E-health and the EU

Lyn Whitfield

The UK takes over the presidency of the European Union on 1 July with constitutional wrangles and budget disputes dominating the headlines.

Yet there is an ambitious social policy agenda for the presidency. In healthcare, the government may be able to set a new agenda for Europe on health inequalities, which is the subject of a ministerial conference this autumn.

It will also need to start building European support to progress some of the policies in November’s public health white paper, since better food labelling, restricting the advertising of ‘junk food’ to children and further restricting the promotion of formula milk are all covered by EU directives.

A second ministerial conference will be held on patient safety. This is interesting in terms of EU politics, since the treaties establishing the EU leave member states with the responsibility to fund and organise health systems, under the principle of subsidiarity.

However, Professor Mark McCarthy, chair of the Faculty of Public Health’s working group, says this and other health system issues were put on ministerial agendas by the European Court of Justice, which has backed the free movement of patients.

Standardisation

Facilitating the free movement of patients and improving safety are two of the key principles of the new ‘action plan for a European e-health area’ endorsed at a ministerial conference in Tromso in May.

It aims to facilitate free movement by ‘achieving the standardisation and interoperability of patient medical records’, to empower patients by improving information systems and to improve safety by deploying decision support and other technologies.

Overall, Ricky Richardson, chair of the UK e-Health Association, argues the plan amounts to an electronic strategy for helping European health systems cope with common problems, such as the need to change public behaviour and to find cost effective ways of coping with rising demand.

Member states must now produce a ‘road map’ to e-health, although the Department of Health’s website argues England is already doing this through Connecting for Health and they "are becoming a model of best practice."

Dr Richardson concurs. "What we call [Connecting for Health] is really an e-health transformation of the NHS," he says. "The presidency gives [Prime Minister Tony] Blair a unique opportunity to draw attention to it and really drive this agenda."

No uniform response

However, others are distinctly sceptical. Healthcare analyst Siddharth Saha from Frost & Sullivan, says that while European health systems face similar issues, and governments are hoping to get similar benefits from investing in IT, there is little sign of one, uniform response.

Germany, France and Spain are putting different emphases on rolling out the European health insurance card, basic infrastructure, electronic medical records and imaging, he says.

No other country is trying anything on the scale of Connecting for Health; and the strong regional tradition within many European countries works against them doing so.

And is Connecting for Health really a model? The action plan talks about ‘building on’ the European Health Insurance Cards (EHICs) to create common identifiers. Yet the cards have no place in the English programme (although UK citizens will see them replace E111 forms from the end of the year).

A consultant who spoke to E-Health Insider also argued that the programme had adopted a messaging standard that was unlikely to be adopted in Europe, so its influence, and ability to benefit from European R&D, were "likely to be limited."

Since the Tromso conference was less than two months ago, there won’t be a big e-health event this presidency. But there will be a big e-government event in Manchester in November.

Conference

The Ministerial eGovernment Conference 2005 is being organised by the Cabinet Office’s e-government unit, and will pick up on another recently published five year strategy, ‘i2010’ (European Information Society 2010).

This is the latest installment of the Lisbon agenda to make Europe "the most dynamic knowledge based economy in the world, capable of sustainable economic growth and with more and better jobs and greater social cohesion".

As such, it contains some familiar sounding aims about creating a single market for information services through shared standards, and investing more in R&D. But it also aims to narrow the "digital divide" between what it calls "information society haves and have-nots", by setting new targets for access to broadband and driving demand for electronic services.

In particular, its "action plan" for e-government focuses on driving the use of e-government services, while ‘reaping the benefits’ of investment in them, for example by rationalizing back office functions.

Several commentators have noted that this chimes very closely with the government’s digital agenda. However, that won’t guarantee it an impact on the ground.

Europe may like its grand plans, but the union tends to have its greatest impact when its core concerns of agriculture and creating a single market are at stake.

In this context, it’s worth noting that the big wrangle over the UK budget rebate could have health implications.

The Common Agricultural Policy is at the heart of the row for distorting spending and contributions, and Scandinavian research has shown that it supports southern European tobacco growers and pushes subsidised high-fat milk, meat and sugars into a continent where obesity is a major concern.

Professor McCarthy says: "We do not need to support produce, but we do need to support farmers and local communities. We have seen some movement in that direction, but the government might like to do more – so I am quite pleased this is on the agenda."