WRITTEN QUESTION E-2534/99

by Neil MacCormick (Verts/ALE) to the Commission

(4 January 2000)

Subject: Free movement of doctors and patient safety

In its Explanatory Memorandum attached to the proposed SLIM Directive simplifying and updating the EU sectoral Directives on the mutual recognition of professional

qualifications (COM(97) 638 final)(1) the Commission signalled its intention to ask the Council to abrogate the existing advisory committees on the training of certain health professionals (doctors, nurses, dentists, midwives and pharmacists). Should the Council comply with this request, the Commission intends to reconstitute these advisory committees by Commission decision, giving them a simplified structure and a much narrower remit. Specifically, the advisory committees would no longer have a mandate to promote free movement of health professionals by proactively updating the minimum standards of competence in the professions concerned. Rather, the advisory committee would only advise on free movement problems referred to them by the Commission.

Is the Commission aware that, in anticipation of a Council Decision to abrogate the existing Advisory Committee on Medical Training (ACMT), the Commission's services have informed doctors' representatives that the Commission plans to initiate no new work in this committee?

Is the Commission aware that on 12 November 1999 the umbrella organisation representing Member State Medical Associations, the Standing Committee of European Doctors, unanimously condemned the Commission's cancellation of the 30 November 1999 plenary of the ACMT and its refusal to initiate work in the ACMT?

Is the Commission aware that Europe's doctors regard the Commission's plans for a new ACMT with no mandate to update EU minimum standards for general and specialist medical training as a threat to the welfare of patients around the EU?

In light of these criticisms from EU doctors, is the Commission satisfied that its current policy on the ACMT and its proposals concerning the future remit of the ACMT comply with the Commission's obligation under Article 152 of the EC Treaty to ensure a high level of human health protection in the definition and implementation of all Community policies and activities?

What steps, if any, has the Commission taken to reassure itself that its policy and proposals in relation to medical training will have no negative health effects?

(1) OJ C 28, 26.1.1998, p. 1.

Answer given by Mr Bolkestein on behalf of the Commission

(8 February 2000)

It should first be pointed out that the situation faced by the Advisory Committee on Medical Training (ACMT) is no different to that faced by similar committees. There are in fact six advisory committees on the training of certain health professionals (doctors, pharmacists, dentists, veterinary surgeons, nurses and midwives). These six committees were set up by the Council under the sectoral directives facilitating freedom of movement for the categories of health professionals in question. These committees have the same operating rules.

The first question concerning the work of the ACMT should be examined in light of the reform of the six advisory committees concerned. In fact, in response to the initiative entitled Simpler Legislation for the Internal Market (SLIM), the Commission announced in its Communication to the Council and Parliament on the SLIM initiative(1) dated 6 November 1996 that it intended to rationalise the way in which the advisory committees on training operated. The measures planned were in fact enlarged upon in the explanatory memorandum attached to the proposed directive to which the Honourable Member refers. Parliament adopted the proposal for a directive at first reading on 2 July 1998. The measures planned should come into force on 1 January 2001 and new committees should be set up on that date.

The current period is therefore a transitional period during which the committees will be able to finish ongoing work without undertaking any new work which they cannot

complete by 1 January 2001. The Commission was therefore justified in informing all the committees concerned in the case of the ACMT, at its meeting on 5 February 1999 about this transitional situation and how it would affect the way in which work was organised. As a result, the ACMT decided to set up informal working parties which would operate independently without financial assistance from the Commission. In this context, the committee agreed that the decision whether or not to hold a meeting provisionally scheduled for 30 November 1999 would depend on how much progress had been made with this informal work.

With regard to the second question on the cancellation of the meeting of 30 November 1999, the Commission would point out that, in general, owing to material and budgetary constraints, a rigorous selection must be made of the requests received from the numerous committees that exist for permission to hold meetings. The meeting of 30 November 1999 was cancelled because no adequate agenda had been drawn up. In fact, the meeting could not be held on that date owing to the state of progress with the informal work mentioned above. The decision to cancel the meeting was therefore justified and in keeping with what the ACMT had itself agreed in this regard.

As to the third question on the protection of patients' interests, it should be noted that the main objective of the training criteria set out in Council Directive 93/16/EEC of 5 April 1993, designed to facilitate the free movement of doctors and the mutual recognition of their diplomas(2), is to establish the minimum training requirements which are considered necessary and sufficient for the mutual recognition of medical diplomas. In fact, as the title indicates, the directive seeks to facilitate the free movement of doctors. To this end, the directive provides for a system of mutual recognition of diplomas based on the observance of minimum training requirements. Otherwise, the organisation and content of training is largely the responsibility of the Member States, in keeping with Articles 149 and 150 (ex Articles 126 and 127) of the EC Treaty. Both these articles expressly rule out any harmonisation of training at Community level. Finally, the protection of human health and patients' interests also falls mainly within the scope of competence of the Member States.

With regard to the fourth question concerning policy on the ACMT and future measures, the Commission would point out that the situation faced by this committee is no different from that faced by other similar committees. Moreover, the Commission wishes to draw the Honourable Member's attention to the fact that the ACMT seeks to ensure a comparably demanding standard of training for doctors in keeping with Council Decision 75/364/EEC of 16 June 1975 setting up this committee(3). The standard of training implemented in each Member State depends on the rules adopted by each Member State, it being understood that each Member State is obliged to observe the minimum training requirements provided for in Directive 93/16/EEC.

In this context, the Commission will continue to organise meetings between the representatives of the competent authorities from each Member State. The appropriate instrument to this end is the Committee of Senior Officials on Public Health established by Council Decision 75/365/EEC of 16 June 1975(4).

Finally, although the purpose of the new advisory committee will be to give opinions on the main subject of Directive 93/16/EEC i.e. the mutual recognition of doctors' diplomas to allow the free movement of doctors this does not prevent the committee from taking account of subjects relating to doctors' training within the framework of the mutual recognition of their diplomas and in keeping with the obligations which the Commission must meet under Article 152 ( ex Article 129) of the EC Treaty.

With regard to the fifth question on the measures taken by the Commission to ensure that its policy and proposals concerning medical training do not have an adverse effect on health, the Commission would point out that, within the limits of its jurisdiction, it is cooperating closely with the Member States and the professionals concerned in order to ensure that all interests are taken into account. The measures planned by the Commission to reform some of the advisory committees including the ACMT are not likely to change this situation.

(1) COM(96) 559 final.

(2) OJ L 165, 7.7.1993.

(3) OJ L 167, 30.6.1975.

(4) OJ L 165, 7.7.1993.