Preliminary hearing of proposed EU Commissioners

The different proposed Commissioners need to be approved by the Parliament and for that the Parliament Question them a special Hearing. According to the draft timetable for the hearings in the European Parliament will take place from the 11th of January to the 19th of January. More exactly Máire Geoghegan-Quinn (Research) is scheduled to be questioned the 13th at 16.30 to 19-30 and Dalli (Health and Consumer) the 14th of January between 13 and 16. Look forward to hear what Dalli will do about the Patient Information and Patient Rights at Cross Border Care Directives.

If you are interested in times for hearings of other commissioners please contact me directly.

Heads of Commission cabinets selected

The various Commissioners to be have selected their Heads of Cabinet. Interesting is that John Bell from Sanco goes to Research. Maybe we get more healthcare focus in research in the future? Darmanin was previously deputy head of cabinet to Commissionair Borg.

See the full list below:

Health Commissioner John Dalli (Malta)
Head of Cabinet: Joanna Darmanin, Malta

Research Commissioner Máire Geoghegan-Quinn (Ireland)
Head of Cabinet: John Bell, Ireland

Commission President - José Manuel Durao Barroso (Portugal)
Head of Cabinet: Johannes Laitenberger, Germany

High Representative for Foreign Policy and Security - Catherine Ashton (UK)
Head of Cabinet: James Morrison, UK

Trade Commissioner Karel De Gucht (Belgium)
Head of Cabinet: Marc Vanheukelen, Belgium

International Cooperation and Development Commissioner Rumiana Jeleva (Bulgaria)
Head of Cabinet: Jochen Richter, Germany

Climate Commissioner Connie Hedegaard (Denmark)
Head of Cabinet: Peter Vis, UK

Energy Commissioner Günther Oettinger (Germany)
Head of Cabinet: Michael Köhler, Germany

Transport Commissioner Siim Kallas (Estonia)
Head of Cabinet: Henrik Hololei, Estonia

Economic Affairs Commissioner Olli Rehn (Finland)
Head of Cabinet: Timo Pesonen, Finland

Internal Market Commissioner Michel Barnier (France)
Head of Cabinet: Olivier Guersent, France

Fishery Commissioner Maria Damanaki
Head of Cabinet: Markopouliotis Georgios, Greece

Enterprises Commissioner Antonio Tajani (Italy)
Head of Cabinet: Antonio Preto, Italy

Development Commissioner Andris Piebalgs (Latvia)
HoC: Christopher Jones, UK (former director DG TREN)

Fiscal affairs Commissioner Algirdas Semeta (Lithuania)
Head of Cabinet: Stephen Quest, UK

Justice Commissioner Viviane Reding (Luxembourg)
Head of Cabinet: Martin Selmaye, Germany

Digital Agenda Commissioner Neelie Kroes (Netherlands)
Head of Cabinet: Anthony Whelan, Ireland

Regional Policy Commissioner John Hahn (Austria)
Head of Cabinet: Hubert Gambs, Austria

Head of Cabinet: Marc Lemaitre, Luxembourg

Agriculture Commissiener Dacian Ciolos (Romania)
Head of Cabinet: to be appointed

Internal Affairs Commissioner Cecilia Malmström (Sweden)
Head of Cabinet: Mia Asenius, Sweden

Interinstitutional relations Commissioner Maros SEFCOVIC (Slovak Republic)
HoC: Peter Javorcík, Slovak republic

Environment Commissioner Janez Potocnik (Slovenia)
Head of Cabinet : Kurt Vandenberghe, Belgium

Competition Commissioner Joaquin Almunia (Spain)
Head of Cabinet: Carlos Martinez Mongay, Spain

Enlargement Commissioner Füle Stefan (Czech Republic)
Head of Cabinet: Simon Mordue, UK

Employment Commissioner László Andor (Hungary)
Head of Cabinet: Anabela Gago, Portugal

Education Commissioner Vassiliou (Cyprus)
Head of Cabinet: Philippe Brunet, France

According the UK Shadow Minister of Health - what will happen if they win next election?

The UK healthcare system ranking as no 14 in the 2009 European Health Consumer Index as well as the recent reports about the very large difference in cancer survival rates across the country makes it quite obvious for everyone that something have to be done to reform the UK healthcare system. Given that it seems very likely that there will be a change in government after the next election I’m happy to have had the opportunity to discuss with Mr Mike Penning the Shadow Health Minister for the Tories about their plans for reforming the British healthcare system.

Initially he plays it safe by explaining that the starting point for the Tories is that Blair won the argument that NHS needs more money and that they will match the increase in funding already decided by the Labour government. But he continues that this massive increase in funding have up-to now not been matched in outcomes.

Stroke, cardiac, major trauma – all area areas where he sees that they are lagging behind in development. I might here be able to ad Allergy – having listening to Professor Prof.Dr. J.G.R.de Monchy at the Universty Medical Center Groningen and learned that in the UK 68% of patients assumed to have Allergies are not tested at all for Allegies a figure that in Germany is 15%, in Spain 27% and Italy 28%. The country that comes closest is Denmark with 40%...

Now Mr Penning explains that the problems are based in the fact that departments are very silo based – and that there is a need to look at the public health agenda. I.e. he thinks that it’s not possible to only address health at the emergency entrance. Since leadership is important the Tories will change the department of Health to the department of Public Health as a clear signal that this needs to be addressed.

