Against protests from David Davis, David Cameron rejected the Patients' Passport policy during the Tory leadership election... but is the idea about to return at the EU level?
Tory MEP John Bowis hopes so. Speaking on the Today programme at 7.10am, Mr Bowis welcomed a Commission initiative (BBC report here) that could see a right to 'health tourism' introduced across the EU. UK citizens could enjoy a right to receive treatment from a health provider in another EU state if it was at a similar cost and if the patient had experienced "undue delay". Mr Bowis implied that the right might be enforced by European courts if Brussels did not act.
John Humphrys on Today implied that "the Tories" were in favour of this policy. If so, that wasn't entirely clear from an exchange between Andrew Lansley and Health Secretary Alan Johnson in the Commons yesterday:
Andrew Lansley: "Will he say whether he will support or oppose the draft directive to be published by the Commission tomorrow, or is he frightened that, in addition to the £490 million extra that we already pay for British residents abroad or visiting other EU member states, many more will choose EU continental European health care in hospitals that perhaps have lower infection rates or lower waiting lists? Are the Government going to support choice for patients or oppose it?"
Alan Johnson: "The hon. Gentleman was doing well until the last bit. A couple of weeks ago, one of the Sunday newspapers took three pages to say that 70,000 people in this country had sought treatment abroad, when we treat 1 million people every 36 hours in the NHS. When one delved into the article, one found that those 70,000 wanted cosmetic surgery or cosmetic dental surgery that could not be provided in this country. It was portrayed as though people were, in the words of the hon. Gentleman, going abroad to escape long waiting times and get cleaner hospitals. However, the start of the hon. Gentleman’s point was absolutely right. We have to consider the directive carefully. I have not seen its terms yet—it is not published until tomorrow—but I have made it clear to Commissioner Kyprianou, as has the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), that we must maintain the crucial principle that clinicians will decide what treatment to give in this country. We need to ensure that the principles that have guided the system for many years are not sacrificed to something that might seem like a good idea for a European directive, but which reduces patient choice in the long run."
Labour are said to be resistant to a proposal that is still in very draft form and, if it happens at all, may be years away. A NHS industry representative on Today said that there were many objections on equality grounds to the proposal. To very easy questioning from Mr Humphrys he said that it would be a proposal that favoured the relatively young, mobile and rich.
9.30am: Fraser Nelson has posted on this topic: "The Labour left is angry about the rich escaping the NHS system by private insurance so you’d think they’d welcome the chance for the poor to do so as well. But no, they say this European plan threatens the foundations of their beloved NHS. I’d like to hear someone explain that to a patient. “Sorry Mrs Dickson, you’ll have to wait in agony for another year but your sacrifice helps protect the ideological integrity of the NHS”. It is a cause they are prepared for others to die for."
1.20pm: Fraser reports that Lansley is backing Brussels on this, apparently saying "What is the government so frightened about? Are they afraid of choice?"
The Conservatives should be wary of supporting this Trojan EU Horse which will extend its remit into our Health Service, they should also be concerned by the way things happen in the UK, for like much of our industry, with this proposal we will see our Health service hollowed out and exported abroad, with British tax payers money being used to invest in services and infrastructure abroad.
Posted by: Iain | December 19, 2007 at 09:09
It is said that we have negotiated an opt-out, so that patients would only be able to recover the cost of treatment abroad with the prior permission of the NHS. But I can't see this working. Can you imagine how the public would react if a woman with breast cancer was required to wait some weeks for treatment in the UK because the NHS had refused to pay for immediate treatment in Belgium?
Posted by: Trumpeter Lanfried | December 19, 2007 at 09:20
No doubt patients will require a compulsory Identity Card.
Posted by: michael mcgough | December 19, 2007 at 09:29
If nationals from other EU states can obtain free medical treatment here, enjoying the privileges as if they are locals, where is the spirit of EU reciprocity and harmonisation the if UK citizens cannot whilst in another EU country enjoy access to healthcare facilities of that country on the same terms as the locals there?
