Royal College of Physicians Roundtable on Patients’ Rights Directive

After a welcome to the debate by the College, Dr. Bernard Merkel of the European Commission (DG SANCO) introduced the subject with a short presentation of the Directive. He outlined the aims of the initiative and the safeguards that are in place to ensure it does not do any damage.

Professor Tamara Hervey, School of Law, University of Sheffield gave an introduction to the legal discussions of the proposed Directive and whether it was: "Revolution or Evolution in Law". Professor Hervey went into the potential arguments against the directive from a legal perspective. She discussed the relationship between the proposed Directive and national (UK) law, the EC treaty and current EC legislation. Professor Hervey raised the controversial point that the proposed Directive could indeed be disproportionate.

John Bowis, MEP (EPP-ED) introduced himself as the rapporteur of the proposed Directive in the European Parliament and informed those assembled that he was hoping to have a draft on the table ’soon’. He outlined a series of issues that need to be clarified before this directive is finished:

 Prior authorisation
 Reimbursement
 Prescriptions
 Top up payments
 Packages of care
 Public/private care
 Rare diseases & European Reference Networks
 Definitions
 Long term care
 Mental health

Mr Bowis Suggested, before he finished, that a new healthcare professional would have to be created, ’a health broker’ who would offer advice on travelling for care.

A very fruitful and informative debate then ensued, chaired by Professor Martin Mckee of the European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine. The debate covered most of the points raised by Mr. Bowis and despite not being exhaustive, the solutions and ideas that where thrown up where very insightful.

One of the biggest issues, as was to be expected, was the issue of prior authorisation. A feeling amongst many of the participants was that a new approach should be taken towards this issue. Instead of seeing prior authorisation as a barrier to movement it should instead be seen as an opportunity. An opportunity to provide patients with certainty and guarantees of reimbursement or payment by the Member State.

Some interesting ideas around the other big sticking point, that of reimbursement where also proposed. A central exchange or clearing house, between European countries that would not even involve the patient (it was admitted that this would be difficult to set up) or making the seeking of prior authorisation optional but for those who do seek it, they receive a voucher of maximum reimbursement (this would still leave some uncertainty). Prior authorisation could be incentivised but optional. This will provide the patient with greater legal certainty when calculating the financing of their healthcare.

Another key point to come out of this UK focused debate was that of Commissioning healthcare. A distinction should be made between a patient receiving healthcare in another Member State of their own accord and a patient being sent by their healthcare system to another Member State for treatment. With this in mind the issue of who is the insurer in the UK system was also discussed: is it the National Health Service (NHS) or the local Primary Care Trust (PCT)?

EPHA was informed that working the 2006 Council Conclusions on Common Principles of European Union Health Systems into the Directive was a large part of the Council’s work. Questions remain about what happens once these principles are put into a legal text: does it enshrine these principles in law?

Several non legislative alternatives to patient safety and quality guidelines where proposed and it was suggested that these where the best way to progress.

Dr Bernard Merkel responded to those who have stated that the Commission has over stepped it competency in setting quality standards. He said that the Commission was not trying to legislate on quality but was, instead, trying to make sure that Member States are up front about their quality standards to enable patients better clarity when seeking care abroad.

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