New EU Health Commissioner-Designate

The new European Commissioner for Health, Androula Vassiliou came before the European Parliament's Environment Committee today for her confirmation hearing. The Commissioner-Designate Vassiliou replaces the former Health Commissioner Markos Kyprianou, who resigned his Commission post last month to return to Cyprus as its new Foreign Minister in order to take forward peace talks on the reunification of Cyprus with Turkish and Greek Cypriot communities. The Parliament will vote next week on Vassiliou's appointment as EU Health Commissioner.

Following her grilling by MEPs, the new Commissioner-Designate Vassiliou will have responsibility for a wide range of animal and public health issues as well as food safety. She will also be responsible for controversial EU plans on cross-border health care, which have been repeatedly delayed since the autumn of last year, and in effect would create a single market in public healthcare. These are now expected in June.

The proposed plans follow several rulings by the European Court of Justice for those patients facing "undue delay" on waiting lists to be entitled to treatment in other EU member states with costs reimbursed by national health systems. The aim is to provide a clear legal framework regarding access to cross-border healthcare services under EU internal market rules, outlining how this will work in practice and to improve the quality, efficiency and effectiveness of EU health care systems. It would allow patients in Scotland to travel to hospitals across Europe for health treatment and to claim back costs on the NHS. Once published, the EU's plans are likely to focus attention on the performance of the NHS as compared to health systems across other parts of Europe.

Initial drafts sparked concern among MEPs about "two speed medical care" and "medical tourism" with most member states remaining unenthusiastic and divisions within the Commission itself. Issues were raised as to the need to respect the diversity of healthcare systems and subsidiarity given that the provision of healthcare is the preserve of national governments and in Scotland is devolved to the Scottish Parliament and Government. The draft of December 2007 proposed that the NHS must fund outpatient treatment in Europe so long as the patient has been referred by a medical professional and is suffering delays. This raised various issues of contention as to whether a patient needs to be on a long waiting list to qualify for treatment abroad or can demand it straightaway, and whether the patient needs prior authorisation from the NHS funding body to be able to travel. The UK government wants to retain control over funding and to ensure prior authorisation remains in the hands of member states.

The Commissioner-Designate said that with the new proposal "we are not talking about the freedom of movement of services but about the right of citizens to get healthcare all over Europe". It is supposed to be part of a "social package" to be launched in cooperation with Social Affairs Commissioner Vladimír Špidla to promote access, opportunities and solidarity for all EU citizens. The new proposal is also now to include a 'safety clause' to allow individual member states to take measures if the "export of patients" becomes excessive and damaging to national health systems. Specifically, a country could require patients to ask for prior authorisation before seeking care abroad. However, Vassiliou also pointed out that the ECJ decision states that for non-hospital care, no prior authorisation is needed. As far as hospital care is concerned, "only if there is evidence that the national systems are going to be over-burdened or will suffer financial loss" can the country of origin ask for prior authorisation.

The issue of patient mobility is of direct concern to Scotland given the potential impact any EU framework in this area could have for the NHS. Scotland would be subject to and face any costs resulting from such rulings. It is essential that the full implications of this proposal (when it is finally published in June) for Scotland be properly considered and is certainly one to keep an eye on.