Posted by: Teck | December 19, 2007 at 10:32
Iain is absolutely right to warn of the "Trojan EU Horse" aspect of this directive, although he has not quite got the measure of the beast when he writes that it "will extend its remit into our Health Service".
The damage, in fact, has already been done with the ECJ ruling on the Yvonne Watts case and the earlier B.S.M. Geraets-Smits v Stichting Ziekenfonds judgement, the effect of which collectively was to define healthcare as a "service" within the meaning of the treaties, and thus bring healthcare provision within the competence of the EU.
Thus, this directive is indeed 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.
While, in the short term, the directive might afford relief to a small section of the community, the longer term implications are thus dire.
The government loses its monopoly control over the health service and shares power with the central government in Brussels, to which it becomes subordinate in this (in addition to many other) policy area.
Given the dire structure and management of the NHS, this might seem superficially attractive (apart from the fact that we are vesting powers in the same organisation which is famed for its superbly efficient management of our fisheries and agricultural policies), except that the same argument could be used 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 point, of course, 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 over of management responsibility to a completely different, unelected government in Brussels.
Unfortunately, within the current treaty structure, we have no option but to go along with this directive. But that means a new Conservative government will face the prospect of its freedom to develop new initiatives in the provision of healthcare being circumscribed, as it is forced into a mold increasingly dictated by Brussels.
For this and many other reasons, it becomes more and more imperative that the Party works towards forging a new relationship with the EU. 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.
Posted by: Richard North | December 19, 2007 at 10:48
We must stop health tourism. Only those who pay into the system should be able to get care from it. Of course emergency treatment should be available wherever someone needs it.
I am in favour of British citizens being allowed to obtain treatment in any hospital, up to the cost of that same treatment in an NHS hospital, and if it is more expensive the patient provides the difference from their own resources. That is my understanding of the patient passport and I support it.
We now have the complete opposite, where if a patient funds a drug not available on the NHS then the whole of their treatment has to paid for. That is disgraceful.
Posted by: Derek | December 19, 2007 at 10:55
Derek, "Proposals for consumer-responsive healthcare" outlined in Platform address your concerns through universal and direct ownership of medical services by the British public.
Posted by: Teck | December 19, 2007 at 11:36
Well, as we are all part of the EU, they can come here for the benefits culture and we'll go over there for some decent medical treatment.
Posted by: George Hinton | December 19, 2007 at 12:07
It's an indictment of the seething irrationality of europhobes that even when the EU comes with something which slots in perfectly to your right-wing free-market ideology, it's got to be a "Trojan Horse"
Posted by: passing leftie | December 19, 2007 at 13:08
This will improve the quality of our public healthcare and should be welcomed. As a party we’ll look daft and dogmatic if we’re prepared to put Euroscepticism ahead of such obvious health benefits.
Posted by: Mark Fulford | December 19, 2007 at 13:45
It's not really that passing leftie, the point is that Britain is having this imposed upon it by bureaucrats and judges over whom we have no control. The fact that the unions are the left are terrified that the EU tyranny may enable Brits to escape the appalling NHS and thereby finally bring the whole edifice down is both hugely enjoyable and irrelevant to the main debate.
We eurosceptics loath the EU because it is undemocratic and unaccountable. That it's latest imposition discomforts its fiercest proponents is exquisite but as our opposition to it and its works is based on priniciple (remember those?) we still decry it. That;s the difference between us.
Posted by: tired and emotional | December 19, 2007 at 13:46
"This will improve the quality of our public healthcare and should be welcomed. As a party we’ll look daft and dogmatic if we’re prepared to put Euroscepticism ahead of such obvious health benefits.
Posted by: Mark Fulford | December 19, 2007 at 13:45"
The "benefits" are marginal and transitory. Furthermore, they are slight compared with the downside - allowing the same organisation which brought us the CAP and the CFP to have a stake in the management of our health care systems.
As I wrote above, the answer to the NHS problems is to change our government in the UK to one which is more capable of dealing with them. To give power to another government entirely hardly seems a rational option.
