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Brian Edwards, CBE
University of Sheffield, UK
Denmark has now taken over the Presidency of the Council of the EU with an agenda dominated by economic problems. Because of its huge reliance on public investment, health is on the front line of the costs control battle. Most politicians are hoping that the reduction in national deficits can be covered by growth but this is increasingly unlikely in many countries. Modernisation is the new buzz word: reduce cost without reducing service.
Despite the dominance of economic issues, Denmark does have a wider agenda, with a number of health issues on it. Top of the health agenda is antimicrobial resistance but the work programme also includes some important areas in child health. The EU wants Member States to pay more attention to the prevention, early diagnosis and treatment of chronic respiratory disease and communication disorder in children. In both areas, they want to see strengthened cooperation between national and European research centres and more screening. This continued commitment to screening may have to be justified as the programmes for screening in breast and prostate cancer come under increasing challenge. They may not be worth the investment and, in the view of some commentators, may even make matters worse for patients.
The rules relating to tobacco are to be reviewed, including the threshold values for tar, nicotine and carbon monoxide.
However, in the short-term, proposals to modernise the professional qualifications directive (2005/36/EC) are of a more direct interest to pharmacists. The Commission plan for a European Professional Card, which would, they hope, speed up the recognition of professional qualifications when an individual wants to work across an EU border .The Commission also want to update minimum training requirements for a number of professions, including pharmacy. Automatic recognition would be granted for professionals from countries which adopted common training frameworks and common training tests. One interesting proposal is to increase the entry level for nursing and midwifery from 10 to 12 years of general education.
Professionals who have been banned from practice by a regulatory body or by a court will find that their details have been passed around Europe. This sounds right, although the standards of conduct and professional behaviour are set at a higher level in some countries than in others.
Language problems remain the greatest public worry and some form of language test looks certain – and so it should!
The expressed aim of these policies is to improve the mobility of health professionals at a time of expected labour shortage. The trouble is, health workforce is being sharply squeezed across Europe and what movement exists is from the poorer countries to the richer ones. The number of unqualified and unregulated health care assistants is on the rise. They are cheap and can perform routine clinical tasks in a perfectly satisfactory manner. Does Europe really need more health professionals?
The Danish programme will also include work on a health security package that would enable the EU to deal more quickly and more effectively with cross-border threats, as well as a review of the Transparency Directive, which relates to the measures that States take to control prices and limit public reimbursement for medical products.
This is a workman-like programme but contains little that is exciting or new. It may be increasingly irrelevant to a rapidly changing and shrinking health sector. The days of constant growth have gone and medicine has to adjust accordingly.
We desperately need vision.