland Act

Placing Social security, too, under local authorities

Making councils self-financing by scrapping VAT and replacing it with a Local Sales Tax

Allowing people to pay their contributions into personal healthcare accounts, with a mandatory insurance component

Letting parents opt out of their Local Education Authority, carrying to any school the financial entitlement that would have been spent on their child

Replacing EU membership with a Swiss-style bilateral free trade accord

Requiring all foreign treaties to be re-ratified annually by Parliament

Scrapping the Human Rights Act and guaranteeing parliamentary legislation against judicial activism

A "Great Repeal Bill" to annul unnecessary and burdensome laws
Can't say I agree with all of it but the ideas are worth discussing and, after all, is that not what we are all complaining about: lack of policy. There is one great advantage to this plan - it cannot be achieved without an exit from the European Union. So if the Conservative Party adopts it ... well, I might vote for them in 2010.

In the meantime I intend to attend the launch tomorrow and shall blog about that. Tim Montgomerie will probably beat me to the finishing line. He always does.

Let me link to another story, one we have been following on this blog. It is most definitely from the big bad world - nothing to do with the EU or our own little party squabbles but much to do with the media, truth and freedom (in whatever order you would like to place those).

Richard Landes reports that France 2 has agreed to an independent enquiry on the Al-Dura affair. He links to a number of articles and comments. Why, one wonders, is France 2 doing this? It can't be bad conscience, as journalists rarely know the meaning of that. Financial problems? Well, we shall see how it develops and whether those missing film minutes will ever be recovered.

After the sudden withdrawal of the healthcare directive – a reversal for the EU commission if ever there was one – the commission is on the back foot again, this time with the soil protection directive.

Although approved by the EU parliamentin November, albeit with an unusually large number of dissenters, the member states have refused to pass it into law.

The proposal was blocked by a phalanx of Britain, France, Germany, Austria and The Netherlands, leaving EU environment commissioner Stavros Dimas in a fit of impotent rage.

"I am very disappointed," he stormed, adding, "despite the strong support of most of the member states and the positive vote and large support from the European Parliament, the Council (of ministers) has not been able to reach a political agreement."

Funnily enough, that "strong support" was 395 votes for the new law and 225 voting in favour of a motion to scrap the whole directive, amounting to the nearest thing to a rebellion the EU parliament can muster. Our friend Dimas is being a tad economical with the truth.

Nevertheless, the offended commissioner still railed at his tormentors, declaring that, "Regrettably, we have missed an opportunity to protect a non-renewable resource, fight climate change and boost European competitiveness," vowing to continue working on the legislation in the coming months under the Slovenian EU presidency. 

More properly called the Soil Framework Directive, this was intended to set common principles and objectives at EU level, and would require member states to adopt a systematic approach "to identifying and combating soil degradation".

The members' refusal to adopt the directive was largely due to concerns about subsidiarity, with some member states maintaining that soil was not a matter to be negotiated at the EU level. Others felt that the cost of the directive would be too high, and that the burden of implementation would be too heavy.

Considering that this was another of those flagship directives, this is quite a setback for our government, which has also had trouble in its own ranks agreeing new standards for motor vehicle CO2 emissions. We'll look at that later today.

But, with this soil directive being chucked out, something is going on in the Brussels corridors of power. Having just caved in on the Lisbon treaty, the member states are showing unusual robustness in standing up to commission. 

On top of the healthcare directive – which is rumoured to be opposed by the UK and other member states – there is an inkling of a new mood. It is too early to tell yet, but this might signal a move to claw back some power that the member state governments have so easily given away. Does the answer lie in the soil?

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