Posted by: Richard North | December 19, 2007 at 14:02
our opposition to it and its works is based on priniciple (remember those?)
You make my argument perfectly. Your opposition is not to *this* policy, but dogmatically to the EU as a whole.
Posted by: Mark Fulford | December 19, 2007 at 15:19
Yes Mark, that is euroscepticism. When you start debating the merits of individual policies handed down from our Brussels government instead of debating whether or not we should continue to be governed by Brussels at all then you have already abandoned the concept of democratic accountability and accepted what eurosceptics largely reject - the EU project.
The point is not the quality or lack thereof of any given EU Directive or measure but that we have given the power to govern us to people we cannot elect or remove.
Anything else is a sideshow for the rubes.
Posted by: tired and emotional | December 19, 2007 at 16:46
Mark Fulford, no its about democracy. If patient passports are the way to go then it should be debated and implemented through legislation here, not via the back door by the EU. I am afraid this is a strategy of the EU, where they hope we take the little goodies they dangle in front of us with the result it opens the door to them meddling yet further in our affairs and we lose the right to legislate over the issue for ever. In this Parliament can ill afford to allow its sovereignty to be hollowed out anymore, for it is already fighting for its life to remain relevant to people, and getting people to participate in elections, losing yet more of its reason to exist is not very wise, and in the end dangerous to all of us.
PS Its should be noted that this ‘policy’ stemmed from an ECJ ruling , a warning to all of us in how secure Gordon Brown’s red lines are in the Constitution he has just signed.
Posted by: Iain | December 19, 2007 at 17:15
I am wary of this idea. Does Britain look to benefit or lose out on the idea? I would assume that we would lose out with having to deal with health tourists from poorer parts of the EU, which would lead to longer waiting lists.
Posted by: James Maskell | December 19, 2007 at 18:26
I don't feel that Europe is any less democratic than the UK and I certainly don't want to squander the benefits of EU membership in an attempt to prove that the worst bits are rotten.
Posted by: Mark Fulford | December 19, 2007 at 20:46
I find it incredible that anyone is still talking about the 'benefits of membership'. What are these mythical benefits?
Europe has no demos. Power is now vastly more remote from the individual and vastly more centralised than in any non-imperial system. Our local and central governments are merely the delivery mechanism for an EU government on which we do not vote and cannot influence. How can you possibly feel that the EU, controlled by the unelected European Commission and the ECJ, is as democratic as the UK was when it was run by politicians we could sack when their legislation produced effects we did not like?
Posted by: tired and emotional | December 20, 2007 at 09:40
"How can you possibly feel that the EU, controlled by the unelected European Commission and the ECJ, is as democratic as the UK was when it was run by politicians we could sack when their legislation produced effects we did not like?"
If it was run by the democratically elected MEPs and not the council of ministers, you'd be bleating even more loudly. You can't have it both ways.
Posted by: passing leftie | December 20, 2007 at 10:27
I seriously doubt if any of this will happen anyway.
Posted by: Malcolm Dunn | December 20, 2007 at 10:36
Leftie, you are avoiding the question I asked.
The EU is not run by the MEPs or by the Council of Ministers. If it were then I would have concerns about either situation. But they would be different to the concerns I have now about an EU run by unelected bureaucrats.
Posted by: tired and emotional | December 20, 2007 at 11:42
You obviously don't understand the structure of the EU. The Council of Ministers is the policy making body. "Unlected bureaucrats" is a value-laden term for "civil servants". You wouldn't want elected civil servants, I take it? The Commission implements policy. The MEPs don't have much power at all.
Posted by: passing leftie | December 20, 2007 at 12:12
Are you saying that all the legislation that emanates from Brussels is hammered out in long discussions by the Council of Ministers and the Commission merely puts into action what it is told to by the Ministers?
Ha. Hahahaha. Ha.
Posted by: tired and emotional | December 20, 2007 at 12:16
I find it incredible that anyone is still talking about the 'benefits of membership'. What are these mythical benefits?
Peace, freedom, democracy, choice, etc., etc.