I must admit that when I heard this I thought for myself that I would have looked more at the financial silos and I was quite happy when at the end of our discussion when we were talking Qualies it became clear that they did have a double approach to the silo issue. More about this further down because before we have time to go there he states that it has been a massive increased spent in bureaucracy– because of the increased of targets driven healthcare. The hospitals have had to work to meet these targets – instead of deliver on outcomes. So priorities have been driven by bureaucracy rather than clinical needs. He also promises that this means that the Tories will abolish the targets!

If the problem description probably is quite PC I’m sure that their solutions are more controversial and I had to ask if national guidelines still will be used. And yes the answer is that they will but he underlines there is no point in diagnosing bowl cancer if you then don’t treat the patients. I read this as there will be a slight different focus in the way guidelines are written compared to today but didn’t go into details.

Another area for change is their ambition to extend the choice – in elective care – and to ensure that information enabling choice is available. The rational for this is that the information now being published was available but not transparent – so what needs to be done is to ensure that this information is freed up! This would empower the patients. I ask about the information that Dr Fosters gathers and he explains that this info isn’t available for the general public or even a Shadow Minister of Health like himself, only for the Department of Health etc . Mr Penning wants instead create one single portal into the web where you should be able to check survival rate etc.

He exemplifies the problem with the recent Dr Foster report that looked at particular hospital and found quite remarkable bad management despite that an excellent report have been published one month earlier. This report came after CTC made a decision to send in team due to the suspicious mortality rates they seen in non public material. Question is how this could have been possible. The answer to this is that according to Mr Penning is that:

1. Tories do not want any pre-booked inspections and on this they will go against till management of care if needed!
2. They want the monitoring of the foundation hospitals to be not only on finance but also the clinical side in order to get a better balance in the inspections.

Asking about top-ups he explains that they will accept top-ups in certain situations meaning that if there are drugs that are available in others countries that you receive a prescription on you should have the right to continue with that particular drug.

So then we came back to the Silos. And admittedly one of the things I find most interesting is that he claims that they will change the definition of the Qualy used by NICE. The problem as he sees it is that the Qualies do not take into account enough factors for example if we have a drug that would extend life. He thinks that it should also look at what the alternative cost would be – for example if you would need 24 hours care at home or hospital instead of this drug. I.e. what should be important for a reimbursement decision is the total cost of the state when a patient has a specific disease. If this could in the same way most NICE work do set the standard of how health technology assessments should be done across Europe I would be very happy!

He mentions that he also thinks there is a need to look at the way we are negotiating with the drug companies – for example on how early the NHS would be involved in the clinical trials. A topic that I need to look more into at a later stage – its quite fantastic for me to realise that a big buyer of medicines like the NHS actually do not negotiate on price!

Quite a lot to do so I’m curious about the plan for execution. He explains that there is a 3. 6 and 9 months program as well as one for 2 and 3 years time. They are already discussing with the civil servants .But in many cases we cannot get the info before we are in place. Still civil servants seem to be aware that the current government is out of ideas and changes have to occur.

So he hopes that after 4 years – there will be more people with better outcomes, some living longer some just treated better. Key will be a massive increase in patient outcomes. Well I just hope that his realism about the quality outcomes by the NHS lasts long enough for all of this to take place.

A patient rights vote for a Swine Flu shot?

Last week a blocking minority (Spain, Poland, Portugal, Slovakia, Greece and Rumania) in the Council put an end to the hopes of getting a decision on the directive for patient rights at cross border care.

Despite that the Swedes basically had sold out everything that would for real have empowered patients and put forward a proposal that merely id codify the current case law and gave plentiful of guarantees that governments should still be in power of healthcare. But the hard core of the minority came well prepared after having had their own pre-meetings and where not satisfied and instead they wanted a proposal that restricted case-law – i.e. discriminating private providers - since that was assessed to go against the constitution the Swedes could not accept going further and revising their proposal even more..

One of the things impacting the outcome where that Greece who up to now have been positive have had a change in government and the recently elected health minister didn’t know what to do. According to my sources who attended the meeting the Spanish Health Minister Trinidad knowing this promised her Greek colleague that the issue will be managed during her presidency meaning that the Greeks could without hesitation not make up her mind yet and instead vote no in order to have more time for contemplation and potentially vote yes later. Right.

There is also a guessing game ongoing on what the Romanians got from Trinidad. What is clear is that the Poles didn’t get what they wanted. The Polish Health Minister Kopacz her own problems since she has missed order swine flu vaccines and then tried to claim that 1. There is no Swine Flu in Poland and secondly if they would get it that the ordinary flu vaccine would work. She did before the meeting try to get Sweden to give her vaccines out of the Swedish stock. This happened when Swedish Health Minister Hägglund visited Warszawa to talk about the Directive about Patient Rights at Cross border care. Hägglund answered that it’s not the government but the counties in Sweden that owns the vaccines but Kopacz didn’t rest and send a letter to Hägglund. Unfortunately the Swedes have classified the letter and correspondence around the topic but this decision have been questioned by Swedish Radio and with some good luck the Swedish constitutional transparency regulations will prove useful.

Good to know for the future, given the appointment of Dalli, is that Malta did in the end line up with the majority in favour of the directive. Maybe Dalli when in charge DG Sanco can ensure that they continue to push the issue. Or maybe Trinidad just didn’t want the Swedes to get this through and actually will deliver to the Greeks so that we will have a new proposal this spring. In the meantime patients will suffer.