Do you agree that greater choice (in healthcare, for example) is a good thing?
Posted by: Mark Fulford | December 20, 2007 at 12:47
Peace? The EU failed to prevent or halt war in Bosnia and Kosovo right on its doorstep, it is too weak to act. I do not believe that Germany would have invaded another European country if we had not all signed the Treaty of Rome. Come off it.
Freedom? Are you seriously saying that we were unfree before we joined the EU and that now we are liberated? Freedom is individual liberty from State interference, the EU has jurisdiction over almost every aspect of our lives. In what sense has that liberated us?
Democracy? The idea predates the Treaty of Rome, I gather. Our democracy in the UK has been rendered impotent by our membership of the EU, the longer we belong as full members the less our votes will affect the laws under which we live. This is simply irrefutable Mark.
Choice? The choice that matters above all others is the choice to kick out the politicians we, the people, have granted temporary power to govern us. All other political choices flow from that meta-choice. Without there can be no choice, democracy, freedom and, ultimately, peace.
The rest of your question is meaningless.
Posted by: tired and emotional | December 20, 2007 at 13:37
"Are you saying that all the legislation that emanates from Brussels is hammered out in long discussions by the Council of Ministers and the Commission merely puts into action what it is told to by the Ministers?
Ha. Hahahaha. Ha."
That's the idea. It doesn't always work perfectly. Sometimes nations interfere with and do not implement policy their ministers instructed the Commission to enact. Sometimes the Commission oversteps its remit. It's imperfect, but generally it works pretty well.
However, we need some kind of treaty to shrink the Commission, make it more accountable to national parliaments, and make the population of a country have greater weight in the Council. Wait a minute...
In light of this I look forward to reading of your support for the treaty.
Posted by: passing leftie | December 20, 2007 at 13:38
Don't hold your breath Leftie. According to a Better Regulation Task force report something like 80% of the proposals adopted by the Commission are effectively agreed in committee by civil servants and never get debated by ministers. The Commission initiates a vast range of proposals itself, these are discussed by civil servants and effectively agreed before rubberstamping by the toy parliament or the Council of Ministers. Our representatives are not driving EU legislation, they are brought in at the final stages of consultation to confer an illusion of democratic legitimacy to the process. You will argue that I am overly cynical, I would say that you are either naive or you are more relaxed about having civil servants determine what you can and cannot do.
The constitution is not about making the Commision more accountable, it is formalising the new nation Europa created to replace all those tiresome nation states.
Posted by: tired and emotional | December 20, 2007 at 13:52
Peace? Yes, the EU's soft power has a genuine transformative effect compared to the US's hard power -- which only works while the target is in the sights. Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia -- all genuine allies now. Without the EU that would not be the case.
Freedom? I have the freedom to move to any other EU nation, without questions. I consider that a good safeguard of my liberty.
Democracy? You could ask the residents of East Germany how it felt to tear down the wall. Alternatively you could look at the EU's decision-making safeguards. 74% majority required to approve a decision, for example. In the UK we only require 50.1%.
Choice? Since you don't care about the choice to live where you want, learn where you want, get educated where you want, let's look at the one thing you do care about: the choice to kick out the politicians. Our MEPs are elected, have the final say on all legislation that is decided by majority voting and have the ability to sack the European Commission. How is that worse than the UK, where we don't even have the ability to kick out a Lord?
Since I've taken the time to answer all your points, I hope you'll do me the courtesy of answering my earlier question (which certainly is not meaningless):
Do you agree that greater choice (in healthcare, for example) is a good thing?
Posted by: Mark Fulford | December 20, 2007 at 20:29
Mark, I agree that greater choice in healthcare is a good thing but it is wishful thinking to attribute the fall of the Berlin Wall to the soft power of the EU. The end of the Soviet Bloc in general was brought about by the US (in particular Reagan) ratcheting up the pressure on the former Soviet Union to the point where it realised it could not win the Cold War. The EU had little to do with this, and was in large part hostile to the US under Reagan.
Posted by: Michael McGowan | December 21, 2007 at 16:28